Section V Home Page http://www.sectionfive.org/ Id of the garden: A case study Amy C. Blume-Ma.... Id of the garden: A case study Amy C. Blume-Ma.... http://www.sectionfive.org/?permanent=5.92 David Lichtenstein 2010-05-07T08:56:20-08:00
Amy C. Blume-Marcovici


This is a room you would expect to find at a psychiatric hospital. The lights are dim but sharp, the color of a worn-out highlighter. There are no windows. The floor is checkered linoleum: black and white, as if that is the way the world works. And for many of the people here, it is a black and white world, in and out of psychiatric hospitals like this. They operate inside a sort of Kleinian masterpiece: constantly vacillating between hope and despair, love and hate, libido and aggression with nothing in between but silence. At times, the silence here is frightening.

Today, however, it is not silent. As an intake coordinator, I have done four admissions already, and it's only noon. I've gotten my interviews down to thirty minutes, moving from a mini-mental status to trauma history with the grace of a fighter pilot.

I'm hungry. It's lunchtime. When I was young, we were not allowed to eat between meals. Kitchen's closed, my mom would say. And that was that. I can picture her face: soft and ironic as she speaks. I suddenly want to feel the sound of those words, and so I whisper them:
"Kitchen's closed."
"What?" my new intake asks and I snap back to the present. "Can't eat" she moans, rolling onto her side. The mattress sags. "I can't, can't." Her bare feet rest on cold metal that is the end of the bed frame. Her thin ankles, swollen with liver spots, are shackled. I flip through her paperwork. She's been in the mental health system since she was 22. Now she's 60. Psychosis NOS. She mumbles something inaudible and I glance up. It's my turn:
"What?"
She looks at me but doesn't answer my question. Suddenly she bursts into a boisterous laugh, lips curled back to reveal a cave of mushy, red decay. Her round face turns so purple I wonder if I should get the nurse, but she stops laughing as quickly as she began. She turns onto her back and stares at the ceiling, quiet and pensive. I wonder what she sees there, in the stain and flake of the plaster. I could ask her: Tell me what it looks like to you. What might this ceiling be? I imagine her answer: a morbid, an ALOG, animal content.
The security guard waiting outside peaks in. I'd forgotten he was there. The Guard. He is a tall man, even in the humbling blue uniform, with sunken eyes. He looks like he could say something wise and funny and sad all at once. Instead he is quiet. "Everything alright?" he asks with his forehead. I smile and nod. A young woman in a room with a cackling patient. He lifts his eyebrows and retreats to the hallway.
"Let's continue," I say. My intake doesn't answer. "Can you tell me where you are?" …Silence… "Do you know why you're here?" …Nothing… I think of Nancy McWilliams' suggestion that psychotically-organized clients require more supportive therapeutic techniques and alter the pitch of my voice to make it gentler, earnest. "Do you know what sort of place this is?" I coo. Still, I get no response.
I breathe in deeply, rustling the paperwork I will soon need her to sign. This could take a long time and my stomach growls. Impatiens are high maintenance, my mother used to say when I got antsy. Flower puns were her favorite. I muse at the way the pun has hybrid itself here: inpatients are high maintenance. Thyme takes time, another she would dole out to her irritated children. I sigh and relax into my chair. "Do you know what day it is?"
Suddenly my intake looks at me. "Day?" She asks as though she has just been woken, eyes caked with fatigue. Her voice cracks as she whispers, "May I tell you my dream?" I am struck by the directness of her question. Saved by a dream! An image of Melanie Klein as a young woman comes to mind: she is lying in a hospital bed in Vienna. The room, despite decades passed, is precisely like this. She is depressed: unresponsive for days until she unexpectedly comes upon Freud's Interpretation of Dreams. I imagine her sitting upright in her bed, arching her arms toward the sky. A miracle case thrust back into a life that would be real and coherent and meaningful. The woman who would bring psychoanalytic theory to psychosis, to clients like my intake. A woman saved by a dream.
"I'd be honored," I answer my intake. I am aware that her dream will desecrate my 30-minute average but dreams are a rare find in this place. I can hear my mother's voice: A dream shared is a secret bared. Sometimes my sister and I told each other dreams over bowls of Lucky Charms at breakfast. Mom would listen, strong hands folded beneath her narrow chin, forehead wrinkled in earnest. It is only now that I realize my mother, a mother and a gardener by trade and choice, would have loved psychoanalysis: her belief that dreams expressed something essential about the dreamer – something bold and raw; her perpetual use of metaphor as a means of hinting at a grander truth, as if to reveal the tip of a Freudian iceberg; her love of digging up the roots of plants to show her children the worms and the scent and the dark, active world that lay beneath. The id of a garden. I almost laugh as I picture her in a large armchair, my skinny, long-haired mother smoking a pipe and nodding as a client free-associates on the couch. My mother, the psychoanalyst!

I suddenly wonder why I am thinking so much of my mother today. I can hear her now: Sometimes we don't know why we do things, but that we did them deserves attention. That line, stern and crisp, was a harbinger of punishment for a deed gone wrong. What, today, have I done wrong? I look at the woman before me. My intake. I try to imagine her as a mother for just a moment, her emaciated arms wrapped around a baby. I almost practice whispering – mom – but she cuts me off. The tone of her voice has shifted: low pitch, staccato.
"What you must know is that I grew up in Oklahoma. The farm was. Oh yes," Staccato beat. She puts her hand up to her hollow eyes, as if trying to get a look at something spectacular. But she fails. "Sometimes in the dream I am inside me. Sometimes I'm not. Do you get that?" She doesn't look at me but I nod, one swift movement. "When I'm inside me, I'm a child again. When I'm not, I'm grown up and I watch myself with my little girl." Beat. She smiles at the ceiling. A sad smile. Perhaps human content this time, likely fictional. "In the dream, my daughter is an infant. She's grown now. All grown up. Yes. How old are you?" I don't answer – an attempt at neutrality – and she doesn't ask again. There is a pause and the silence leaves me guilty. I rustle paperwork and she goes on.
"The dream is in a house –always in this house. It is – yes – on our land – on the farm – but it is not our house. Not. Our. House!" She cringes here, shaking her head. Two beats go by. "Yes. I'm in the house. Inside myself. I'm a child again and I look out the window. I see meadows and the gold sky. Oh, so nice! Grandfather is plowing and all the sun is on him. I could look at this – yes!
"Then, outside of me, I have my daughter in my arms. I am watching myself. I'm rocking her to sleep in the small kitchen in that house. But it's not ours! There is something cooking on the stove. Bubbling. It's milk. Burning milk. Yes." Beat. "Then I'm back in myself. I'm a child again but my child is alive. We are both children! Do you get that? We're both children and she's crying and I cannot reach her. She's inside that little kitchen but I'm outside now and I'm too small to open the door. All I want is to get through that door! To get into that room. I cry, too. Our cries are the same. They are exactly the same." She pauses. A complete shift in her face and she smiles. "Sometimes I like knowing that we sound the same, my daughter and I. Get that?"
I think about it for a moment. Does her daughter speak like this, now? A staccato hum? Do I speak as my mom did? Would our cries be in sync? Silent moments pass. The Guard looks in, assessing our condition. He seems to understand that we are okay and he puts his hand up, gesturing to us across a black and white divide, letting us know he is near. A superego in waiting. My intake's face recoils. She turns on her side, away from me. Mattress sag and she continues.
"The kitchen door is so tall. It's covered in wallpaper. Blue and gold paper just like the one my mother put in her bedroom when I was little. I remember. The gold was so bright. So smooth against the fuzzy blue. I was not allowed to touch it. Forbidden." Staccato beat. "This is the paper covering the door to the little kitchen. I will have to ruin it to get inside. Destroy the paper to get my daughter! She is crying so loud now she is starting to melt. All I want is to get to her but I can hardly bear to rip the paper. I'm so scared. I'm scared to touch it!" Beat. "And then the crying stops. Just – yes – suddenly. Instead there is this awful noise. This terrible, terrible drilling. I don't know what it is. I am inside my little body and I am a small child, yet I know that my mind is not little anymore. I should know what is making that noise! I try to get to the window to look out but the window is crashing in on me. The house is caving in! Oh! It is my grandfather – yes – and he's plowing right into the house. He's plowing through the brick walkway and up the front step. He's plowing right through the floorboards. The blades are moving so quick and throwing dirt into my eyes. I can smell the dirt and it is rotten. Dirt is in my mouth and I cannot breathe!
"Then I realize he is plowing right to the kitchen. He is going to rip the wallpaper! He is going to tear it down! He is going to plow right through my baby!" Her voice has gotten loud and her eyes are shut tight. She turns onto her back again, lying like a corpse. The purple has left her face entirely and she is pale. She looks so small. "But then – the most awful part – awful! Awful part. I am outside myself and I realize." Beat. "I realize that it's me. I'm riding the tractor. I'm plowing through the door. I am going to kill the child I love." She moans, once, loudly. One sorrowful staccato. Then, her eyes open. She blinks and her face smoothes. She smiles red decay at the ceiling. INCOM: of this I feel sadly certain.

I feel the pen in my hand. I turn it over and over. I look down at my paperwork – nearly blank. Diagnosis? It daunts. Family history? It chides. I think: on the outside it's empty, but on the inside there's not room for another word. In her own way, through fantasy – through a dream – she completed my assessment. A dream shared…and yet impossible to translate. I close my eyes.

Diagnosis: Schizoid personality, I want to write. I think of long moments of silence and my intake staring at the ceiling like a tiny, frightened child. Diagnosis confirmed by use of primary process defense: withdrawal into fantasy. It dawns on me that my intake is stuck, both in her dream and in her reality, in infancy. I think of Klein's theory that early infancy is characterized by a paranoid-schizoid state and realize that my intake is stuck in that chasm, small and unarmed. Notable split between aspects of self: an inside-me and an outside-me, I imagine myself sketching in the air across the blank page.

Family history: A grandfather, a mother, a daughter. I think of Harry Guntrip's work on object relations. He wrote of the schizoid person's ambivalence toward attachment: her longing for closeness conflicted by a deep fear of obliteration by those who get close. For Guntrip, the schizoid is preoccupied with questions of her own boundaries. Does she exist? Will she be overtaken? My intake's Grandfather comes to mind: a man with all of the sun in the world, and yet able to turn my intake into a monster on a tractor, to take her over completely. A powerful man, safe at a distance – through a window – and yet deadly up close. Mother: a woman with boundaries as fragile and forbidden as wallpaper. Daughter: a child so loved that the boundaries between mother and daughter have become permeable and distorted, merging two humans into one sad and lonely cry. I imagine my pen moving across the page: Disorganized attachment, indicative of Ainsworth's confused and disoriented type.

Homicidal ideation: I think of a mother who loves her child and, yet, believes she may murder her. While not actively homicidal, patient is preoccupied with sources danger and, through introjection, afraid of her own aggressive tendencies.

Mood: Annihilation anxiety. Terror. The patient is paranoid about her own death. Terrified of melting, of being obliterated.

Thought Process: Internal preoccupation. Splitting defense in which patient vacillates between a world that is all-good (the outside-me world in the field beyond the window) and a world that is all-bad (the inside-me world in a suffocating house).

Appetite: I realize my own hunger has dissipated. I am on a roll and I smile at the thought of the psychiatrist reading my imaginary notes. Preoccupation with oral-level issues, I write, thinking of Fairbairn's "love made hungry" which characterized his schizoid position. In their inability to get what they need from their love object (mother, daughter), the schizoid person becomes increasingly hungry for love, increasingly needy. In turn, the strength of their hunger brings the growling fear that love itself will devour and obliterate that which is loved. And thus, a daughter is churned by a tractor. Noted also by continuous mention of a "kitchen".

Sleep: Characterized by nightmares. A time when the id brings forth a world of terror and fears of being taken over, engulfed by an evil house.

Appearance: Thin…I think, looking at the gaunt woman before me. McWilliams theorized that schizoid people tend to be physically thin in order to ward off fears of their own hunger, their own propensity toward engulfment, absorption. Thin by fear, I airbrush. Thin by defense.

Speech: Whispers and staccato beats. Splitting even in her speech. Paucity.

Substance Abuse: Burning milk.

Past trauma: A plow through floorboard. Ripping wallpaper. A murderous tractor.

I sigh. Would this do?

I want to say something. I want to thank her. I want to tell her a dream of my own – a dream I'd had about my mother soon after she died. In the dream, I was looking for my mom, digging frantically through the earth. My hands were raw, fingernails chipping. I could hear the sound of them breaking – snap, snap, snap – as I dug. But I needed to find her. I knew she had to be somewhere in this earth – somewhere in the depths of it. The soul has the deepest roots, she would have said. Mustn't she be somewhere? But then I woke and in my hands were nothing but sheets, sweaty and crinkled. In my heart, I was paralyzed with the dread: she's gone.

I thought about us: my intake deep in the trenches of annihilation fears, terrified of being wiped out, smothered by dirt, plowed over by a man with the power of the sun. Paranoid anxiety. And me, clenched by fears of utter abandonment; depressive anxiety surfacing with the force of a death-plow. Is this some sort of projective identification? An intense countertransference? Am I feeling her daughter's anxiety, what Heinrick Racker would have called complementary countertransference? Is her daughter rooting in the dirt, searching for her mother, my intake? Is she crying when her hands come to surface, bloody and failed?

Or am I feeling what my intake feels, Racker's concordant countertransference: this strange sense of being constantly lost in my own fantasy. Am I, like her, lost in primitive withdrawal? And if so, what am I defending against?

I hear The Guard come into the doorway. In his presence, I realize that I have a job to do and it must be done. Stuttering over my words, my voice meek, I ask my question again: "Do you know what day it is?" I expect nothing as I watch my intake scrutinize the plaster.

But I am surprised.
"Day?" she starts. "Yes. Today. Today is Mother's Day."

I drop my pen. On the upper right corner of my paperwork, in my own handwriting: Sunday, May 10, 2009. In haste, I had scribbled the date of my first Mother's Day without a mom a hundred times today. Yet I had no idea.

I feel tears in my eyes and I start to turn away, so my intake cannot see. But for some reason I change my mind. I let the tears come, facing her.

My intake looks at me. Then, a red smile.
"You're melting," she whispers and takes my hand.





References
Ainsworth, M.D., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological
study of the strange situation. New Jersey: Lawrence Erlbaum Associates, Inc.
Fairbairn, W.R.D. (1954). An object-relations theory of the personality. New York: Basic
Books.
Guntrip, H. (1969). Schizoid phenomena, object relations and the self. New York:
International Universities Press.
Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-
Analysis, 27, 99-110.
McWilliams, N. (1994). Psychoanalytic diagnosis: Understanding personality structure
in the clinical process. New York: The Guilford Press.
Mitchell, S.A. & Black, M.J. (1995). Freud and beyond: A history of modern
psychoanalytic thought. New York: Basic Books.]]> Winning Essay in the Student Essay Contest "On enc.... Winning Essay in the Student Essay Contest "On enc.... http://www.sectionfive.org/?permanent=5.91 David Lichtenstein 2009-11-12T10:49:08-08:00
Encountering the Unconscious: A More Than Twice Told Tale

by Dan Livney

Dan Livney is a 2nd year clinical psychology doctoral student at Chestnut Hill College in Philadelphia.

I'm a frustrated fiction writer, there I've said it. But I have a few stories which weave subtle and ambiguous threads of meaning through my life.

Take this one, for instance. I woke up in the morning, this was some years ago, and in my mind was the remainder of a dream. I tried to hold it in my mind and recall as much as I could about it. It had a rare quality. Though dreams having a literary quality may not be uncommon, my dreams, at least, don't usually translate so directly into the written word. This one felt like a short story that I could put down on paper, almost (but not entirely) without modification. Even as I first began to turn it over in my mind, I thought that it seemed to have coherence, structure, and even tone—all the things a good story needs.

I've written a number of things before and since, most of them started and then abandoned. But here was one piece that coalesced from beginning to end, almost effortlessly, onto paper. And I felt that it was, of all things, quite good. I've reread that story dozens of times and shared it with pride with friends. True to its source, it is very much a snapshot out of my subconscious. Over the years I've found that the better I've gotten to know myself the more of myself I've found in it, each time I come back to it.

The dream, and the short story which came out of it, date back about 10 years now. And in that time no new work emerged anywhere near as good as that one. But from time to time, as I continued to show this story to new people, I found that I began to tell another story about that first one. That second story is the topic of this essay. And so here then, recursively, is my "encounter with the unconscious."

The tale, or perhaps part fable, I found myself telling others about a brief moment when one particular desire, to write good fiction, came true.

"When I was a little boy of about 7 or 8, we had a plum tree in our garden
that never gave forth any plums. Then one year, out of nowhere, two appeared, side by side. It was an exciting moment. My father and I watched them grow and bulge, and I wondered how we would know when the right time to finally pick them would be. I came home one day to find that my father had made the decision without me; the plums were resting in the windowsill of our kitchen, which overlooked the garden. There the plums sat, ripening, until they had gotten to be brown and mushy on the inside. Looking for the perfect plums, in his greed and inexperience, he had ruined them. The short story, you see, is kind of like those plums. It showed up out of nowhere, and just sits there, unconnected to anything before or since.

This is a reconstruction of a metaphor I used several times, always to make a similar point. Although eventually I came to suspect that what that point was had never been really clear to me. In Freudian terms, jokes and parapraxes, and perhaps little curious metaphors like this one, suggest the presence of repressed motives. In order to help me try and uncover whatever possible hidden meanings may lie in my story of the plums, I'd like to try a little exercise. What I'd like to do is to make an in vivo examination of my "latent state of mental life" by using Freud's technique of free association. "If we make use of this procedure [psycho-analysis] upon ourselves, we can best assist the investigation by at once writing down what are at first unintelligible associations" (Freud, 1911/1989).

But before I do this, I'd like to ask: what brings my focus to this particular
example? It is, quite simply, its unexamined and maybe paradoxical state. Looked at rationally, my metaphorical tale adds little to my companion's understanding of the short story. In essence what it does do is repeat the idea that this story is unique to my experience. But it avoids other seemingly important questions, such as what meanings or explanations do I give it, or its solitary state. And also, it seems curious to me that I should have been so fond of this anecdote so as to repeat it more than once. To attempt and answer these kinds of questions I'm going to try and let my mind wander over the story of the plums. I will ask the reader to believe me that as I start this exploration I have no prepared answers which amount to any more than a rough outline of a hypothesis or two. Instead I ask the reader to come upon this psychoanalytic exercise along with me, so without prejudice we may both see where it leads.

As I now begin, I ask, what do I make of this narrative? If I were scoring it as a response on the Rorschach using the Exner system, I might note the presence of one "Cooperative" and one "Morbid" Special Scores; a "Botany,"Human" and "Food" content; and one Pair. Unfortunately, this seems like a rather intellectualized beginning, which speaks mostly to how difficult it is to be really honest with yourself and with others, in this case the reader. In finding myself starting out by immediately going to an interpretation which appears to speak more to mind than to emotion, I presume the presence of a resistance. This adds to my belief that the content of the narrative, as much as the content of the original short story-cum-dream, is laden with unconscious meaning. With awareness of my initial misstep, I'm going to try again. This time attempting to be more nearly true to Freud's recipe of saying whatever comes to mind:

Twin plums, testicles…old woman…fear…old shed to one side of the yard; broken down, door half open; gloom inside…fear…sex, adult sex, not childhood images…father…discontent…image: digging a hole in the back of the yard, with a little plastic sphere I was wearing on my head. I'm suddenly aware of someone behind me, I turn and its my father taking a photograph. He thinks it's cute (I suppose) that I'm wearing my little hat, but I feel humiliated. Plums, growth…unconnected. Pick, spic, ice pick, kick…soccer. Image: playing soccer with my father in a local park, falling over backwards after a kick, as if imitating professional players on TV.

I'm going to stop here. I think there should be enough material just in these
few lines to serve my purpose. What is the experience of free associating like for me? Anxiety-provoking. To dive into something with no preconception of where I might end up, it has always frightened me. It scares me most when I first start the process; fear attains a gilt-edge of exhilaration as I become more comfortable with it. Once I stop and come back to try again, perhaps after some days or weeks, the initial feeling is always one of anxiety. My stomach becomes tight, and my mouth dry. I become easily distracted, start thinking of things I'd rather be doing. I'm forced to bring myself back. Eventually I feel slightly flushed and I don't want to continue any longer.

Only now that I've finished with the free-association part of my task; and assuming I was honest, that is, by saying things as they came to mind without trying to edit or curb them, can I now go back and try to make sense of what appeared. I should first acknowledge that obviously this is not the same kind of free association that one might do on a therapist's couch. Whereas on the couch one says whatever comes to mind, here the situation is slightly altered. I'm free associating while contemplating a particular paragraph—it's a case of one episode of free association based upon another. A second difference, of course, is that I'm doing this with only a theoretical reader in mind, rather than with a real person present. Whether this is a "legitimate" methodology for looking at the contents of the unconscious, almost begs the question. I'm not conceptualizing the unconscious as a state or a place, or even as a subset of consciousness or ego, however one chooses to define those words. I believe that the "boundaries" of the unconscious are considerably harder to define. If one looks at the task I've chosen for myself, it would seem that the choice I've made is a conscious one. There are obviously other topics I could have chosen to focus on. I could have chosen to discuss the short story directly rather than the anecdote I've told about it. Or else I could have chosen some entirely other episode from my life to ponder. But I would argue that the choice itself has unconscious parameters—I chose it because with associations and feelings unknown it has been weighing on my mind.

I will put the argument regarding method aside for the moment, while I go back now and examine the contents of my free association sample. To start with, I've asked my father about his recollection of the story of the plums, and among other discrepancies to my own memories, to his recall there was only one plum. Perhaps, as an adult, he would be more likely to remember the situation accurately, or perhaps his unconscious is playing its own tricks, there's no way to know, and I don't think it really matters. Trying to decipher the unconscious residues from a memory is little different than trying to do so from a dream—you start with the recalled event as it is presented, rather than by trying to reconstruct an accurate picture of the event. Thus, the twin image of the plums, and the immediate connection to a sexual image, is noted.

The next image which came to mind was the old woman. During the period of time when we lived in a house with a plum tree in the back yard, an elderly woman who lived across the street was a significant nurturing figure in my life. The next feeling which comes up is fear, followed by a sinister image: the old, spooky shed. Next, fear again, then again a sexual image. The association proceeds to my father and an interaction with him from about the same period. In re-reading my words, I now see that an element of editorializing had crept in ("He thinks it's cute I suppose…"). So what I would note here is there might be a deflection of feelings. Because rather than simply describing the feeling this image evokes as it emerges, maybe sadness, I immediately add a concrete interpretation of the scene.

Moving along with the images, I now return to the plums, and I connect the words "growth" and "unconnected," perhaps related to the way I describe the appearance of the plums as unconnected "to anything before or since." Why this comes up here, I don't see for the moment. Next there is a rhyming association: "Pick, spic, ice pick, kick…soccer" I might interpret the presence of the word "spic" as representative of latent racist tendencies which I would assure the reader I don't have any particular inclination towards), but there could also be another meaning. The offensive quality of this word lies in its derogatory singling out of the (in this case, Hispanic) other as different, and therefore implicitly inferior. Coming as I do from an immigrant family, it seems quite plausible that, especially as a child, I would have felt the full weight of being "different." So, perhaps within this particular word are contained feelings not only of my own inferiority, but also of associated embarrassment of my parents, different as they were from other kids' parents. An "ice pick," which I've rarely encountered in my day to day life, except as murder weapon in spy novels, seems to be an aggressive association. The last image (playing soccer) is again one with my father, but this time it's a more positive one.

To further put the images into context, it should be noted that the free
associations were made a few hours before going with my girlfriend to spend the evening with some members of my family, including my father. It seems reasonable to assume that whatever unconscious representations of repressed mental states are assumed to exist, they can best be understood through the filter of current events.

In fact, as I now move on from a line-by-line reading to trying to organize what I see, it seems that there are two principal motifs appearing in the free associations: interactions with my father, and sexual themes. The question of whether the present draws out certain aspects of the past, or if the past casts a particular shade over the present immediately comes to mind, but I'm going to refrain from entertaining an idea I'm afraid could lead down a circuitous path. In either case the themes evidently coexist in some way. The one presumption I feel inclined to make is that they are not in fact separate, that is, their coexistence is not incidental or otherwise random. For instance, nurturance runs through both of them, and also contextualizes the appearance of the old woman.

I see, too, some ambiguity in the associations. There is fear, mentioned explicitly twice, and implied in the image of the creepy shed. There is humiliation, and aggression. But the sexual allusion is phrased "adult sex, not childhood images." Though not much elaborated on, it's a fairly sanguine phrasing, explicitly avoiding any juvenile connotations. So the juxtaposition of unpleasant images comes with at least two healthy ones: the sexual allusion, and the final image. That last image I read as a childhood expression of aspiration and idealization: "Teach me how to be a great soccer player, so I can grow up to be strong and successful like they are." Perhaps I associate the experience of becoming an adult, in part by having an adult to look up to, as connected to the successful formation of romantic relationships.

So far, I've tried to interpret what hidden meanings can be discerned in my associations to the "tale of the plums." But the other question that comes to mind is, what purpose does the story serve to the interaction? Why do I feel this need (perhaps shy of a compunction) to tell it, as a commentary of sorts on the short story? As I said earlier, I do see the tale as a sort of a distraction. It provides a metaphor for the idea that while I'm proud of this one short story, I'm saddened that I've found myself unable to write more like it. But it adds little beyond that, and thus seems a bit overly elaborate for its purpose. Prior to the metaphor, of course, the short story itself was a form of interaction. So then, when I say that I "I would like to be a writer," what I'm really saying is that this is a certain kind of communication that I would like to do more of.

According to Freud (at least as of the writing of The Interpretation of Dreams), the dream, and as I would claim by extension, any successful piece of fiction, is an attempt at "wish fulfillment." But strangely, with the plum metaphor what I find is perhaps the reverse. With the secondary interaction (the first being when I give another person the short story to read), I introduce a diversion. My stated goals, above, in giving another my short story are to share a personal piece of myself, and to share an accomplishment of which I'm proud. Those things should theoretically be at least some part of the focus of this secondary interaction. Instead my reader receives something else to consider, another tale, which besides its commentary on the short story, is also laden with its own multiple layers of meaning--they receive the dubious gift of plums.

I could postulate that this new gift is an attempt to undo, or at least divert from, the first gift. Perhaps there is some discomfort either with being proud of my accomplishments, or of disclosing so much of myself to another—after all, I am much more aware than a casual reader of how much the short story really tells about me. It could be that elements of my free associations point to either a source, or at one example, or at simply one expression of these discomforts. It could be that my current relationships, appearing here in the form of my girlfriend, are in some way affected by these patterns of hidden or adumbrated meanings. It is also possible that the short story, now perhaps become its own repressed symbol, plays the part in my unconscious of a"desire fulfilled." And perhaps there are other parts of my unconscious that battle away with it as "too good," and therefore unacceptable.

So if I were to summarize my predicament: I started with a dream, which is an unconscious process. While still groggily lying in bed I decide that this is not just any dream, but one that I can and should write down in the form of a short story. What combination of processes, conscious and unconscious, brought me to that decision is, like the source of the dream, far from clear. I surely do not, lying there in bed, think about form and structure and syntax. In writing the story I make an attempt to stay as true as I can to what I remember of my dream, but I believe that some level of conscious translation occurred nevertheless. Once the story is written, I share it with a number of others over a period of years, more than once telling those others a certain metaphor connected to this story. Only after a long time do I make note of the fact that it is a relatively static tale I've repeated—which makes it, like a recurring dream recounted in therapy, one worthy of particular note.

Several months ago when I first started thinking about this essay that I'm writing now, another apparently conscious "choice" started to form in my mind: that I should write about this metaphor of the plums. Then, when I started to write about it, I made yet another apparently conscious choice: that I was going to use the method of free association to examine this tale (that is based on a short story, which is based on a dream).

There are plausible conscious and rational explanations I could make for many of the links in this chain. For example, my desire to write fiction likely has a role to play in my decision to write my dream down as a short story, rather than, say, as a journal entry. And, taken at face value, the story of the plums does tell something about the appearance of the short story: it is certainly not a full-fledged attempt to hide all meanings. If I had wanted to do that I could have simply not shared the short story with anyone in the first place. But I think that, too, at every step there are aspects of my experiences, fears and behaviors, the impulse for which is not entirely apparent.

Of course, I could take an even further step back, and see the original dream itself as one that retains the content of both not fully apprehended experiences from my childhood, combined with, if one is to believe Freud in this, residual experiences from the day's events when the dream occurred. Given all this, and keeping in mind the title of this essay contest, Encountering the Unconscious; when, I would ask, along the thread which seems somehow to connect my childhood to this very moment, and which surely permeates the dream, the short story, the metaphor, the free association sample above, as well as this essay, is the unconscious not encountered? And so to get back now to my earlier question regarding the legitimacy or usefulness of this particular method—while what I have done here may differ from the classical way of apprehending the unconscious, if one accepts the idea that the unconscious is in fact in some way in play everywhere and all the time, (to the point that the differentiation between conscious and unconscious process is not entirely clear, although I grant that some such difference exists), then the discussion about what is the proper way to encounter it becomes little more than a semantic one. I would subscribe here to Freud's equally blurred delineation of the two states when he writes:

…We know for certain that they [latent states of mental life] have abundantpoints of contact with conscious mental processes, and all the categories whichwe employ to describe conscious mental acts, such as ideas, purposes, resolutionsand so on, can be applied to them. Indeed, we are obliged to say of some ofthese latent states that the only respect in which they differ from consciousones is precisely in the absence of consciousness. (Freud, 1915/1989.)

Lastly, I would underline the iterative nature of my encounter with the unconscious; each step involves a further exploration into the meanings found within previously delved layers of connections. To the extent that there is a conscious effort involved, its aim is to clarify and to attempt to make explicit the dynamics and emotions hidden behind the uncovered symbols.

References:

Freud, S. (1989). On Dreams. (J. Strachey, Trans.). In P. Gay (Ed.), The Freud Reader (p.144). London: W. W. Norton & Co. (Original work published in 1911)

Freud, S. (1989). The Unconscious. (J. Strachey, Trans.). In P. Gay (Ed.), The Freud Reader (p.575). London: W. W. Norton & Co. (Original work published in 1915)

***]]> Today's Open Question: Why is the Unconscious k.... Today's Open Question: Why is the Unconscious k.... http://www.sectionfive.org/?permanent=5.90 David Lichtenstein 2009-05-28T08:12:40-08:00
Why is the Unconscious known by what it is not?]]> Two winners share this year's Schillinger prize: M.... Two winners share this year's Schillinger prize: M.... http://www.sectionfive.org/?permanent=5.89 David Lichtenstein 2009-05-28T07:28:12-08:00 I've been working with Willy, a man in his 80's an.... I've been working with Willy, a man in his 80's an.... http://www.sectionfive.org/?permanent=5.87 David Lichtenstein 2008-10-26T08:06:35-08:00
A year or so ago, his oldest daughter died. I had come back from a vacation to his numbness and literally unexpressible grief. It's his inability to experience his grief--and what it took for him to move forward--that I want us to think about.

His daughter's death had not been unexpected. She had had advanced liver disease--the consequence of intravenous drug use earlier in her life, and the consequence, Willy himself had acknowledged many times, of a life of promiscuity and drug abuse. "I lost my daughter many years ago," he would say.

But now he was also saying, "There must be something wrong with me. I can't cry. I can't mourn...." "I don't know, doc," he would say, "What's wrong with me?" Over the weeks that followed he would lapse into a numb silence and then into his repetitive questioning and fruitless self-examination. I sat with him, I felt for him, I tried to give him a way to think about himself--in all the ways psychoanalytic clinicians do: how he might feel; how I might feel, what it all might mean: the frustrated anger with his daughter, the disappointment, his self-protective distancing from his own feelings.... All to no avail.

Then in a session some months after the event, Willy was talking about his wife and their early relationship. He was remembering the early sweetness of married life, how much his wife had wanted a baby girl, a little "meidlele," he said in Yiddish, and how when the baby was born, he said, "We had our little meidlele," and at that his voice broke and he cried!

There was nothing I needed to say at that moment; I offered him the box of tissues; I took one myself.

So the question: What happened there? Why did the word in Yiddish, and his saying it aloud, allow things to move forward--forward with the emotional process of grieving, and, subsequently, forward with the interpretative process as well?

Surely there's something to say about this question from a range of psychoanalytic prespectives. My own feeling is that what is most interesting here is the nature and power of early language--how we talk to ourselves in our intimate and ungarded moments--but I'm eager to hear what others might think.

--Henry Seiden]]> Our New Name Please note our new name. The Sphi.... Our New Name Please note our new name. The Sphi.... http://www.sectionfive.org/?permanent=5.85 David Lichtenstein 2008-06-24T10:42:37-08:00
Please note our new name. The Sphinx is an enigmatic character: sometimes woman sometimes man, part human part beast, neither silent nor discursive. The Sphinx poses a question. Like the psychoanalyst the Sphinx is not the one who knows but the one who may provide the condition for new knowledge. This is the spirit of The Sphinx as a site of inquiry on the web, a site where psychoanalytic inquiry takes place. We invite you to engage The Sphinx. Post your inquiries. Submit your hypotheses, half formed queries, and open questions. This site is open to all to read and to respond. All members of Division 39 may join: click 'register' and you are then free to enter into discussions and post replies.

Please note: Your user name and password will be sent to you automatically when you register. If you don't see it in your email inbox check to see if it went into your spam folder. If you have any questions or problems registering, please contact us directly.]]> The Special Enough Child? A patient says (in so.... The Special Enough Child? A patient says (in so.... http://www.sectionfive.org/?permanent=5.84 David Lichtenstein 2008-06-24T10:38:59-08:00
A patient says (in so many words), "I know I'm not the center of your universe and not the only person to whom you're important... but I can still feel Special Enough to trust this process we are in together and allow it to help me without undermining things." Clearly the analyst has created a holding environment and is behaving as a Good-Enough mother. But what processes are actually at play in the patient?

Winnicott's good-enough mother is by now quite usefully ubiquitous. But I wonder what exists, qualitatively, on the other side of the dyad. A special-enough child? With so much focus on the interrelatedness of mother/child throughout early development, surely the presence of a good-enough mother is not the sole guarantee of success. Neither does not-quite-good-enough mothering doom every child to the same sealed fate. So what are the achievements and contributions of the child with (and without) good-enough mothering? What is her experience? At the other side of symbiotic merger, does the child perceive coming into her own existence? Winnicott says the infant goes from requiring a mother-person's full-time presence simply to exist ("there is no such thing as a baby") to an awareness of dependence on an object who must be shared with others. That seems a rather challenging leap, one requiring both intraspychic and relational scaffolding for safe passage. How does the child let go of the idea that its own wishes for things (including for a perfect mother) makes them so? How does she grasp that it is mother's choice to meet her needs, and how might it come about that such awareness does not wipe out or subsume the child's agency in wanting? Perhaps there is something about feeling she is special-enough to her good-enough mother to risk the transitions towards increasing autonomy. Being too special leaves the child no room to see herself as effective (all good is the work of the Perfect Mommy - I can't be trusted to get anything that right). Being not special enough keeps the child imprisoned in a non-responsive environment, where there is no evidence that wishes initiate or deserve met needs, and thus no sense of being worthy.


(I'd be happy to know about writers who take up this perspective, and/or of concepts I may have misread!) --Priscilla Butler]]> Editor's Note: What follows are the complete text.... Editor's Note: What follows are the complete text.... http://www.sectionfive.org/?permanent=5.82 David Lichtenstein 2008-05-19T04:52:42-08:00 What follows are the complete texts of two papers that were presented in slightly shorter versions at the recent meeting of Division 39 in NY (April 2008). They are introduced by a new discussion written by Ghislaine Boulanger.
The papers present how the psychoanalytic field has addressed and failed to address the psychic meaning of profound historical and social trauma in general and in particular those associated with Nazism and the Holocaust.

Please send us your responses and comments.




From Dissociation and Denial into Meaningless:
A Response to Kuriloff and Prince
Ghislaine Boulanger, Ph.D.

This response cannot possibly do justice to the breadth and scholarship of Kuriloff's and Prince's papers; their conclusions are so far-reaching, the ripples assume tsunami-like proportions for psychoanalysis. I don't have the luxury of time to reflect on all the points they make, yet the luxury of time and distance to reflect will turn out to be a key part of my brief response to their work.
Last fall I supervised a case conference in a clinical psychology program in a New York area university. The patient being presented was a refugee from Africa, where he had been tortured and imprisoned and his wife raped by his torturers. I won't go into the abject details of his life in New York as he awaited political asylum and the various tortures he, in turn, visited on the young woman who was presenting this difficult case. The chair of the program had brought my book Wounded by Reality to the presentation so, in introducing me, he could explain why he had invited me to supervise this case. One senior faculty member picked my book up off the table, and, without bothering to conceal his contempt, said, "Reality, Ghislaine, haven't you gotten past ideas like that yet!"
I responded, "When reality hits you in the face, it's hard to look away." But, in fact, as these presentations have shown us, I was wrong (and later I'll tell you why I was right too), psychoanalytic theory has aided and abetted those who can dissociate in the face of reality.
Bob and Emily have given us two rich and thought provoking presentations about how our psychoanalytic forbears in America looked away when reality hit them in the face. And, how the consequences of that reaction – in some cases for better (as Emily points out in describing our contemporary emphasis on the self inherited from Fromm and Kohut), but most often for worse -- continue to reverberate on an institutional level through psychoanalytic training programs, though our theories, our practice, and in some graduate programs. American psychoanalysis carries within its theory and the very structure of its institutions the legacy of the Holocaust.
It is quite an irony that trauma originally inhered in the very concept of psychoanalysis, a theoretical and clinical discipline constituted by Freud's and Breuer's discovery that the psyche's failure to metabolize trauma has long lasting unconscious consequences. And psychoanalysts spent the rest of the next century trying to erase this fact from their collective memory. Putting aside what has been written about the political pressures to abandon the theory of seduction, in his biography of Freud, Darkness in the Midst of Vision, Breger argues that Freud privileged the Oedipal drama over earlier development because his own early traumatic losses and disappointments lead to such vulnerability and feelings of helplessness that the fantasy of an oedipal victory was much more empowering to Freud.
And fifty years later, as these papers – "like a series of electric shocks" -- show us, our psychoanalytic forebears, refugees from Hitler and the Holocaust, spent their professional lives persuading themselves and their patients that psychic reality trumps real life events every time. Bob suggests that the next generation of psychoanalysts in America can be compared to second generation Holocaust survivors. As with the victims of all received trauma, their characters and, in this case, their theory and their attitude to the outside world were shaped by what had been transmitted to them. They became more and more inward looking, clinging unawares to the unexplored realities of their parents' trauma. Worse, when these inevitable frailties, these necessary defenses against terror or despair, that will occur when there are no others to help us titrate our appreciation of what has happened to us, (and here I'm thinking not only of Hartman, but also of Fenichel and Jacobson) the danger comes when these reactions are codified, reified, become the letter of the law. As Bob points out, the interrupted mourning of the founders of American psychoanalysis has become part of the group process. A mindless application of a theory that is out of touch with people's lives, but served a protective purpose earlier, became the new orthodoxy. An in-group and an out-group were created, and those who didn't adhere to the fundamentals of this law were assigned to the out group. In the fifties, sixties, seventies and later, those who spoke out about reality were stigmatized, pathologized, relegated to the hinterlands of "psychotherapy." Times are changing however, today the worst that can happen to me for not submitting to this orthodoxy is that I get sneered at when I supervise a case conference – and then I get invited to present on the topic of reality!
While I find Bob's analogy to second generation Holocaust survivors compelling, I am also reminded of the inhabitants who were discovered in the last century in the West Virginia and Kentucky hollows in the Appalachian Mountains who had retained the customs, accents, and music of their Scots-Irish forbears who had themselves immigrated to these villages some 200 years earlier. So isolated were they from the rest of the world, they were completely out of step with changing times not only in America but also in their countries of origin (See Sherman and Henry, 1933). Theirs is the solution to the classic emigrants' dilemma writ large. It is a conscious and/or unconscious determination to preserve continuity with the country of origin. An attempt to deny the pain of loss and to avoid the feeling of not belonging to the larger culture led these Scots-Irish villagers to put boundaries around their own narrow world and privilege continuity over innovation. So Hartman downplays his own vitality in the service of continuity. While Fromm, another kind of immigrant, determined to embrace the new world and to repudiate Nazi imperialism, organizes his own theory to privilege agency and personal subjectivity, but in so doing also abandons a more nuanced psychoanalytic stance.
If the emigrants from Europe were simply dealing with the consequences of immigration, that would have been one thing, but for them it was a double whammy, not only were they exiled from their own country and culture, but many of them were survivors of Hitler's persecution of the Jews.
As Emily quoting Paul Russell reminds us, trauma always involves some failure of recognition. In the short run, in the midst of loss or in recovery after trauma, it takes the presence of a steadfast witness who does recognize and is prepared to acknowledge and explore the ways in which the psyche will twist and turn to escape painful and unalterable facts A witness who understands that, when the psyche can get away with it, avoidance, denial, dissociation, disavowal, and revision become ways of tolerating the intolerable so that we can get up each morning and take care of what has to be done. So Bergmann says, the central experience of his adulthood, did not impact psychoanalytic technique, Hartmann says he suffered "not at all" from the conditions in Nazi Germany (despite having a Jewish wife). Bob recounts a telling vignette where the attendees at the last Psychoanalytic Congress before World War II, nearly all of them Jews, whispered together about their plans for escape in the breaks between papers that were devoted to psychoanalytic theory. I am reminded of Margaret Little's story of Winnicott getting up during a meeting of the British Psychoanalytical Society to point out that there is an air raid going on. I use this vignette as a parable to demonstrate how privileging psychic reality at the cost of traumatic reality renders our theories meaningless. What need is there for bomb shelters when psychic reality protects us from global conflicts?
And the tradition continues, Emily begins her paper with the decision at the White institute to continue their case conference on 9/11, some participants experiencing relief on being reminded that, when asked how she would respond to the declaration of war, Fromm Reichman had said, "I will do what I do best, psychotherapy,"
And she may have, but when it came to working with immediate survivors, Fromm Reichman was much wiser than that, she counseled stepping out of the traditional role to offer physical and moral support to survivors in the immediate aftermath. She adapted her techniques to suit the crisis at hand.
I said above that I was, nonetheless, correct when I replied that when reality hits you in the face, it's hard to look away: I have just come back from a trip to Israel where I was invited to speak to the psychology faculty and graduate students at the University of Haifa. I was getting more and more nervous about that talk. Firstly, given the fate of psychodynamic thinking in most American university psychology departments, not to mention in the field of traumatology in general, I thought I would meet with complete incredulity as I offered a dynamic understanding of adult onset trauma. Secondly, I figured they hardly needed to hear from me, they knew so much more than I did about the topic. One of them said to me, confirming my worst fears just before my lecture, "A year ago this university was under siege from Lebanon, rockets were landing all around us."
I was astonished and moved by the reception I got. Not only did they welcome my ideas, they were hungry for them. They had little patience with stories about the denial of reality by American psychoanalysts, they were in the midst of reality. But, and here's what struck me as so powerfully, while they all had questions about countertransference and technique, none of them could think beyond the clinical work they were doing. They themselves were traumatized, several of them multiply traumatized, and they were working with patients who shared these experiences, they couldn't escape it. In the face of an overwhelming reality, they had to adapt, but they didn't know how to think about it. As Eliot says in the Four Quartets "We had the experience, but missed the meaning,' And I was reminded once again that one of the consequences of trauma is the failure of symbolic functioning.
As I thought about this, I felt much more compassion about the necessary denials of our forebears and some understanding of the second generation, like the professor who ridiculed my interest in reality, but I also wondered about future generations of psychoanalysts– assuming that they are coming along. How will they judge our struggle to incorporate the reality of the war on terror, the war in Iraq, the war in Afghanistan, the erosion of our civil liberties, widespread poverty in the face of plenty, and our professional association's moral failure to stand up for the rights of the disenfranchised in these wars, into our practice as psychoanalysts. I hope that the pioneering work of Lynne Layton and her colleagues in bringing these realities into the consulting room heralds a return to the earliest days of psychoanalysis that Russell Jacoby describes in The Repression of Psychoanalysis. This was the era before Hitler, before exile, and before Fenichel, Jacobson, Annie Reich and many others had to purge their thinking of any dangerously left wing political or social commitments in order to fit in to the new world.
References:
Boulanger, G. 2007 Wounded by Reality: Understanding and Treating Adult Onset Trauma. The Analytic Press, Mahwah, N.J.
Breger, L.(2001), Freud: Darkness in the Midst of Vision. New York, Wiley.
Eliot, T.S. (1997/1943). The Four Quartets. New York: Harcourt Brace.
Layton, L., Hollander, N., and Gutwill, S (2006), Psychoanalysis, Class and Politics: Encounters in the Clinical Setting. New York: Routledge.
Jacoby, R. (1983) The Repression in Psychoanalysis: Otto Fenichel and the Political Freudians. Chicago: University of Chicago Press.
Sherman, M. and Henry, T (1933), The Hollow Folk]]> Theory as Trauma A foray into applied psychoanal.... Theory as Trauma A foray into applied psychoanal.... http://www.sectionfive.org/?permanent=5.79 David Lichtenstein 2008-04-21T09:19:18-08:00 A foray into applied psychoanalysis

Emily Kuriloff, Psy.D.
… We forget that all of us are in the ghetto, that the ghetto is walled in, that outside the ghetto reign the lords of death, and that close by a train is waiting. (Levi, 1986, pp.50-51)
…The greatest enemy of Fascism is man. (Grossman, 1980, pp.195)

It was Tuesday, September 11, 2001, and the radio in the taxi had just reported that the second tower had fallen. I paid my fare and proceeded to the third floor of the William Alanson White Institute. The weekly clinical services meeting would welcome Gail Hornstein, author of a new biography (2000) of Frieda Fromm Reichmann, a founder of an American psychoanalytic tradition upon which the White Institute was built, and a refugee from Nazi Germany.
The conference room on the Upper West Side of New York was far from empty that morning as the minutes passed, and while a small number of participants chose not to stay, it was decided fairly quickly that the program would proceed. Hornstein broke the tension by noting that Fromm Reichmann herself had not cancelled a similar weekly meeting on the Monday night of December 8th, 1941, despite the fact that Roosevelt had just declared World War II. When she was asked at that gathering what she would do for the war effort, Fromm-Reichmann reportedly stated, "I know what I'm going to do. I'll do what I know best. I'll do psychotherapy" (p. 117)
On September 11, 2001, and earlier, on December 8th, 1941, those of us who went on with our meetings and our lives "as usual" temporarily jettisoned a threatening, destabilizing reality. Such is one typical response to calamity. Yet there have been other moments in the history of psychoanalysis when such use of compartmentalization is neither temporary nor partial. Martin Bergmann (1984), for example, replies to a question regarding the effect of the Holocaust upon clinical psychoanalysis by stating, "The Hitler experience was the central one of our adulthood, and the significance is undoubtedly very great, but I would not see it as particularly in terms of psychoanalytic technique…It does not seem, to my knowledge anyway, that it affected the technique per se, apart from the general development which psychoanalytic technique has undergone…" (pp.209-210)
This essay challenges Bergmann's notion that theoretical and clinical psychoanalysis can so readily be isolated from cultural context, particularly the context of Nazi Europe. I am not suggesting that this or any one upheaval represents the singular influence around which all subsequent psychoanalytic theory and praxis springs. And because the mysterious unconscious, and dissociated or repressed experience lie at the center of my musings, a measure of inference is required. Furthermore, even the most obvious or substantial connections between a theorist's ideas and nascent Holocaust themes cannot fully encompass the trajectory of a unique mind in action.
Nonetheless I invite the reader to focus upon the usefulness, and not merely the correctness of the hypotheses in the service of greater and broader understanding. Approach the argument, if you will, in the less linear spirit of curiosity, even wonder, sparked by the realization that the disruptions of fascism were universally, if not uniformly in play during a critical and defining period in the development of Psychoanalysis. The goal, finally, is to begin a fruitful dialogue regarding this fateful relationship after long silence.
That prominent psychoanalysts rarely publicly acknowledged the Holocaust's influence on their professional lives is the greatest obstacle to understanding its impact. For most of the twentieth century, but particularly during the immediate post war era, analysts valorized a notion of neutrality, while subjective experience was relegated to the heap of irrelevant or, worse, neurotic interference. As but one example, when the Columbia Psychoanalytic Society's Bluma Swerdloff (1963) interviewed Heinz Hartmann, she asked about the relationship of his personal experience to his ideas. His responses are rather general and reflect his satisfaction with his career in America. Asked if he "personally" suffered from Hitler's Anschluss he answers, "No, not at all." (74). Editing his recorded remarks at a later date, Hartmann omits a revealing comment in the transcript, regarding his wife's status as a Jew in Nazi Europe. "That was always very difficult", (75) he had originally said, but later deleted. During a separate interview, (1973) his wife, Dora, a Viennese pediatrician retrained in the US as an analyst, was somewhat more revealing of the family's plight. She likewise highlighted their good fortune, notably their Swiss citizenship as a result of her husband's family legacy. Clearly the Hartmanns were not subjected to the same degree of uncertainty or victimization as were others with less status, money, or international connections. Yet Dora Hartmann also comments upon her long wait for a second round of US Visas for the family, after the time sensitive documents expired because of an initial decision to relocate in Paris. Later, when the Nazis encircled Europe and the Hartmann's fled France to a surrounded, albeit neutral Switzerland, Dora describes feeling "like a mouse in a trap." (19) Ultimately she, too, trivializes this chapter. "But, I mean, there are a lot of things that happened", she concludes, "I don't think its really of professional interest…"(17) How similar this sounds to her husband's earlier (1963) comment that his transition to the United States was "comparatively easy, not in every respect, but professionally it was easy." (Italics added, p. 74) Nowhere in either conversation lies the hint of a challenge to the compartmentalization of the personal and the professional, while this writer, a product of my time, constructs a thesis defined by a now dominant historicism. For both better and worse, what is public is understood in dialectical relation to the private, and vice versa.
What, then, can be said about the impact of the Holocaust on psychoanalysis? Do Bergmann's and D. Hartmann's disclaimers merely suggest the systematic, positivist thrust of mid century psychoanalysis, while my hypotheses reflect a deconstructive relativism? Perhaps, but Bergmann's and the Hartmann's responses may also reveal some degree of trauma, of experience so overwhelming as to be only partially appreciated, even adaptively dissociated. After all, as Russell (1996) notes, trauma by definition, inspires some "failure of recognition." (602) Hartmann and his contemporaries were in fact more than civilians in physical proximity to terror or war. He and his fellow psychoanalysts were specifically targeted as Jews, as members of a so-called "liberal" profession, and/or as political activists who were among the opposition to National Socialism. Western and Middle Europeans who had achieved great professional and social stature over a lifetime were suddenly disenfranchised and separated from their bourgeois comfort and beloved culture. They lost close family and friends forever. As Steiner describes, "All were suddenly to find themselves propelled into a colossal institutional, personal, psychic, and emotional maelstrom. "(p.5) Freud's own narrow escape did not benefit his closest biological relatives-his four Viennese sisters- all of whom were killed at Auschwitz. The second generation of European analysts-those born around 1900- were similarly affected, A. Freud, Fenichel, Hartmann, Kris, and Kohut being among the best known.
Heinz Hartmann
Freud's 1923 work on the tripartite model and the organizing functions of the ego clearly lay the groundwork for much of the scholarly and creative contributions of Heinz Hartmann, long considered the founder of Ego Psychology. Hartmann's focus on the Ego's adaptation as a means to reference psychic life and health thus preceded the advent of National Socialism and the Anschluss in Austria, and emerges instead from a larger philosophical and scientific tradition upon which Freud first drew. Greenberg and Mitchell (1983) claim that Hartmann's proceeding from the premise of Freudian theory- as -bedrock reflects his exposure, via his father and grandfather, to constitutional law, wherein the "constitution is a given" or, in this case, "the essence" of Freud is diktat. (p. 238) Shafer,(1970), on the other hand, appreciates Hartmann as an innovator. Put differently, Shafer refuses to accept Hartmann as the self appointed representative of a tradition, a thinker who criticizes "Neo-Freudians", for instance, for undoing what he terms an "at least semi-systematic" psychoanalysis. "The part is based on the whole" of a unified theory, Hartmann typically explains, so that changing one aspect may corrupt the whole of metapsychology.
(1964, p.132) Shafer instead notes Hartmann's willingness to expand upon, or alter aspects of Freudian principles. Praising Hartmann's rejection of Freud's "dualistic framework", or his questioning of such absolutes as "pleasure principle-reality principle, sublimated-unsublimated, id impulse-ego defense" (60), Shafer explains that Hartmann introduced "notions of degree" and "flexibly managed reference points" that also served many "conceptually distinct functions"(61) Hartmann's son Ernst, himself a psychoanalyst who has contributed to the literature on Dreams, recalls that his father privately spoke of Freud's limitations as a thinker, viewing him instead as the consummate messenger of a new sensibility. (personal communication) Shafer does acknowledges that Hartmann "rather consistently underestimated (or underemphasized?) the extent to which he disagreed with Freud, correcting him, altering some of the foundations of his theory, and perhaps above all establishing a basis for a continuing challenge of psychoanalytic theory." (59) What might account for this "underemphasis"?
Challenging accepted belief invariably places a group member in danger of disapprobation or even rejection, and is rarely done with alacrity, regardless of the particular circumstance. But in Hartmann's case also consider the ambiance surrounding metapsychology at the time, captured in a conversation recounted by an emotionally moved Sterba (Steiner, 1983, p.147) that occurred just before he fled Vienna. Freud compared the expulsion of psychoanalysis from Europe to the fall of Jerusalem's second temple in 70 A.D. He then added, Sterba reports, that he hoped his followers--not unlike the 'high Priests' in ancient Yavneh-- would safeguard and spread his ideas in exile. Sanctifying metapsychology in this way may have been fueled by its public depreciation and brutal eviction from its all too recent birthplace. Healthy dissent in this context would be mistaken for a form of irreverence, or continued destructiveness towards an already devastated community with little opportunity to sufficiently mourn.
A consummate scientist in part fulfilling Freud's dream of a general psychoanalytic theory of mind, Hartmann developed the notion of an autonomous ego as a part of an individual's normal adaptation—more precisely a "conflict free sphere" of the ego, fueled neither by libido nor aggression. (1939,1964) Makari , (2008) a psychoanalytic historian who also notes Hartmann's less dualistic vision in favor of "a dialectic between inner and outer", suggests that such a conception represents " an adaptation to the problems created by the collapse of liberalism in Europe." (454) That Hartmann imagined psychic function unbridled by onerous conflict or instinctual pressure, was, according to Makari, his dedication to "the potentials of human liberty while islands of freedom in Europe were being devoured." (455)
Makari tells us that it was only after finding refuge in America, however, that "ego psychologists wrapped themselves in Freud's coat and attempted to collapse differences…" (484) Their vibrant homelands soon to become graveyards, Makari concludes that the "exiled survivors and followers fell into the vastness of their future accompanied by a word, a name, a talisman: Freud." (485)
Ironically Hartmann's "conflict free sphere" may best represent his own conflict regarding his status as loyal Freudian vs. innovator. On the one hand, the sphere's distinct or exceptional status is an attempt to expand while preserving Freud's dynamic, energic model, but on the other hand it suggests human motives independent of the drives. We are left with the provocative question, "From what source does this sphere derive its energy?" Hartmann remains vague on this point. In an "unelaborated footnote" (Greenberg, 1991, p.49) to a late paper on sublimation, Hartmann finally uses the term "noninstinctual" or "primary ego energy" to refer to that which comprises the "conflict free" sphere. Greenberg spells out that such language betrays an heretical notion that there are, in fact, aims "not organized around libidinal or destructive needs", so that Hartmann "is whistling past a theoretical graveyard when he dismisses this new idea as a 'terminological note."(49)
Indeed, Ego psychology's contributions regarding the various ways and means of adaptation prompted meaningful changes beyond theory, altering clinical psychoanalysis. Relying less upon the Analyst's "genetic" or 'id' interpretations that leap over the analysand's defensive/adaptive strategies, the analyst's inquiry instead begins "at the surface" so that the patient herself becomes the owner and agent of her actions and reactions, and finally of insight and change. (Kris, 1951)
If Hartmann or Kris acknowledged in writing that their concepts propelled new analytic rules of engagement, they repeatedly assured the reader that Freud himself was working towards such developments, implying the professor's all important, if tacit approval. Whether or not they were willing or able to say as much, however, defense analysis is also an idea of its time. That is, clinicians manipulated by the "Hitlerai", perhaps felt their will and agency in sharp relief, and as pivotal in mental functioning. (One refugee analyst writes to Jones upon her escape: "You cannot imagine what it means for us the feeling of having won back human freedom." [Steiner, 120.]) To particularly highlight and foster the patient's activity and will was thus a corrective, and perhaps more keenly valued as central to mental health and happiness. Many of us who have lived and worked during more than fifty years of relative peace and safety, (before September 11th, that is), in a society that encourages freedom of expression and individual differences, have felt less covetous of our "human freedom", and lingered longer in the tension between self and other, attachment and separateness, assertiveness and surrender.
The earlier generation instead suffered the narcissistic crisis of the victim, forced to flee degradation and disenfranchisement without the option to stand and fight for oneself and one's people. Ego psychology's focus on personal agency and responsibility, vs. its relative disinterest in the Other may thus be the refugee analyst's renunciation of this passive, ignominious identification with victim hood
Despite such over determined motives, the Ego Psychologist's appreciation for self determination can be particularly useful to patients when the roar of acute trauma or the hum of the cumulative sort becomes imprisoning. Identification with this analytic attitude introduces the possibility of movement from a conviction of embeddedness to the possibility of experimenting with new ways of being .
Erich Fromm and Melanie Klein
The psychoanalyst Erich Fromm, a refugee from Nazi Germany who had studied at the prominent Berlin Institute, shares Hartmann's respect for individual agency. Unlike Hartmann, Fromm acknowledges the impact of German Fascism upon the individual psyche and society in general. In his book "Escape from Freedom", for example, Fromm accounts for Nazism's success in the human tendency to succumb en masse for fear of loss of love or disapprobation. For him conflict is not the chafing of forbidden wishes (drive derivatives) against guilt and fear of punishment, but instead the pain of loneliness, and the anxiety of the unknown vs. the triumph of personal subjectivity and agency as it differs from the mob or the status quo.
That this quintessentially interpersonal view of conflict is cast in terms of world politics confirms that the civic unrest and danger of the age was all consuming, particularly to an analyst less averse to the impact of culture and society upon the private psyche. That he makes use of a situation in which the survival of civilization lies in the balance also reflects the manner in which the crisis influences the quality of Fromm's thinking for the rest of his days. Even as he introduces a useful revision to Freud's quantitative conflict theory, he ironically leaves the reader and the patient little room for conflict. In short, there is the more 'exalted' direction of humanism, which he translates as an appreciation for, and loyalty to the individual, vs. the 'wrong' or lowly choice of surrender to a authority or to mere familiarity. Where is Fromm's tolerance for the gray area that is so characteristic of a psychoanalytic awareness, the struggle back and forth that is itself transformative, and moreover the mourning for what is always lost by virtue of having chosen?
Fromm may be speaking from his interest and study of Rabbinic Judaism, in which clear ethical choices become imperative acts. (Bellamy, 1998, p.110) Yet Fromm's views might also be construed as characteristic of a trauma response. A splitting off of psychic awareness or consciousness causes a split between idealization and devaluation of the other, or of a particular position vs. another. Klein might understand Fromm's style as a "paranoid-schizoid", as opposed to a "depressive" stance, the latter a more fulsome and nuanced readiness for ambivalence and conflict. She conceives of these two modes as fluctuant, as opposed to points upon a linear progression or regression. Because Klein recognizes how difficult it can be for the individual to sustain a depressive anxiety, the paranoid schizoid alternative offers protection, particularly when an opportunity to repair conflict feels untenable. Among the immeasurable factors that must have influenced Klein's thinking, it bears noting that this more supple theory was conceived by a Jewish analyst who left Germany in 1926, before Hitler's ascent to power, certainly with no hint of the peril Nazi Germany would bring to those outside its kith and kin. While her reasons for quitting Berlin were undoubtedly due to personal and professional conflicts, she was nonetheless "invited" by a then eager British psychoanalytic society who, as she put it, afforded her "lots of work with favourable material, scientific and personal prospects." (Likierman, 2001, p.11) She was thus in Britain by choice. Fromm was invited to Chicago in 1934 by Horney, but by then he was among an ever growing flock of Jewish analysts in flight from the Nazi regime. (Ortmeyer, 1995, p.23) With little opportunity to repair or resolve the public and private anxiety into which Fromm was propelled, a paranoid schizoid response may have been all that was bearable.
Still, in her intellectual biography of Klein, Liekerman (2001) notes that as the London Blitz raged a child patient of Klein's had obsessive, "yet realistic" fears of Hitler. (p.72) The boy's preoccupation with the Nazi's war, according to Liekerman, "only served to intensify Klein's quest to discover more about internal wars and their outcomes". As Makari(2008) points out, the "Kleinian model had no place for historical specificity." With its focus on the intrapsychic and more pointedly sadistic impulses, Makari imagines how "hollow" such clinical explanations of war anxiety must have sounded to "those in Europe who looked at Nazi Germany and wondered what happened to the land of Geothe and Schiller." (448)
Klein's inward focus after an interwar period characterized by a greater psychoanalytic integration of culture and psyche begs the question: Was her conclusion that "Hitler was the convenient temporary receptacle for [the child's] early anxiety situation, itself Oedipal", (p.72-3) a brilliant clinical formulation, or, (we must ask the obvious), was Klein's conception a 'convenient temporary receptacle' for the overwhelming trauma of bombardment, and the anxiety-the near panic, I would imagine- she herself experienced, not knowing where Hitler might go next? Kleinian tradition remains dedicated to the study of unconscious processes within the psychoanalytic situation, with less focus not only on the environment, but also the so called "two person" back and forth in the dyad. This, despite the quintessentially relational nature of Klein's ideas, focused as they are upon self and other. That Ogden (1989) and Mitchell (1988) have appropriated her formulations to better suit the current relational turn may to some degree be a corrective to Klein's avoidance of actual events so intolerable as to be avoided or trivialized.
What then of Fromm through the Kleinian eyes of Ogden and Mitchell? Fromm's mien may have at times alienated patients, (perhaps those from a later generation more so than his own) making them feel, as Maccoby writes, as though they were "being hit over the head with a stick" .( p.74 ) Yet this paranoid-schizoid approach was an appropriate, or well related response to Fascism. Imagine if Fromm were able to extend his rallying cry to the whole of German citizenry at the time, or even to those German Jews who refused to take seriously (until the gates to immigration were finally sealed off) that the lines of right and wrong, and moreover of life and death were being starkly drawn, and picking sides was all? Would the plight of even a few Holocaust victims have been altered?
The nature and content of Fromm's comments regarding Adenauer's postwar Germany (1968, unpublished manuscript), reflect a rigidity of characteter, a persistence of a more or less paranoid schizoid stance, long after its usefulness in time. In 1968 Fromm insists that for Germany, "The forces which were underlying the expansionism of the monarchy and of Hitler are still the same, and they are rallying.." He warns the casual citizen not to be lulled by the break up of Germany's military or of the nation itself, lest the world be ignorant to a repetition "of the years 1933 to 1937". Undoubtedly post war Germany felt uneasy with its Nazi past, sometimes downright revisionist when asked to claim responsibility, and yet the nation was in no way spoiling for another world war.
Perhaps, then, Fromm is suffering from what the historian and German Jewish refugee Fritz Stern (2007) describes regarding his response to the American student movement in 1968. He notes,"…with the European past in mind, I saw things too starkly. When colleagues heard the murmur of dissent, I may have heard the distant sound of marching thugs." (260). The beneficiary of a contemporary deconstructive historicism, Stern acknowledges the "keenness of insight" that his personal involvement in his work awakens. ( ) As a result he counsels caution for historians, and for us all. He quotes Faulkner, who warns: "The past isn't dead. It's not even past."(401)
Otto Fenichel
Otto Fenichel, once an outspoken activist, became seemingly reluctant to speak out against the status quo. He left a burgeoning career as a psychoanalyst when he fled Austria as much because of his leftist, subversive politics as his Jewishness, and tried in earnest to re-establish himself in the United States. In his book The Repression of Psychoanalysis,( 1983) the author Jacoby mourns the loss of Fenichel's bold appraisal of the individual embedded in a repressed and oppressive society. According to Jacoby emigration to moderate capitalist democracies less than sympathetic to a particularly Marxist critique further inhibited the so called "political Freudians" . We are told that while Fenichel continued to send a secret letter (a 'rundbriefe") to his circle of like minded refugees, his professional future in America took precedence, part of which involved a rigorous, time consuming residency program that would re-train him in medicine, and this during his late 4o's. It is meaningful that this training was not a requirement, per se, for him to practice psychoanalysis, but rather a means towards acceptance into the most established institutes. During this period his classic tome, The Psychoanalytic Theory of Neurosis, was also completed and published. Jacoby groups this effort together with all of Fenichel's attempt to capitulate to the American medical establishment, and critiques the work as mechanical, even perfunctory. As Fenichel completes his book and begins to surrender himself to a grueling hospital regimen, Jacoby evokes a portrait of an overweight middle aged man in an ill fitting white suit typically worn by house officers half his age. Only months later he was to die suddenly of a cerebral aneurysm, a demise hastened, we may assume, at least in part by the trauma of expulsion, resettlement, but moreover the struggle to integrate who he was with what was lost along the way.
Does Fenichel's fate foreshadow a mainstreaming "death" of European psychoanalysis, a profession that became distinguishable only by specific content from any American medical subspecialty, complete with its scientific facts and technique?
Decades before the Holocaust, Freud, pictured in Gay's(1985) biography as the epitome of a bourgeois gentleman rather than a renegade, yearned for the sort of wider acceptance and recognition psychoanalysis received in post war America. He had wished to be the creator of a general scientific theory, not unlike his hero Darwin. Mindful of the high representation of the Jewish minority in the movement, and in response to a mounting anti Semitism in the culture at large, he chose the non Jewish Jung, and later Hartmann, (who was only 1/4 Jewish) to appeal to the majority, the mainstream. (Roazen,1992) Whether psychoanalysis was, or would have ever been amenable to the sort of challenge to culture and tradition Jacoby celebrates in the early efforts of Fenichel and his peers thus remains questionable.
Nonetheless Freud had in fact condemned American society as a superficial, "anti- paradise," where quantity, or material consumption of goods, superceded quality. He once told Jones that America was "useful for nothing else but to supply money." (Gay, p. 565) He resented its opposition to lay psychoanalysis in favor of the supply and demand of trained analysts controlled by affluent physicians, proof to him of America's preoccupation with the dollar rather than a depth psychology. Although Freud the moderate social democrat was by no means a Marxist, this appraisal of materialism in the United States bears some similarity to the ideology of his more politically radical followers. Alas we shall never know what might have been the fate of psychoanalysis had it matured at its place of inception, had its presses not been seized, its books never burned, and its founders, most especially those on the ideological edge, allowed to continue amidst the intellectual and cultural traditions that nurtured them, voices in what was fast becoming an increasingly complex international movement.
Jacoby, not unlike Makari, suggests that a general conservatism instead affected all of psychoanalytic theory and praxis after the scare of the Holocaust. Steiner (2000) takes a similar position, and refers to the correspondence between A. Freud and Jones, among others, peppered with questions regarding one analyst's or another's entry into England or the USA. While Jones and Freud were interested in the candidate's level of scholarship, a strict test was also loyalty to the cause, or to metapsychology. Of equally great concern was the impression one might make in their new environs. Jones speaks of a certain analyst's "unmannerliness", (p. 140) as a problem, for who knew how quickly the refugees might wear out their welcome?
Once ensconced in the New World, particularly, an orthodoxy regarding the primacy of sexuality, the frequency of analytic sessions, the training of lay analysts, and so forth, all seem to support Jacoby's conclusions about a highly regulated and rigid psychoanalysis after the Holocaust. Whatever political and economic factors in Europe and moreover in America helped to support the tenor of the era, I would add a more psychodynamic force to the mix, or a re- enactment of the trauma of exclusion and exile. Rather than psychoanalytic renegades or moreover moderates, perhaps some of the refugees preferred the role of gatekeeper anointed with what in those circles was the Godlike distinction of Training Analyst, (Kirsner, 2000) titans in a club where small differences were exploited. Could it be that the specter of authoritarian hierarchies made the possibility for a shared, and less fixed relatedness a greater challenge? The unacknowledged traumatic nature of past maltreatment perhaps surfaced, as Richman (1996) explains, "not as a verbal narrative, but as symptom or reenactment." (641)
Henry Krystal
Indeed aspects of the ossified, unyielding behavior among post war psychoanalysts are reminiscent of the trauma response outlined by the theorist and clinician Henry Krystal. Himself a concentration camp survivor, Krystal's efforts reveal an avid focus, rather than the more typical inattention to the psychic impact of overwhelming experiences. He maps reactions to catastrophe as a progression from excitability towards an emotional and even physical rigidity and disengagement, certainly a caricature of the ideal 1950's training analyst, but not without some likeness to the model. Such stereotypic movements and reactions, Krystal explains, provide a shield against any further affective siege upon the psyche. Despite his classical psychoanalytic training and his loyalty to the orientation, Krystal (1966, 1972) recognizes that traumatized patients require a rich mix of cognitive and affective intervention in order to tolerate and integrate what has been unbearable.
That Krystal (1972) noted the usefulness of support and education to his patients struggling with their feelings, and recommended that the therapist expose some of his own emotion in order to model for the dissociated or overwhelmed sufferer, contradicted official rules of analytic abstinence and neutrality. Thus for many years his prescient work was presented only as it applied in the therapy of "unanalysable" patients whose trauma history prompted addictions or severe character pathology.
His was not only considered a more "active" or supportive form of treatment than was psychoanalysis, but, moreover, Krystal's area of focus was not deemed truly psychoanalytic because he privileged actual horror over intrapsychic conflict, horror that may have occurred in adulthood, rather than originating in childhood "fixation". (In response to Krystal's (1984) comment that Jews infused with the trauma of the Holocaust struggle along with all trauma victims to have faith, Bergmann makes the statement that "When Krystal is entering into this controversy, he is entering into it as a feeling Jew, but not, in my opinion, as a psychoanalyst." (p.225-226)) Thus, what Krystal was doing could only be termed "psychoanalytic psychotherapy" at best. That many people undoubtedly benefited from Krystal's intervention in a manner in keeping with, and even promoting a deep analytic inquiry probably could not have been published at the time of writing, and Krystal's narrative is careful to avoid such assertions. As in the case of Hartmann, some of his unconventional ideas are relegated to a footnote. (1972, p. 194 ) Today psychoanalysts of all sorts reference him. Is it our distance from his trauma that which allows us to emerge from a rigid, repetitive template towards a greater appreciation and awareness of the psychoanalytic uses of this and a myriad of other theoretical and practical ideas?
Heinz Kohut
Take another example of a struggle for and against self expression, this time in the life of Heinz Kohut. Kohut escaped from Vienna to America via England, and wanted nothing more than to be an integral part of his new society, in fact to become a personage in the most respected and powerful psychoanalytic organizations in the USA. (Strozier, 1972) Kohut's orthodoxy during much of his professional life may betray something of his narcissistically vulnerable character, a tendency that could only be exacerbated by his history of expulsion. According to Kohut's biographer Strozier, Kohut was bursting with new and controversial ideas of his own that he mostly suppressed, or tried to reconcile with accepted Freudian doctrine. In his promoting a separate developmental line for the emergence of the "self", Kohut claimed to be placing "new wine in old bottles" (1972, p.11) Yet the Dutch boy with his finger in the dyke is a more appropriate metaphor for the tortured language and logic of his first book. It is not until he knows he is dying of Leukemia that Kohut, who laughingly refers to having made himself into "Mr. Psychoanalysis", (Strozier, p. 1 27 ) finally uses his own independent voice.
This voice, however rich and profound, continues to betray his desire for normality and inclusion, despite any private experience or circumstance to the contrary. He views aggression, for example, as reactive rather than primary, or a response to a threat to the patient's self. As an outgrowth of this conceptualization, Kohut insists upon the therapeutic stance of empathy as opposed to confrontation and interpretation of a patient's rage, a tack perhaps reminiscent of the Christian doctrine of "turning the other cheek". Whether or not this stance is helpful (and as a clinician I myself can find it quite helpful at times) for the purposes of my discussion its rigidity suggests it is over determined, possibly a part of Kohut's lifelong ambivalence, but particularly his post war denial of his Jewish background. That is, alongside a burgeoning intellectual openness and creativity, Kohut also constructed what Strozier (2007, in press) calls "a thick tissue of lies" regarding his Jewishness, including the myth that his mother was born a Catholic, and "dragged him off to church every Sunday" during his childhood. Kohut's protégéé Ernest Wolf (1996) notes that his initial fear and dislike of a "Teutonic", Aryan sounding Kohut was based on his own Holocaust trauma as a German Jew persecuted and expelled from Hitler's Third Reich. What is astonishing in Wolff's recollection is that Kohut reportedly provided no clues, even after the two men became intimates, that despite his accent and mien he, too, was of Jewish, if assimilated parentage, and fled Austria. Wolf ends stating, "Even though my own Jewish identity has never been questioned by myself or by others, it has presented me with enough serious problems to make it quite easy for me to understand that one might not want to call attention to one's Jewish lineage." (p.3) Perhaps easy to understand, but nonetheless not a thing Wolff, nor most refugees, did, or supposedly would do.
Kohut once responded to a journalist's question regarding his interest in narcissism by referring to his expulsion from Vienna, stating, "I've led two totally different, perhaps unbridgeable lives", (italics mine) which he claims made him "alert to the problems of the fragmented self and how it tries to cure itself." (Quinn, 1980, p.124. quoted in Marcus, et al, 1983, p.88) It tries to cure itself, and at what cost?
Michael Basch, a German Jewish refugee from the Holocaust who was both Kohut's analysand and a member of a group of younger analysts who formed around Kohut , relates a revealing memory in this regard. Having just spoken in his native tongue at a small dinner party in which Kohut participated, Basch recalls Kohut turning to him and exclaiming, "I didn't know you spoke German!" (Strozier, 2001, p. 187) What more dramatic suggestion of an unconscious or dissociated relationship to his history- Kohut's "two unbridgeable lives"- than this moment?
In what might be construed as another revisionist turn, Kohut's landmark work "The two analyses of Mr. Z" (1979) is reminiscent of the relationship between the Old and New Testament. (D.M. Rappaport, personal communication) Mr.Z. (most likely Kohut himself according to Strozier and others) is at first made aware of his unconscious aggressive wishes and conflicts by the analyst who expects a level of personal responsibility and acceptance of the "laws" which govern society or reality. But a second, more empathic analyst appears, not unlike in the second coming, and provides the antidote to the Freudian/ Old Testament God of reckoning. Perhaps Kohut preferred the "loving- kindness" of Christian doctrine to the more legalistic Torah and a "vengeful" God, regardless of the rabid anti Semitism that turned his life upside down. Yet his ever increasing denial of his own history and heritage, as well as such details as his request that a hymn by Martin Luther (!) be played at his funeral (Strozier, 2001, p.380) further suggests the dissociation from his identity as a persecuted Jew, even a modicum of Jewish self hate.
My interpretation of Kohut's behavior and ideas is a leap taken towards the possibility that he, and other victims of the Holocaust may in part dissociate from, and moreover internalize the aggression directed against them. While this can facilitate an identification with the aggressor and fealty to the victor, a more provocative possibility regards one of the most important schisms in our field--that which disputes the primacy of aggression in narcissism and other "character" pathology. Might we wonder whether Kohut's side of the argument is to some degree fueled by the unmetabolized trauma of the Holocaust?
Certainly Kohut's contribution is much more than a reflection of his own struggle with the hate and loss he suffered as a Jewish victim of the Holocaust. In fact, Kohut's willingness to welcome, rather than to interpret the patient's beleaguered subjectivity, to be available instead as a "self object" in order to reinvigorate the development of identity, all serve as a remedy for the very rigid and proscribed post -Holocaust psychoanalytic norms and therapeutic engagement heretofore noted. Enriched by even greater flexibility and an emphasis on the intersubjectivity in the dyad, his legacy helps to keep psychoanalysis vital today.
And just as Fromm's heavy handed directives seem appropriate to the situation in which he found himself, so Kohut's focus on the self may address post Holocaust angst regarding the specter of annihilation. As Wangh (1983) notes, rather than emphasize intrapsychic conflict, "the preoccupation with 'narcissism' is, in my opinion, an outgrowth of the experience of the Nazi Holocaust…The question 'shall man exist'?" Can man exist?" is to be faced. "(p. 209) Kohut's more pointed concern regarding how man is to exist-deadened or enlivened, compromised or self possessed- may further serve as some redress to the psychic violence against the human being as a unique subject, perhaps among the most horrific of Nazi crimes.
Psychoanalytic theory's immersion in context may thus be inevitable. When inhumanity threatens, a moral imperative seems to have contributed to Fromm's insistence on the individual voice in the consulting room, or Kohut's banking of his own subjectivity in order to restore a patient's beleaguered self. Fromm's assertiveness or Kohut's reticence counter Bergman's characterization of a psychoanalytic theory and praxis unaffected by the Holocaust in its midst. Hartmann's focus upon the patient as agent of her defensive or adaptive behavior, developed at a time when fascism threatened all manor of personal preference, also stands in opposition to Bergmann's conclusion.
The same persecution, terror and expulsion that may have helped to shore up humanistic, liberal ideals in psychoanalysis also contributed to its severity. As I have attempted to argue, an at least partially defensive veneration of Freud, prompting diffidence among ambitious, creative innovators like Hartmann can be understood as a response to catastrophic losses and incomplete mourning for a broken past.
Fromm's ultimatums in the consulting room and Klein's interpretations untouched by culture and history are not unlike the 'paranoid schizoid' reactivity that Klein herself offers as a result of the individual's perceived, and in this case actual threat to self.
In fact the majority of post-war psychoanalytic institutions maintained rather unyielding rules of engagement and theories of therapeutic action. There was little room for independent variables such as culture or the analyst's subjectivity. Politicized clinicians such as the Marxist Fenichel embraced a more conventional life in McCarthy's 1950's America, and psychoanalysis itself, for better and worse, became as mainstream as any other medical specialty.
If patients complained of disturbances that were to a significant degree a result of the Holocaust, or to actual traumatic events, they were relegated to the hinterlands of 'psychotherapy,' as the early research and recommendations of Henry Krystal clearly indicate. In this way psychoanalysis was free from challenges to the intrapsychic model as outlined by a reified metatheory. Moreover, psychoanalysts themselves were protected from their own traumatic history.
Of course it is easier to pinpoint the inhibitions, identifications, and repetitions that beset our traumatized founding forefathers and mothers than it is to deconstruct and understand the impact of our own traumas on our lives and work. Current events are always the most distant from self-reflexivity. Each generation must seek out a position from which to both cope and yet act. Gerson evokes the importance of what many psychoanalysts have come to know as "the third" in this almost impossible endeavor, that space between "the scream and the silence."







BIBLIOGRAPHY

1. Ahktar,S. (1999), Immigration and Identity: Turmoil, Treatment and Transformation. New York: Jason Aronson

2. Aron, L. (2005) The tree of knowledge: Good and Evil Psychoanalytic Dialogues,15 (5) p.681-707

3. Aron, L (in press) Reflections on Heinz Kohut's religious identity and anti-semitism; Discussion of C. Strozier's Heinz Kohut and the meanings of Identity. Contemporary Psychoanalysis


4. Bellamy, E.J. (1998) Affective Genealogies. Psychoanalysis, Postmodernism, and the Jewish Question after Auschwitz. Lincoln, NE: Nebraska Universities Press

5. Bergmann M, (1984) Psychoanalysis and the Holocaust: A Roundtable. In: Psychoanalytic Reflections on the Holocaust. Selected Essays. Luel, S. and Marcus, P. Eds. New York Ktav Publishing House, p.209-229

6. Busch, F. (1994) Beginning a psychoanalytic treatment: establishing an analytic frame. J. Amer. Psychoanal. Assn. 43(2)" 449-468

7. Bettleheim, B. (1943) Individual and Mass behavior in extreme situations. Journal of Abnormal Social Psychology. 38:412-452

8. Figley, C. Ed. (2005) Mapping Trauma and its Wake. New York: Routledge

9. Ferenczi, S. (1950) Further Contributions to the Theory and Technique of Psychoanalysis. London: Hogarth Press

10. Fromm, E. (1941) Escape from Freedom. New York: Ferrar Straus.

11. Gay, P.(1985) Freud: A Life for our Time. New York: W. W. Norton

12. Gray, P. (1982) "Developmental Lag" in the evolution of technique for psychoanalysis of neurotic conflict. J. Amer. Psychoanal. Assn. 30:621-655

13. Greenberg, J. and Mitchell, SJ (1983) Object Relations in Clinical Psychoanalysis. Cambridge: Harvard Universities Press

14. Greenberg, J. (1991) Oedipus and Beyond. A Clinical Theory. Cambridge, Mass: Harvard University Press

15. Grossman,V. (1980) Life and Fate. New York, NY: New York Review Books

16. Halberstam, D. (1993) The Fifties. New York; Random House

17. Hartmann, H. (1939) Ego Psychology and the Problem of Adaptation. New York: Int'l Universities Press, 1958

18. Hartmann, H. (1964) Essays on Ego Psychology. Selected Problems in Psychoanlaytic Theory. New York: Int'l Universities Press


19. Hornstein, G., (2000) To Redeem One Person Is to Redeem the World. The Life of Frieda Fromm Reichmann. New York: The Free Press


20. Jacoby, R.(1983) The Repression of Psychoanalysis: Otto Fenichel and the political Freudians. New York: Basic Books

21. Katz, S.T. (1983) Post-Holocaust Dialogues. New York: New York University Press

22. Kirsner, D. (2000) Unfree Associations. Inside Psychoanalytic Institutes. London: Process Press


23. Kohut, H. (1971) The analysis of the self. New York: International Universities Press

24. Kohut, H. (1979). The two analyses of Mr. Z. International Journal of Psychoanalysis, 60: 3-27


25. Kris, E. (1951) Ego Psychology and interpretation in psychoanalytic therapy. In C. Thompson (Ed.) An Outline of Psychoanalysis. (77-93) New York: International Universities Press

26. Krystal, H.(1968) Massive Psychic Trauma. New York: Intl Universities Press

27. Krystal, H. (1975) Affect Tolerance. Ann. Psychoanal. 3:179-219

28. Lang, F. (2006) The Believer. Psychoanal. Quart. 4: 1161-1179


29. Levi, P. (1986) The Drowned and the Saved. R. Rosenthal, Trans. London: Michael Joseph, 1988

30. Liekerman, M. (2001) Melanie Klein: Her Work in Context. New York and London: Continuum


31. Maccoby.(1990) The two voices of Erich Fromm In: A prophetic analyst Erich Fromm's Contribution to Psychoanalysis. Cortina, M. and Maccoby, M. Eds. New York: Jason Aronson
32. Makari, G. (2008) Revolution in Mind. The creation of psychoanalysis New York: Harper Collins

33. Marton, Kati (2006) The Great Escape. Nine Jews who Fled Hitler and Changed the World. New York: Simon and Schuster

34. Mehlman,J. (1990) Translator's forward. In: Elizabeth Roudinesco. Jacques Lacan and Co: A History of Psychoanalysis in France. Chicago: Chicago Universities Press


35. Mitchell, S.A. (1988) Relational Concepts in Psychoanalysis. An Integration. Cambridge, Ma: Harvard Universities Press


36. Marcus,P. and Wineman, I. (1985) Psychoanalysis encountering the Holocaust. Psychoanalytic Inquiry 5 (1) : 85-99

37. Ortymeyer, D. (1995) The Founders. In: Handbook of Interpersonal Psychoanalysis. Lionells, Fiscalini, Mann, and Sterns, Eds. Hillsdale, NJ: Analytic Press


38. Ogden, T.H. (1989) The Primitive Edge of Experience. Northvale, New Jersey: Jason Aronson



39. Roazen, P. ( 1992 ) Freud and his Followers. New York: Da Capo press

40. Richman, S. (2006) Finding one's voice. Transforming trauma into autobiographical narrative. Contemp Psychoanal 42: 4 pgs.639-651

41. Russel, PI (1996) Trauma, repetition, and affect. Contemp Psychoanal 42:4 601-621


42. Steiner, R. (2000) "It is a New Kind of Diaspora". Explorations in the sociopolitical and Cultural Context of Psychoanalysis. London and New York: Karnac Books

43. Stengel, E.(1939) On learning a new language. Intl Journ Psychoanal 20:471-479

44. Strozier,C. (2001) Heinz Kohut. The Making of a Psychoanalyst. New York: Ferrar, Straus

45. Strozier, C. (in press) Heinz Kohut and the meaning of identity. Contemporary Psychoanalysis

46. Terry, J. (1984) The damaging effects of the survivor syndrome. In: Psychoanalytic Reflections on the Holocaust: Selected Essays, Ed. Luel S. and Marcus, P. Eds. New York: Ktav Publishing Co.

47. Wolf, E. (1996) The Viennese Chicagoan In: Heinz Kohut and the Psychology of the Self. Alan Siegal, Ed. New York: Routledge

48. Wolstein, B. (1975) Countertransference: The Psychoanalyst's shared experience and inquiry with his patient. Journ. Amer Acad. Of Psychoanal. 3 (1) p.77-89


49. Wangh, (1984) Psychoanalysis and the Holocaust. A roundtable. In: Psychoanalytic reflections on the Holocaust: Selected Essays. Ktav Publishing: New York.
Emily Kuriloff, Psy.D.
5 West 86th Street 1B-B
New York, New York 10024
Ekuriloff@aol.com



Emily Kurilof
New YorK]]> DRAFT THEORY AS THICK DESCRIPTION[1] Robert P.... DRAFT THEORY AS THICK DESCRIPTION[1] Robert P.... http://www.sectionfive.org/?permanent=5.77 David Lichtenstein 2008-04-21T06:35:24-08:00 THEORY AS THICK DESCRIPTION[1]

Robert Prince, Ph.D.

The question, How did the cataclysm that befell Europe during the Holocaust effect Psychoanalysis?—has been seriously neglected if not repressed. An attempt to consider this question leads immediately to trying to understand its avoidance, and implications of its avoidances for psychoanalytic institutions and ideas.

Psychoanalysis is a survivor of the Holocaust. Certainly we approach all survivors, even those who happen to be psychoanalysts, with care, partly because of our own dread and awe and their sensitivity acknowledging the impact of the external world on their lives and especially to attributions of damage. If insight amounts to shining a light on something that is, in Salberg's(2007)felicitous phrase, "hidden in plain sight." then Emily Kuriloff's decision to look at six psychoanalytic theorists in the context of their personal Holocaust experience is a stunning illumination. To use a concept from anthropology, Kuriloff "thickly" (Geertz,C.1973) describes psychoanalytic theory by adding this layer of historical context. The goal of my discussion is to provide further historical support and elaboration regarding the perspective that Kuriloff brings to psychoanalytic ideas.

While most psychoanalysts aspire to support theory by clinical observation, lurking just beneath this surface objectivity is a passion about our psychoanalytic beliefs that becomes all too apparent when they are challenged. The broad range of often maddeningly inconsistent or contradictory tenets of diverse psychoanalytic theorists has gradually necessitated a recognition that in addition to its being a limiting factor, a theorists' subjectivity can also significantly enhance the dimensions of theoretical constructs(Stolorow R., Atwood, G. , 1979) One such aspect of theory, rarely discussed but especially salient in psychoanalysis, is its social function. Shared tenets provide a unique cohesiveness. Freud eloquently expressed this idea with reference to Judaism on his reception by representatives of the Hebrew Community of London who greeted him in 1938 after his flight from Vienna :" "We Jews have always known how to respect spiritual values. We preserved our unity through ideas, and because of them we have survived through this day. ( Diller J.,1991, p. 122 ) " In her essay Kuriloff goes as far as to suggest that this need for unity in the face of Nazi persecution left theory nearly sacrosanct, so that creative innovators may have had to struggle to find their voices. It is not exaggeration to say that the price of continuity and belonging was for some analysts a strict adherence to a set of theoretical constructs. In some groups the boundaries of ideas were so narrow that transgressing them fractures personal relationships as well as risks expulsion from the group. The ultimate psychoanalytic insult is "superficiality" , and many of the theorists who included a cultural dimension particularly feared disparagement as "mere sociologists." Here is another possible contribution of the silence regarding the impact of the Holocaust. Nevertheless it is an unacknowledged truism that psychoanalytic theories are always located in a wider social context and understanding the context gives breath to understanding the theory.

One context for psychoanalysis is its origins during the struggle for emancipation and assimilation of Middle European Jews (Diller,J 1991, Oxaal, I.,1998, Sallberg, J. 2007) Jews not only constituted the overwhelming majority of the new science but also had, as a primary objective, precisely so it would not be regarded as a Jewish science, attracting non-Jews to the fold. At the same time, the expansion of psychoanalysis after World War I coincided with the rise of Nazism and the ultimate annihilation of not only the original centers of psychoanalysis in Vienna and Berlin but also of European Jewery.

Kuriloff frames her discussion within the social context of modern day terrorism, or the decision to go on with a psychoanalytic meeting at the William Alanson White Institute as the twin towers were literally falling. This scene evokes a eerily similar story of a meeting of the Prague Psychoanalytic Society chaired by one of Kuriloff's subjects, Otto Fenichel. Also in the midst of an historical emergency-- the Anschluss on March 18, 1938-- a group of psychoanalysts gathered around the radio are considering canceling the reading of a paper by Dr. Hannah Heilbrun .Fenichel evokes a story of his father. Anxious about an ill family member, the elder Fenichel refuses dinner until mother tempts him by telling him that his favorite roasted meats are being served. Father's mood lifts and he says that such fare is welcome on any occasion. Fenichel draws a parallel to psychoanalysis, and just , as dinner was served, so, too, the meeting was held (Simmel, E.,1946 ). The story, however, does not solve the problem. Although it strives for an heroic enunciation of an ideal by gamely disavowing a grave threat, anxiety lurks. A similar scene occurred later that same year at the Psychoanalytic Congress in Paris, the last one before the war. The assembled analysts do the psychoanalytic business of attending papers while in the spaces between they discuss with one another their plans for escape As Meszaros (1998) writes, "During the presentations, the participants dealt with internal psychic events, and in the breaks, they discussed the threatening external reality. All personal concerns revolved around the question of emigration (p.211)." Although this may have been the only means by which the meetings-and by extension the supportive experience of a professional 'society'- could continue at all; in an ironic inversion , the real depth seems to be located in conscious concerns about reality while the superficial is located in the presentations about the unconscious and psychical reality.

While all of these vignettes speak to a denial or dissociation during a catastrophe,the degree of post war dissociation of Holocaust trauma is also quite evident, and not only among the theorist/victims themselves. The majority of psychoanalysts notoriously minimized if not ignored the significance of the Holocaust in the analyses of survivor, and later children of survivors analysands. In the first three decades after the end of World War II, the literature was sparse. Bettleheim's (1942) and Niederland's (1961,1964) articles in which the term "survivor syndrome" was given currency appeared outside of psychoanalytic publications. 1 In an added irony, Axelrod et. al. ( 1980) published a study of the in-patient charts of hospitalized children of survivors in the very same journal Niederland (1961) had published his landmark article almost twenty years before. In an era in which extensively detailed histories were an integral part of hospital case records, Axelrod found that a history of parents' survivorhood was still overwhelmingly omitted.

The neglect in psychoanalytic writing seemed to mirror neglect in clinical work. Henry Krystal 's watershed Massive Psychic Trauma was published in 1968 and was the first comprehensive presentation of clinical findings by leading psychiatrists. Judith Kestenberg, another of the pioneers in the field, who was to organize a Study Group of the American Psychoanalytic Association in 1974, sent out several hundred questionnaires in preparation for a congress on child psychiatry to be held in 1970 in Israel. (Bergmann,M., Jucovy, M. ,1982) Her results "enabled her draw more conclusions about the analysts that the patients. She found that many analysts showed an amazing indifference to the problems, and that many were startled because it had never occurred to them to link their patient's dynamics to the history of their parents' persecution (pp. 26-27)."

As Kuriloff notes in her discussion, Krystal's work was extolled in the growing trauma and survivor literature. However, it was marginalized by mainstream psychoanalysis. A central theoretical obstacle in attending to survivor dynamics has been the antimony in psychoanalysis between psychic reality and external reality. Boulanger, (2007), for example, has written extensively about the challenge to psychoanalytic theory posed by adult onset trauma. Confronted with overpowering reality, it seems that psychoanalysts retreat to the primacy of infantile phantasy. The connection between Holocaust trauma and the patient is minimized or avoided. For example, Freedman (1978) reports his analysis of a patient who had developed an unusual perversion. When anxious, he would seek barbers of very specific appearance and provoke them with complaints that they were not shaving him closely enough, particularly around the throat. During these encounters he masturbated under the sheet. The patient had lost his family in the Holocaust. A hero of the Warsaw Ghetto, he had been a partisan fighter who strangled the enemy with wire and was finally interned in Bergen-Belsen until the end of the war. None of these facts were integrated with the content or meaning of his perversion, and instead, the analysis was conducted entirely on the basis of the interplay of "primitive and oedipal elements (p749) " with bare reference to the role of his Holocaust experiences. The case, or more accurately the "classical" approach to it , has since attracted much discussion ,(Blum, 1978; Roiphe 1978; Oliner, 1996, 2000; Scharff,1998 ) and appreciation for some of the intertwining of early experience with adult trauma (Oliner, 1996) and emphasis on the role early pathology in the unfolding of the effects of later trauma. (Scharff, 1998).

Kohut's (1971) Mr. A. also had a childhood history of persecution when his family was forced to flee the Nazis twice, at ages 6 and 8. When Kohut was asked by Kestenberg (1982) to "provide the material that would allow us to search a connection of the pathology with Holocaust experiences , he felt certain that such a connection did not exist (p.41). " Kuriloff has suggested that such adamant denial of the Holocaust stem in part from Kohut's own defensive anti Semitism.

The strongly held theoretical justifications for holding on to the classical view are put in some perspective by the following observation of Hochman (1978) from a psychoanalytic clinic in a major city cited by Wilson and Fromm (1982), "Two cases came up for discussion, where social and ethnic factors were important. One was an Irish Catholic and one was the daughter of Polish Jews. While there was an extensive discussion about the importance of the cultural factors in the first case, there was little such discussion in the second case, with no recognition of the importance of the Holocaust. … Many analysts have been affected directly and indirectly by the Holocaust. In spite of extensive analytic discussions of the death instinct and murderous and sadistic fantasies, discussions of murderous and sadistic reality take on an unsettling presence in the analyst's consulting room (p. 290)." .

The six theorists that Dr. Kuriloff chooses highlight the most salient- and overlooked- characteristic of both survivors and of analysts – namely how different they all are. Their heterogeneity conflicts with our desire to make neat categories based on similarities. In fact common traumatic experiences produced highly individual effects. But their experiences were in fact quite varied. While all endured significant danger and losses , the quality and degree varied. One important difference was when they escaped (Hale,N., 1995,Eisold,K. 1998)As Kuriloff notes in her comparison of Klein and Fromm, analysts who emmigrated earlier, for example Horney, Alexander, and Rado, tended to be more adventuresome in their thinking, coming by invitation and choice, seeking opportunity. They may have planned to return. However, like Judith Kestenberg who had come to the United States to do research with Paul Shilder, they found themselves stranded. The later ones, who came by necessity and in desperation. tended to represent more mainstream psychoanalysis . Thus the backgrounds of persecution of the theorists Kuriloff presents are dramatically different from each other except with respect to the fact that a thick curtain has fallen over the entire era with the events relatively unknown despite the survival of the vast majority of analysts.
In fact very few were actually interned. The notable exceptions were Bruno Bettleheim who was a political prisoner in Dachau and Buchenwald between 1938 and 1939; Edith Jacobsen, some of whose patients were murdered and whose arrest in 1935 and incarceration over many months stirred fears she would be tortured to reveal names ; Karl Landauer, one of Fromm's analysts who with his family was stuck in Holland, died in Concentration Camp; the heroic John Rittmeister ,whose name seems to have been forgotten, one of two Christian analysts[2] who joined the resistance.





Most analyst got out of in time, which is not to say that their flight was without suffering. Although Anna Freud referred to it as a "new kind of Diaspora (Steiner, 1989) it was largely dissociated from institutional consciousness. Grinberg and Grinberg (1984) draw attention to the scant attention psychoanalysts have paid to migrations despite personal experience during their careers. Exact numbers are elusive but of the 2000 psychiatrists in Germany in 1933, 600 had left for 80 countries around the world by 1939 (Peters, U. 1988). By 1934, 24 of 36 full members of the German Psychoanalytic Society had managed to leave. Between 1938 and 1943, 149 analysts were aided in the emigration by a most ambivalent American Psychoanalytic Association and the Emergency Committee on Immigration (Hale,1995). The intent of that committee was equally to control the process of assimilation (Eisold, K., 1998); its charge stated 'the primary functions of the committee were to restrict and control immigration, to direct it to communities not already overcrowded, and to keep the teaching of analysis centered in the hands of our recognized teaching institutes' (Muhlleitner & Reichmayr, 1995, pp. 108-9).

Ernst Jones stands out as a eminence gris simultaneously raising funds and using influence with powerful figures of the day and also magisterially directing émigrés to various countries and even specific cities based on their politics, personality and above all their theoretical fealty (Hale,N.,1995, Roazen, P.,2001, Steiner,R., 1989) In contrast to the earlier group of refugees who were initially received as authorities and special teachers anointed by their personal contact with Freud, this group was greeted as if they were threats, interlopers demanding scarce resources, potential competitors for a diminishing patient pool. Lay analysts faced particular hurdles in America while medical analysts faced recertification in a foreign language. In the best of circumstances they faced humiliations that contrasted sharply with their previous positions as members of the psychoanalytic aristocracy. Princess Marie Bonaparte in a 1943 letter to her son from South Africa writes, :"Its horrible being a refugee. One is a 'nuisance' to everybody, and, oh, don't they just let you feel it. (de Mijola,1993, p139 )"
Fredrick Wyatt who left Austria in 1934 and returned to teach in Germany in 1974 bitterly describes the refugees as suffering rebuffs, scrounging for a living, learning a new language and mores and feeling helpless. He goes on to describe withdrawal and resignation, a slow place of adaptation, the challenge learning idioms (Wyatt,F., 1988). He writes: " Adaptation to a new culture inevitably means giving up what, in essence, has been an integral part on one's self.(p.148)" In a similar voice, Paul Federn's son Ernst Federn (1988) writes, "I can now present to you adequately the true tragedy that befell psychoanalysis in exile. Not only did that exile mean the loss of home, but also the loss of language and the loss of philosophical bearings. This loss was all the harder to bear as language and philosophy also meant economic and social status (p. 158)."

If looking forward would be fraught, so to would be looking back. Anna Freud's use of the word "Diaspora" was of course reference to the result of the destruction of the Second Temple in Jerusalem. The third temple was the Berlin Institute. Chasseguet-Smirgel (1988) writes, "Where the history of psychoanalysis under Nazi rule in Germany is concerned, it is almost as if one had quite literally obeyed the order: 'You are requested to close the eyes" appearing in one of Freud's dreams. One must not see (p. 1058).' With the ascension of the Nazis in 1933, Jews could no longer serve in the administration of medical societies and two members of the Berlin group who Would later be identified as confirmed Nazis (Roazen, 2001) , Felix Boehm and Carl Muller Braunschweig with Jones' support, approached Freud for his blessing taking over control of the Institute. Their purported aim was to preserve psychoanalysis in Germany until better times. However the exclusion of the Jews as part of official Nazi persecution was mirrored by the tacit collaboration by the non- Jewish members who remained. Thus Eichoff (1995) reports the bizarre scene in 1936 of two separate celebrations of Freud's birthday, one attended by Jewish, the other by non-Jewish members. The Berlin Institute would withdraw from the I.P.A. later that year and be absorbed into the Goring Institute where it would contribute ideological support for Nazi crimes against humanity. Not surprisingly, the events of these years raise a range of opinions. At one extreme, Peter Loewenberg, a historian and psychoanalyst judges the attempt to preserve the Berlin Institute harshly: "Freud was clearly more interested in preserving the organization and presence of psychoanalysis in the Third Reich than he was in the dignity and self-esteem of his Jewish colleagues or in the conditions that are necessary for psychoanalysis to function as a clinical therapy…. It is painful and mortifying to read the record of how the leaders of an honored institution, in order to save the organization and promote the careers of the new successors to leadership, humiliated and cast out a large majority of its members to accommodate to a totalitarian state. That a "scientific," or for that matter a "humanistic," society would exclude qualified members for ethnic, racial, religious, or other extrinsic grounds for the sake of the existence of the institution, defies the autonomy of science from political ideology and the morality of valuing individuals which is the humane liberal essence of psychoanalysis itself. [Cited in Roazen,P. 2001, pp. 23]"

In contrast Chasseguet-Smirgel (1988), in a review of Evard's (1984) Les Anees Brunes (The Brown Years) expresses suspicion of "these reproaches (p.1063)" and calls for " a little more Sorrow and a little more Pity (p 1065)." Recalling Freud's fateful meeting with Boehm, she repeats Lampl-de Groots report that Freud said to Boehm, " I have nothing to forbid them and nothing to demand of them," and then observes "Is not this remark, with all the scorn and bitterness of the world, totally in keeping with Freud's character? Moreover, is it really so extraordinary that the majority of Germans, and Freud too, were unable to predict the horrendous acts that were to follow? (p 1064)."

However, there is more to the narrative. In 1949 the German Psychoanalytic Society (DPG) under Harald Schultz- Hencke petitioned the I.P.A. for re-admission and was granted provisional membership. The objection to full membership was not Nazi era misdeeds but rather questions about Schultz- Hencke's "neo-analytic perspective (Conci 2003,p 176) ", i.e. his deviations from adherence to classical Freudian theory. Consequently the German Psychoanalytical Association (DPV) formed under Muller- Braunschweig and was granted full membership in 1951. In a clear example of the the social function of theory ( Goggin J., Goggin E., 2001) conclude that theoretical orthodoxy was "one way of advertising one's dissociation from the Nazi past" ( p. 145).

The I.P.A. returned to hold a congress in Germany for the first time in 1986. Chasseguet-Smirgel (1987), served as program chair and in an exquisitely nuanced yet emotionally electric article, describes a meeting filled with tension above and below the surface. In particular she evokes the specter of the past and the present conflict between fear of and the need for remembering and understanding. She writes, cutting in several directions and through multiple time periods, "We must regretfully conclude that our analytical identity is fragile and that courage and independence of mind are rare (p.437.)" Chasseguet-Smirgel's account, whether one agrees with all of her conclusions, is written from the vantage of one is undeniably sees the world through the eyes of a thoroughly classical psychoanalyst, yet one who avoids using theory in the service of disassociation The result is a description of past events brought into the present that is nuanced, powerful and extremely uncomfortable.

Chasseguet-Smirgel's willingness to address the legacy of the Holocaust for psychoanalytic relations is unusual. However in the last twenty years there has been an increasing attention to the history and maladaptive aspects of psychoanalytic organization (Eisold K., 1994; Kirstner,D.,1998; Hale, N. 1995; Prince, R.1999; Roazen.P., 2001) . Few links, and these are usually in passing, are made to trauma. And most, in the spirit of Dr. Kuriloff's frequent wise reminders to appreciate complexity and repudiate reductionism, reflect multiple strands of explanation. However in a paper describing the history of French psychoanalysis during the Occupation, de Mijolla (2003) rhetorically asks: "How was it possible in these times of mistrust, impoverishment, and scarcity not to arouse deep-seated resentments, which were simply waiting for the right moment to manifest themselves?( p.155)"

The answer is: It wasn't. Authoritarianism, intolerance of dissent, betrayal, intimidation, all become evident in psychoanalytic institutions. Many of these organizations became dictatorships governed by what Kirsner(1998) called " a ruling clique." Schisms occurred in almost, if not all Europe, Australia, South America and in the new hubs replacing Vienna and Berlin, the United States and England. Henry Murray, of the Boston Psychoanalytic Institute, is reported to have commented on "an atmosphere too charged with humorless hostility … an assemblage of cultists, rigid in thought, armored against new ideas, and …ruthlessly rivalrous for power (quoted in Eisold, 1994, p. 786). Victor Rosen (cited by Kirsner, 1998) describes the isolation of the institutes from the surrounding communities. A series of "outposts" wishing the rest of the world would go away; a description eerily reminiscent of the isolation of survivor families. Eisold (1994) also describes " a psychoanalytic Weltanschauung that places the analyst, in his own mind, apart from the world within which he lives and works (p795.)." Such separation and isolation effectively results in making the psychoanalytic organization, like the survivor family, a kind of refuge from a threatening world that could be regarded with condescension or contempt.

In the U.S. , intensifying with the influx of the refugees, a second "Psychoanalytic Civil War (Hale,N. 1995)" is described between 1939 and 1942 with a particular battleground over who could be a training analyst. It pitted earlier and later arriviste and native American against each other and in shifting alliances with each other. The importance of the "training analyst" status and membership on the institute education committee is that represented the power basis guaranteed control of the power. According to Arnold Richards, (cited by Kirsner, D. 1998) once one became a training analyst one was almost like God and could do what one wanted. Analysts traced their "lineage" to Freud via their training analyst and this guaranteed the continuity of power going forward. In the post war years the Europeans kept to themselves and according to Kirsner (1998) did not socialize with their American counterparts. He writes, "Given the trauma and terror suffered by the Europeans during the 1930s together with their common background, it was understandable why they grouped together socially in the US. But this carried over to professional matters, leading to a climate of paranoia in the institute which affected all its members Like refugees throughout the ages, perhaps their experiences of persecution in Europe, followed by becoming refugees and living in a totally new environment predisposed them to being more defensive, to try to cover over their fears and insecurities with a strong need to achieve and to cling on to power (Chap. 1)." Both his and Kuriloff's text suggests that this conflagration is a repetition, or enactment, rather than an acknowledgement of the original trauma of living in an authoritarian society





Suffering different degrees of trauma, the psychoanalysts of Europe nevertheless shared the necessity of mourning . However to some degree they were faced with significant obstacles to completion of this vital task. The death of Freud, their totemic figure, was far overshadowed by their own enormous losses and the challenge to survive in a new, present reality. Varvin (1995) discuses the severe consequences when interrupted mourning becomes part of group process. He cites Volkan (1993) who wrote :" A group that has been persecuted transmits its grievance from one generation to the next… and the latest generation is psychologically motivated to repeat in one way or another symbolic or realistic derivatives of the event in order to change passivity into activity, and to correct wrongs done to the forbearers. (p.103)." The transposition of what Kirsner (1998) called " a fortress mentality" and other totalitarian themes into their current realities rises to the status of such "derivatives."




Can we identify broad dimensions of theory that are likely to show the impact of the Holocaust? For individuals who had endured such losses, would not the idealization and overvaluation of the ideas they brought with them, particularly the Freudian canon, even at the cost of rigidity and the inhibition of progress, be some kind of compensation? Would they fiercely protect this ideas both as a connection to a past and as a way of restoring lost status and self-esteem? A prime example of such an over valued idea is the extreme emphasis on psychic reality at the expense of the all too painful other kind. Closely related is the psychoanalytic theory of trauma. The continued post-war radical privileging of early childhood events in the face of massive adult trauma speaks to the operation of some defensive blinders. Another instance or the impact of history is the move in ego psychology pointed out by Hale (1995), away from hereditarian beliefs in reaction to the Nazi glorification of instinct and irrationality. The clinical theory emphasizing anonymity, with deep roots in Freud's writing if not his actual practice, bares a second look in light of the secretiveness of the group of analysts who dominated after World War II. For example, despite their predominant Jewish backgrounds, Ostow (1982) speaks of a "gentleman's agreement" among these analysts "one does not discuss Jewishness (p150) " For a group whose personal exposure brought such danger, it would make great adaptive sense, as again it did for survivors, to reveal as little of themselves as possible.



Perhaps the most important theoretical response to the Holocaust is the struggle to derive meaning and a reason for living - a theoretical phoenix rising from the ashes. Implicit in the thought of each of the psychoanalysts of the Holocaust is some transcendent response to it. Most concretely, Frankl titled his opus, Man's Search for Meaning. As Kuriloff notes, Kohut articulated the complementary visions of heroic and tragic man and the striving for the realization of the nuclear self. Fromm presented the goal of the development of a humanistic conscience. Fenichel's passion for psychoanalysis seems to have formed the basis of his own adaptation. In a review of Fromm's Escape from Freedom (Fenichel,O. 1954), he applauds Fromm's social interest as he criticizes his every deviation from Freudian thinking. Klein's world of internal objects persists regardless of the surround. Krystal addresses the completion of mourning as a necessity and a life goal. In a remarkable essay he writes that "heart of the work of psychoanalysis can be reviewed in two parts….(the second is ) the acceptance of the inevitability and necessity of every event which was part of one's life as having been justified by its causes. It may be said that the challenge in the acceptance of one's old age and the completion of psychoanalytic work is the same- to acquiesce and embrace what has happened and to renounce continuing anger about it. (Krystal,1995,p83). Even Bettelheim, lately castigated for his image of the concentration camp inmate, strove to develop a theory of autonomy.



Dr. Kuriloff's examination of psychoanalytic theory through the lens of the impact on it of historical trauma can potentially be taken as an attempt to pathologize and thus devalue.The sensitivity of both survivors and analysts to attribution based on trauma remains a concern. However, as pointed out by Rakoff, not to have been effected by such trauma is the true indictment of one's humanity. Personally, my own struggle to construct a view of the world and an image of human being has taken place in the shadow of my knowledge of the Holocaust. I freely admit the possibility of projection, but it seems there is ample evidence for the representation of Holocaust trauma in psychoanalytic theory and the further enactment of it in psychoanalytic institutions. Bringing the perspective of the traumatic context of a crucial period in psychoanalytic history is emphatically not intended to detract but to add a layer of understanding. Today's psychoanalysts are like the second generation offspring of survivors to whom Holocaust trauma was oftentimes unwittingly transmitted. Awareness of what is otherwise denied and enacted is essential to our understanding and moreover our sense of agency, both as professionals and as human beings. Recognizing that we are descendents both of an intellectual tradition and the historical context in which it was formed only deepens our appreciation of the legacy of our psychoanalytic mothers and fathers.







Axelrod,S. Shnipper,O, Rau,J., ( 1980) Hospitalized offspring of Holocaust Survivors: Problems and dynamics. Bull. Menninger Clinic., 44(1): 1-14.

Bergmann,M., Jucovy, M. ,(1982) Prelude in M. Bergmann,M., M. Jucovy, eds. Generations of the Holocaust, New York: Basic Books.

Bettleheim (1943) Individual and mass behavior in extreme situations. Journal of Abnormal and Social Psychology,38, 417-452.


Bergmann, M.S. (1997). The Historical Roots Of Psychoanalytic Orthodoxy. Int. J. Psycho-Anal., 78:69-86.Bergmann, M. S. (1993). Reflections on the history of psychoanalysis.J. Am. Psychoanal. Assoc., 41:929-953.


Blum, H.P. (1978). Psychoanalytic Study of an Unusual Perversion—Discussion. J. Amer. Psychoanal. Assn., 26:785-792


Boulanger (2007) Wounded by Reality, Hillsdale,N.J. :Analytic Press

Chasseguet-Smirgel, J. (1987). 'Time's White Hair We Ruffle'. Reflections on the Hamburg Congress. Int. R. Psycho-Anal., 14:433-444

Chasseguet-Smirgel, J. (1988). Les Années Brunes. Psychoanalysis Under the Third Reich.1. J. Amer. Psychoanal. Assn., 36:1059-1066



Cocks, G. (1985), Psychotherapy in the Third Reich. New York: Oxford University Press.

Cocks G. 2001 Death of a "Jewish science"? Psychoanalysis in Nazi Germany. Psychoanalysis and History;3:211-25.

Conci, M. (2003). James E. Goggin and Eileen Brockman Goggin, Death of a "Jewish Science". Psychoanalysis in the Third Reich. Int. Forum Psychoanal., 12:173-178

de Mijolla, A. (2003). Psychoanalysis and Psychoanalysts in France between 1939 and 19451. Int. Forum Psychoanal., 12:136-156

Geertz,C (1973)The Interpretation of Cultures. New York: Basic

Diller, J. (1991) Freud's Jewish Identity: A Case Study in the Impact of Ethnicity.London: Associated University Presses.


Eisold, K. (1994). The Intolerance of Diversity in Psychoanalytic Institutes. Int. J. Psycho-Anal., 75:785-800


Eisold, K. (1998). The Splitting of the New York Psychoanalytic Society and the Construction of Psychoanalytic Authority. Int. J. Psycho-Anal., 79:871-885

Eickhoff, F. (1995). The Formation Of The German Psychoanalytical Association (Dpv): Regaining The Psychoanalytical Orientation Lost In The Third Reich. Int. J. Psycho-Anal., 76:945-956

Federn,E. (1988) The fate of a science in Exile. in E . Timms and N Segal Eds. Freud in Exile, New Haven, Yale pp156-153.

Fenichel,O. (1954) Psychoanalytic remarks on Fromm's book, Escape From Freedom, in H. Fenichel, D. Rapaport (eds.) The Collected Papers of Otto Fenichel,New York: Norton. P

Evard,J. (ed.) Les Années Brunes. Psychoanalysis Under the Third Reich. Paris: Confrontations, 1984, 216 pp.

Frankl, V. (1985), Man's Search for Meaning (rev.). New York: Washington Square Press.

Freedman, A. (1978). Psychoanalytic Study of an Unusual Perversion. J. Amer. Psychoanal. Assn., 26:749-777


Gillman,S, Contructing the image of the appropriate therapist: The struggle of psychiatry with Psychoanalysis. In eTimms,E.

Goggin,J, Goggin,E (2001) Death of a "Jewish Science". Psychoanalysis in the Third Reich: Indiana: Purdue University Press,

Hale, N. G. (1995). The Rise and Crisis of Psychoanalysis in the United States. New York: Oxford Univ. Press.

Hochman, J. (1978), Unpublished manuscript.

Kirsner (1998) Unfree Association: Inside Psychoanalytic Institutes. www. Human-nature.com/kirsner/index.html

Grinberg, L., Grinberg, R. (1984). A Psychoanalytic Study of Migration: Its Normal and... J. Amer. Psychoanal. Assn., 32:13-38.

Kestenberg,J., Kestenberg,M., The Background of the Study, in in M. Bergmann,M., M. Jucovy, eds. Generations of the Holocaust, New York: Basic Books.

Kirsner, D. (2000). Unfree associations: Inside psychoanalytic institutes. London: Process Press.

Krystal, H Ed. (1968)Massive Psychic Trauma, New York, Int. Univ. Press.

Krystal, H. (2007) Personal communication.

Kohut, H. (1971) The Analysis of the Self , New York, Int. Univ. Press.

Mészáros, J. (1998). The Tragic Success of European Psychoanalysis: "Int. Forum Psychoanal., 7:207-214.

Niederland, W.G. (1961) The problem of the Survivor J. Hillside Hospital., 10:233-247.

Niederland, W.G., (1964) Psychiatric Disorders among Persecution Victims : A contribution to the psychopathology of concentration camp pathology and its aftermath., J. Nerv. And Mental Dis., 139: 458:474.

Ostow,M. (1982) Judaism and Psychoanalysis, New York , KATV

Oliner, M.M. (1996). External Reality: The Elusive Dimension Of Psychoanalysis.. Psychoanal Q., 65:267-300.

Oliner, M.M. (2000). The Unsolved Puzzle of Trauma. Psychoanal Q., 69:41-61.

Muhlleitner, E. & Reichmayr, J. (1995). The exodus of psychoanalysts from Vienna. In F. Stadler & P. Weibel. ed. The Cultural Exodus from Austria, Vienna: Springer Verlag, pp. 98-121.


Peters,U (1988) : The Psychoanalytic Exodus: Romantic Antecedents and the loss to German intellectual life. in in E . Timms and N Segal Eds. Freud in Exile, New Haven, Yale pp156-153.

Prince, R. (199) The Death of Psychoanalysis: Murder?Suicide?Or Rumor Greatly Exaggerated? Northvale N.J.:Aronson.

Oxall,I (1988) The Jewish Origins of Psychoanalysis Reconsidered. in E . Timms and N Segal Eds. Freud in Exile, New Haven, Yale pp156-153.


Roazen, P. (2001). The Exclusion of Erich Fromm from the IPA. Contemp. Psychoanal., 37:5-42.

Simmel, E. (1946). Otto Fenichel. Int. J. Psycho-Anal., 27:67-71


Roiphe, H. (1978). Psychoanalytic Study of an Unusual Perversion—Discussion. J. Amer. Psychoanal. Assn., 26:779-783.

Scharff, D.E. (1998). The Holocaust: Chaired by Ilany Kogan, Rehovot. Int. J. Psycho-Anal., 79:376-379.

Stolorow R.,Atwood G., ( 1979) Faces in a Cloud: Subjectivity in Personality Theory, New York: Jason Aronson

Steiner, R. (1989). 'It is a New Kind of Diaspora…'32. Int. R. Psycho-Anal., 16:35-72

Timms,E. Segal, N. , (eds.) (1988) Freud in Exile: Psychoanalysis and its Vicissitudes. New Haven: Yale.

Varvin, S. (1995). Genocide and ethnic cleansing. Psychoanalytic and social-psychological viewpoints. Scand. Psychoanal. Rev., 18:192-210

Volkan, V. (1993). What the holocaust mean to a non-Jewish psychoanalyst. In: Moses, R. (ed.), (1993). Persistent Shadows of the Holocaust. Madison, Connecticut: Int. Univ. Press.

Wilson, A. and Fromm, E. (1982). Aftermath of the Concentration Camp. J. Amer. Acad. Psychoanal., 10:289-313

Wyatt,F. (1988) The Severance of Psychoanalysis from its Cultural Matrix, in E . Timms and N Segal Eds. Freud in Exile, New Haven, Yale 1988 145-155




________________________________________
[1] Originally presented as a Discussion of Dr. Emily Kuriloff's "Theory as Trauma" at the Clinical Conference of the William Alanson White Institute , New York April , 2007

1 A symposium sponsored by the Israeli Psychoanalytic Society was held in 1966 and in 1967 the International Psychoanalytic Association Congress in Copenhagen sponsored a symposium titled, "Psychic Traumatization through Social Catastrophe."
[2] Käte Dräger was the other. Chasseguet-Smirgel (1987). Cites the following from Dräger 's lecture delivered in 1970 to commemorate the Jubilee of the Berlin Institute: "We can ask after the event whether the analysts should not have all emigrated in 1933…. the chronicle of the years 1933–1945 would be easier to write if we could tell the tale today: At a certain point in the development of the situation, the "Aryan" analysts simply said "no" (p436)."

Robert Prince, Ph.D., ABPP
robertprincephd@verizon.net]]> In his pursuit of the laudable goals of more passi.... In his pursuit of the laudable goals of more passi.... http://www.sectionfive.org/?permanent=5.74 Henry M. Seiden 2007-04-25T08:27:33-08:00
Freud quoted Schiller and his advice to young poets when he described the open attention to what comes to mind. Freud's recognition that he was introducing into therapeutic service a tool of thought used by poets and artists should remind us that rather than a dry and formal routine, the method of free association is rooted in an appreciation of surprise and risk-taking.

'Natural' conversation on the other hand, while apparently more relaxed and informal is heir to all the checks and limits that socialization supplies. Regard for the other's turn in a conversation, indeed for the other's comprehension and general feeling of well-being, place reasonable constraints on what we say in 'natural' conversations. Relaxing these constraints and opening up the possibilities of speech, i.e. the possibilities of what one can say and how one can say it, is a way to let more not less passion enter the discourse.

Hoffman is right that analysis can drag on in a long and lifeless manner. He is also right that it is the analyst's proper responsibility to seek and suggest ways to enliven the work and its effects. However, this is best done by a greater appreciation and attention to the often subtle passion of free association not replacing it with the more obvious expressions of feeling in 'natural' conversations.


--David Lichtenstein]]> Here's a lovely poem by Israeli poet Yehuda Amicha.... Here's a lovely poem by Israeli poet Yehuda Amicha.... http://www.sectionfive.org/?permanent=5.73 Henry M. Seiden 2007-03-13T07:51:30-08:00 Open Closed Open (2000). It raises an interesting question for psychoanalysts. Everything we've been taught about repression and, more recently, about dissociation would have us predict that we should be better able to talk about joy than about pain--and yet....

The precision of pain and the blurriness of joy. I'm thinking
how precise people are when they describe their pain in a doctor's office.
Even those who haven't leaned to read and write are precise:
"This one's a throbbing pain, that one's a wrenching pain,
this one gnaws, that one burns, this is a sharp pain
and that--a dull one. Right here. Precisely here,
yes, yes." Joy blurs everything. I've heard people say
after nights of love and feasting, "It was great,
I was in seventh heaven." Even the spaceman who floated
in outer space, tethered to a spaceship, could say only, "Great,
wonderful, I have no words."
The blurriness of joy and the precision of pain--
I want to describe, with a sharp pain's precision, happiness
and blurry joy. I learned to speak among the pains.

(From "The precision of pain and the blurriness of joy: the touch of longing is everywhere", a poem sequence by Yehuda Amichai in Open Closed Open, (translated form the Hebrew by Bloch and Kronfeld) Harcourt NY, 2000, p. 105.)

Clearly Amichai is on to a deep truth. How do we account for this fluency about what is painful--and our relative wordlessness when it comes to joy?

Comments welcome!]]> Our new masthead features an image of Oedipus cont.... Our new masthead features an image of Oedipus cont.... http://www.sectionfive.org/?permanent=5.71 Henry M. Seiden 2006-12-16T01:15:30-08:00
What walks on four legs in the morning, two legs at noon, and three in the evening? Oedipus, famously, solved the riddle, answering that man crawls on all fours in infancy, walks upright on two legs in adulthood, and uses a cane in old age. I've always felt that that answer--correct though it be--is a disappointment, anticlimactic and fundamentally unsatisfying. (There might be a better modern answer. Maybe the question hints at an evolutionary awareness: a progression from beast on all fours, to homo sapien with upright posture, to human being in human culture dependent on his tools.)

Also famously, the answer Oedipus gives is no real solution to anything; it only leads him further into a trap. He defeats the questioner, becomes king of Thebes, marries his mother and embroils himself still more deeply in his (Freud will make it our) tragedy. (If anyone wants to be reminded of the whole story, here's one of many summaries available on the internet: Sphinx) The moral, I guess, is watch out for pat answers, especially if fate (or your deepest nature) is against you.

Still, the riddle evokes a timeless and compelling human situation--answer correctly or die! And there's the possibility that (at least temporarily) human reason will defeat brute supernatural force. And the matter the riddle addresses is nothing less than the nature of human nature!

The Sphinx came to the ancient Greeks from still a more ancient Egypt (for a capsule history, see History). The Sophoclean question arose in an age we can hardly expect to apprehend directly. But the times must have privileged simple and certain answers. Today the Sphinx might pose a different riddle altogether, one expressing one or another of the puzzles of our own age. And a modern riddle would have to have a different form--an open-endedness: it would have to be a riddle without an already-known answer.

What would a comtemporary riddle about the natue of human nature be like?

What is mind that it can know and not know what it knows?

or:

What is the nature of human beings that we strive against ourselves?

or:

Why do we seek out and create the very life circumstances we'd most want to excape?

Anyone else interested in formulating a riddle?

~Henry Seiden]]> AFTER TRAUMA, HIDDEN OR OBVIOUS: POSSIBILITIES FO.... AFTER TRAUMA, HIDDEN OR OBVIOUS: POSSIBILITIES FO.... http://www.sectionfive.org/?permanent=5.70 Henry M. Seiden 2006-11-07T09:22:46-08:00
Johanna Krout Tabin, Ph.D. ABPP

Note: These papers were presented at the Section V Panel, APA, New Orleans, LA, August, 2006. (They are also online as downloadable pdfs on the Section II link on the Division 39 home page .)

An important part of the mission of Section V is to keep abreast of innovation in psychoanalysis. The papers which follow offer ground-breaking applications of psychoanalytic understanding in trying to help victims of trauma. Marvin Hurvich contributes a theoretically grounded but clinically practical exploration of annihilation fantasies. Sharon Farber speaks in the same way to the use of cutting and other self-harming mechanisms. She shows the clinical importance of recognizing the adaptive function of such behaviors.



PSYCHIC TRAUMA, ANNIHILATION ANXIETIES AND PSYCHODYNAMIC TREATMENT
Marvin Hurvich, Ph.D. ABPP

PSYCHIC TRAUMA MARKERS

Key indicators of psychic trauma were delineated by Freud in 1920: a feeling of helplessness associated with sudden onset; surprise; an impact that is overwhelming; and obligatory repetition in the service of mastery. The subsequent literature includes many definitions of psychic trauma. Ferenczi (1933) added betrayal of trust, underscoring the importance of relational issues. An overall framework includes the components of a traumatic event, a traumatic process, and a traumatic effect, accompanied by painful affect. (Rangell, 1967, p 79).

A broad definition of psychic trauma was provided by Greenacre (1967): any conditions which seem definitely unfavorable, noxious, or dramatically injurious to the developing young individual" (p. 128). A narrower definition is that psychic trauma is associated with devastating and shattering experiences that result in internal disruption as a result of putting ego functioning and ego mediation out of action (A. Freud 1967, p. 242;), and may interfere with or threaten the integrity of the sense of self. (Pao?) A distinction has been made between a traumatic neurosis and a traumatic event (Mahony, 1984). In the former, most of the psychopathology is seen to result from the subject's inability to assimilate the traumatic experiences. In the latter, the major traumatic significance is based on the role of the traumatic event in activating psychopathological tendencies (p. 53). The current author adds that there are transitional phases between un-assimilability and the activation of latent psychopathological trends in the wake of traumatic experience. Both the traumatic neuroses and the traumatic event tend to arouse annihilation anxieties. The presence of annihilation anxieties may thus be seen to constitute trauma markers.

Psychic traumas can have organizing influences on the mental sphere, and play a dramatic role in shaping the further development of the individual. "The residues of the past and the content of the future tend to be formulated, constructed, and reconstructed in terms of that [traumatic] experience" (Dowling, 1986, p. 212).

Annihilation-survival fantasies comprise key psychic contents of trauma. Annihilation anxieties involve concerns over survival, self -preservation, and safety. Two central areas of concern are for the integrity of the sense of self and the intactness of the ego functions. Annihilation anxieties are triggered by survival threat; are found early but can be engendered throughout the life cycle; constitute a basic danger; are residuals of psychic trauma; have specifiable sub-dimensions; may occur in presymbolic form or be associated with fantasies in conflict and compromise formation; may arise with or without anticipation; may be accompanied by controlled or uncontrolled anxiety; are motives for defense; and may be associated with particularly recalcitrant resistances (Hurvich, 2003).

Annihilation anxieties can be specified on the level of clinical description and on the level of clinical generalization (Waelder, 1962). Examples from the level, of clinical generalization have been described as (a) fears of being overwhelmed, being unable to cope, and of losing control; (b) fears of merger, entrapment, or being devoured; (c) fears of disintegration of self or of identity, of emptiness, meaninglessness, or nothingness, or of humiliation-mortification; (d) fears of impingement, penetration, or mutilation; (e) fears of abandonment or need for support; and (f) apprehensions over survival, persecution, catastrophe (Hurvich, 2003).

Specific annihilation fantasies that are residuals of the traumatic experience often serve as components in the organizing function of psychic trauma for the given person, centering around individually configured meanings of being overwhelmed, unable to cope, invaded, merged, and imminently destroyed. Zetzel (1949/1970) observed that soldiers whose narcissistic defenses of invulnerability protected them from experiencing any fear prior to battle were the ones whose sense of safety in the world was compromised as a result of exposure to combat, which fragmented their specific fantasies of invulnerability.
Annihilation anxieties can be shown to play a significant role in all the major forms of severe psychopathology, conditions which are especially found to include traumatic events in the life history: panic, nightmares, phobias, borderline, narcissistic and psychotic conditions, dissociative states, perversions, and psychosomatic disorders (Hurvich, 2003a). Sharon Farber, a member of today's panel, has written convincingly about the relation between eating disorders and annihilation anxieties and eating disorders.

When annihilation fantasies are accompanied by markers characterizing the more pathological, maladaptive, and primitive pole (uncontrolled anxiety, disorganizing regression), the reaction is more likely to qualify as a traumatic response. Conversely, when the markers found along with annihilation content are on the more adaptive side (controlled anxiety, presence of reflective awareness, etc.), there is a greater likelihood that it is an anticipation of a traumatic situation. Time for recovery, and traumatic residuals, including the possibility of a traumatic neurosis or Post-Traumatic Stress Disorder are relevant here. Time of onset, be it infantile, childhood, adolescence or adulthood, is a key variable. Severe childhood trauma tends to result in a permanent expectation of a return of the traumatic state and dread of its return. A fear of emotional experience develops and this results in an impairment of affect tolerance (Krystal, 1989). Under debate is the contribution of psychic trauma to pathogenesis more generally, and how to distinguish pathological influences of trauma from other pathological effects. While his conception of psychic trauma changed as his theories evolved, Freud (1939) attributed a key role to psychic trauma in all symptom formation.

The expansion of trauma theory, and a first step toward an integration with the psychoanalytic theory of anxiety, involves the formulation that the experience of being overwhelmed, a signature of the traumatic moment, can also be anticipated and associated with controlled anxiety, and hence be included in the basic danger series (Hurvich, 2001, 2003a). Thus, issues related to being overwhelmed or annihilated (Freud, 1923, p. 57) may be part of a traumatic moment in present time, or may constitute a danger situation that is anticipated in future time: concerns about being overwhelmed may thus be either present, actual, or potential threat (Schur, 1953; Hurvich, 2003a&b).

Traumatic events are experiences processed by the subject as constituting a threat to psychic and/or physical survival. A basic assumption is that shock and strain trauma decrease a sense of safety, increase a sense of vulnerability in the world, and a heightened fear of imminent destruction--mortal terror. This threat is reflected in fantasies, conscious and/or unconscious, that have survival-annihilation content, and in defensive-restitutive fantasies and behaviors directed against the fantasies and the disruptive and sometimes intolerable affects associated with them. While the DSM-Kraeplinian approach emphasizes descriptive, observable, symptomatic manifestations of psychic trauma, the more recent PDM - Psychodynamic Diagnostic Manual, 2006-to be reported on this Saturday in a meeting to be chaired by Nancy McWilliams - additionally includes a focus on intrapsychic events and much more.

Annihilation-survival-related contents and anxieties involve terror, fright, and dread. They reflect residues of and intrapsychic reactions to traumatic experience. The ideational aspect entails a dynamic fantasy content that is found at varying levels of symbolization/mentalization, such as fears of being overwhelmed, unable to cope, merged, invaded, and losing or being negated in one's sense of self. Such fantasy contents, uniquely elaborated by each individual, and the defenses against them, extend and particularize the utility of the concept of psychic trauma. They are amenable to psychotherapeutic inquiry as are other psychic contents (Hurvich, 2003a). This schema has been used to construct measures to assess annihilation anxieties clinically (Hurvich, 1991, 2003a; Hurvich & Simha-Alpern,1997) and empirically (Hurvich, et.al., 1993; Levin & Hurvich, 1995; Benveniste et.al. 1998).

POSSIBILITIES FOR TREATMENT

Anna Freud (1936) pointed out that the general technical rule of analyzing the defenses did not have a favorable therapeutic result when the defense had been engendered as a result of the patient's fear of the strength of his drives. This technical caveat was a major basis for the clinical application of ego psychological principles to the theory of technique with more disturbed individuals, who regularly manifest traumatic residues and annihilation anxieties. Analyzing the defensive aspect of these patients' material tends to interfere with ego functioning and the maintenance of a coherent sense of self. Since the self tends to be an organizer of ego functioning, any therapeutic interventions which strengthen the coherence of the self will aid in improving the level of adaptive behavior. These include reflective (empathic) responses, other forms of support, some encouragement, providing of transitional objects, verbal and nonverbal refueling, and, sometimes, a degree of self-disclosure. These, in addition to the standard clinical procedures of clarification, interpretation, and reconstruction, further self-integration.

There are always a number of considerations relevant to the therapist-patient setting. For those who manifest high levels of annihilation anxieties and a traumatic history, an important issue involves the therapist protecting, maintaining, and enhancing the patient's sense of safety and comfort in the room. With such patients, timing and tact trump most other concerns, especially until a trusting relationship and a working alliance have been established. This is both difficult, and not always realizable. Due to the substantial and sometimes extreme sensitivity of such individuals to narcissistic injury, hostile or critical overtones and seductive or rejecting implications in the therapist's tone and message are especially toxic and counter-therapeutic.

For patients prone to panic experience, a supportive, calm, containing, and non-intrusive stance by the therapist helps the patient increase his tolerance for anxiety. Judicious, relatively ego-syntonic interpretations facilitate the patient's integration of cognitive and affective components of his experience.
From the interpretive side, it is often helpful to analyze and work through maladaptive ego functioning. "We have to show the patient, not only the many determinants of his anxiety, but also how and why a given situation gets out of hand and deteriorates into a traumatic situation. [Schur, 1971, p. 117] A relevant goal here is to facilitate the shift from uncontrolled to controlled anxiety.

A detailed knowledge of the clinical manifestations and implications of the major manifestations of annihilation anxieties is helpful. Such relevant phenomena as fears of being overwhelmed, merged, invaded, disorganized, in addition to excessive concerns over death, dying, bodily harm, and serious injury are also manifestations of excessive annihilation concerns, and it is therapeutically useful to underscore the annihilation meaning of such fears and to elicit associations when the patient is capable of such activity.
Relevant to all of this is that annihilation concerns of the patient, when these are extensive and strong, often trigger related issues in the therapist. One of the challenges of helping these difficult patients is the successful utilization, processing, and control of countertransference reactions. Since obligatory repetition is a major feature of psychic trauma (Freud, 1920), an especially challenging aspect of working with these patients is their strong, typically unconscious tendency to do to you what was done to them, to induce you to do to them what was done to them, and other variations of the Law of Talion (Hurvich, 2006). Winnicott's sage advice, to avoid retaliating against the patient, is more likely to be achievable when the therapist is able to process her or his countertransference reactions. An additional complicating factor here is that the patient's traumatic repetitions are typically accompanied by annihilation and death-related imagery/fantasies.

But the problem of annihilation anxiety-related countertransference reactions in the therapist are found in a broader range of therapeutic work with disturbed patients. The persecutory/malevolent transferential attitudes of psychotic and especially paranoid patients are frequently experienced by the therapist in the countertransference as threatening her or his psychic survival. As J. Wallerstein (1997) has written, "The central countertransference of the clinician, namely, the fear of annihilation, provides the key to the primitive psychological roots of the transference and illuminates the highly disturbed psychological functioning of the patient. For the clinician is not reacting with the kind of anxiety that is aroused in a relationship with a neurotic patient, but with a much greater, far more primitive fear of personal and professional annihilation." There is a basis to conclude that underlying traumatic residues play a role in the background of many seriously disturbed patients who do not meet the criteria for traumatic neurosis or PTSD (Hurvich, Knafo 2004).

BIBLIOGRAPHY

Dowling, S. (1986). Discussion of the various contributions. In Rothstein, 1986, op cit., pp. 205-217. Rothstein, ed. The Reconstruction of Trauma. Madison, CT: International Universities Press.

Ferenczi, S. (1933/1968) Confusion of tongues between adults and the child: The language of tenderness and of passion.Contemporary Psychoanalysis, 24: 196-206.

Freud, A. (1936). The Ego and the Mechanisms of Defense.

Freud, S. (1920). Beyond the pleasure principle SE

Greenacre, P. (1967). The influence of psychic trauma on genetic patterns. In S. Furst, ed., Psychic Trauma, pp. 108- 153. New York: Basic Books.

Hurvich, M. (2002). A Proposed Expansion of the Danger Series: Annihilation as Present or Potential Threat. Edmund Weil Memorial Lecture April 21, 2002

Hurvich, M (2004). Psychic Trauma and Fears of Annihilation. In D. Knafo, ed.: Living with Terror, Working with Trauma: A Clinician's Handbook. Jason Aronson: NJ.

Hurvich, M. (2006). The law of talion, the golden rule, and self-esteem regulation. Fall Colloquium, LIU, Brooklyn.

Rangell, L. (1967). The metapsychology of psychic trauma. In A Rothstein, ed. (1986) The Reconstruction of Trauma: Its significance in Clinical Work, pp. 51-84. Madison, Conn.: International Universities Press.

Waelder, R. (1962). Psychoanalysis, Scientific Method, and Philosophy. J. Amer. Psychoanal. Assn., 10:617-637

Wallerstein, J. (1997). Transference and countertransference in clinical interventions with divorcing families In M. Solomon & J. Siegel, eds. Countertransference in couples therapy, New York: Norton.


***


THE INNER PREDATOR:
TRAUMA AND DISSOCIATION IN BODILY SELF-HARM
Sharon K. Farber, Ph.D., B.C.D.


People who live with self-mutilation (scratching, picking at, burning, or cutting the self), disordered eating (binging, purging, self-starvation), or compulsive body piercing, tattooing usually cling to it ferociously, and have little ability to reflect about how and why they live this way. To be really helpful to these patients, we must engage them in wondering about just what self-harm does for them, how it evolved in their lives, and what they will need in order to relinquish it (Farber, 1995, 1997, 2000, 2003; Farber, Jackson, Tabin and Bachar in press). These questions are the subject of this presentation.

These acts are generated out of dissociative experiences. In every act of self-harm there is more than one participant and more than one self-state. There is the dissociated part of the self being abused and another dissociated part doing the abusing. Dissociation makes possible the extraordinary feat of being the victim and the victimizer all at the same time.
There is a growing psychoanalytic interest in dissociation as basic to human mental functioning, and a view of the mind as a configuration of shifting, nonlinear states of consciousness, shaped not only by repression and intrapsychic conflict but also by trauma. Dissociation is a precious psychic survival tool that arises from the need to separate and compartmentalize aspects of traumatic experience while maintaining the attachment, to those who have neglected or abused them (Howell, 2005; Bromberg, 1998). Human responses to trauma involve physiological and behavioral hyperarousal, along with numbing, dissociative responses (Herman, 1992). When confronted with a life-threatening situation at a very young age, human beings, like the other animals, may react as if they were frozen, immobilized, paralyzed (Marks, 1994). Like the other animals, humans also exhibit radical changes in eating behavior and may become self-injurious (Epling and Pierce, 1996; Farber, 1995, 2000; Favazza, 1996).

Trauma not only separates cognition from affect (the customary psychological definition of dissociation), but also psyche from soma. Many patients have chronic physical symptoms that are actually dissociative in nature, because events that should have been processed mentally have been dissociated and experienced instead as somatic events ({Nijenhuis and van der Hart; Nijenhuis, 2004; Sacksteder, 1989a, 1989b). Because trauma dissociates thought from affect and mind from body, the body may repeat and relive that which the mind wants to forget.

When the body weeps tears of blood, we need to wonder what terrible sorrows cannot be spoken. When food that had tasted good suddenly feels like poison and has to be purged from the body, we should wonder what traumatic experiences exist that cannot be contained, metabolized, and integrated. ...The body speaks of that which cannot be said in words, of secrets, lies, and trust that has been broken (Farber 2000).

The split between psyche and soma starts to form in infancy, when the mother's lack of relatedness to the infant's soma and developing psyche, reflected in how she cares for and holds the infant, leads to the development of the infant's own lack of relatedness to his soma and psyche. The capacity to develop mental representations of the body and its contents is thwarted, and thus the unity of the mind and the body does not develop.
This view of the split between psyche and soma was basic to nineteenth-century views on hysteria, particularly by Pierre Janet, (1907), the French neurologist and psychiatrist, and Charcot, but was not basic to Freud's view. Janet (1859-1947) was the most important clinical investigator of dissociative states who studied the "mysterious leap from the mind to the body" (Deutsch, 1959), known then as conversion hysteria, the process by which repudiated mental content is transformed into physical symptoms. Freud recognized that the dramatic somatic symptoms of hysteria were induced by psychological trauma ({Freud, 1910) but subsequently dismissed the phenomenon of dissociation that Josef Breuer , his associate, believed was at the root of hysteria ({Breuer, 1895). The result in psychoanalysis is an emphasis on repression at the expense of dissociation. "Part of our work as analysts facilitates the restoration of links between dissociated aspects of self so that the conditions for intrapsychic conflict and its resolution can develop (Bromberg 1998. p. 13)."

Dissociation has been called "the escape when there is no escape ({Putnam, 1992, p.104)." Self-harm allows the individual to adapt to the most horrific of circumstances without becoming psychotic and without killing himself or someone else, and in that way serves an invaluable defensive function. But it is far more than a defense, and more than a symptom. It is the behavioral component of a part of the self with a set of needs, feelings, and perceptions that have been dissociated from the patient's total self-experience. It meets the needs of a part of the self that is at odds with the patient's ordinary experience of herself. It both expresses and defends against unrecognized archaic needs and feelings. It numbs painful affects and protects the patient from fears of annihilation and disintegration. Often the patient experiences this part of herself as foreign, alien, as "not me" (Bromberg 1998) because it is self-destructive and out-of-control. "It is like there is a monster or a demon in me urging me to stuff myself and make myself throw up." Or, there is an external seductively caring voice urging her, "Go on, sweetheart. Do it. Just a little cut will make you feel so much better. You know it will."

Despite her view of the self-harm as negative and crazy, this secret part of the self is precious, and so anyone who tries to take it away from her will be met with ferocious resistance, and sometimes even more violent and dangerous symptoms. We need to understand the nature of the attachment to self-harm if we want to keep these patients from developing careers as mental patients, going from therapist to therapist, hospital to hospital.

Attachment theory helps us understand how human beings can become so attached to pain and, suffering that they cannot imagine living without it. If we examine how self-harm evolves as a survival tool, this will tell us something about the treatment of patients who harm themselves. Darwin's theory of natural selection tells us that when survival is threatened, one can "kill or be killed", "eat or be eaten ". One can be the predator or one can be the prey. To be the predator is to be powerful; to be the prey is to be annihilated.
Each species in the animal kingdom has its own biologically based attachment system that attaches its offspring to its caretaker and caretaker to its offspring in order to protect the newborn from predators in the environment (Bowlby, 1969). The caretaker must have a deep attachment to the child to insure his biological survival, and to provide the sense of security needed for the development of self-regulatory functioning, such as eating, sleeping, heart rate, breathing, body temperature, growth hormones (Hofer, 1995). A secure attachment helps the child to develop a basic sense of trust and to tolerate separations. The attachment ensures that the child survives and thrives in other future attachments as well.

When those who are meant to protect the child are neglectful or unattuned, the child comes to feel unprotected, in his real environment or in his imagination, from those who might harm him, and can experience an intolerable anxiety about being annihilated, as Marvin Hurvich (2003, 2006) has thoroughly described. This annihilation anxiety engraves a pathway in his brain, creating a template upon which all subsequent anxiety-provoking situations are patterned (Farber 2000). When those who are meant to protect the child come to harm him instead, this creates a deep and confusing attachment in which the child becomes powerfully attached to the parent he fears will annihilate him, and powerfully attached to pain and suffering.

The object becomes split into good and bad object representations that allow him to maintain his attachment to both the good aspects of the object and to the bad, as if they were two separate people. Despite the shift from passive prey to active predator, the predator-to-prey object relationship is repeated and the attachment to pain and suffering is repeated by means of presymbolic wordless physical traumatic reenactments in behavior, in relationships to others and to ones own body, as I will describe.

These individuals articulate through their bodies what may be biologically based primal and universal urges that remain relatively unarticulated in the rest of us. Robert Stoller (1991) asked "How common are the little sadomasochisms of everyday life, covert but observable: the skin pinching, cuticle tearing, gum picking, colonic treatments, deep massage, hairpulling, dreamy-self-and-other-stimulations (p.23)."

Self-Regulation and Symptom Substitution

The primary function of self-harm is to regulate both the self and relatedness to others. The individual turns to self-harm in order to circumvent the need for human relatedness, and to release tension by terminating dysphoric moods, affect states, and states of consciousness.
Although the remarkably high comorbidity between disordered eating and self-injury had been documented in numerous studies, there was no explanation as to how and why they were linked together. This question became the subject of my dissertation study (Farber 1995), and became the adventure of a lifetime. I found that these behaviors actually serve as a form of self-medication (Khantzian, 1985). Both bulimic behavior and self-mutilation were found to be extremely potent forms of self-medication, of approximately equal potency (Farber 1995). When a patient gives up one behavior before the ego is ready to relinquish it, as often happens when a patient stops the behavior to please the therapist or gain discharge from the psychiatric hospital, another self-harm symptom of more or less equal potency will crop up in instead (Farber 1995).

Here is an example from my practice (Farber 2000). Dina, age 23, was one of numerous children from a large chaotic family. Two sisters remember being beaten by their father although Dina has no memory of this. For years Dina experienced depression, drinking binges, promiscuity, bulimia, compulsive shopping and shoplifting. Shortly after her first shop-lifting arrest, she recognized that her life was out of control and was hospitalized voluntarily. While in the hospital she Prozac was prescribed and she began attending daily Alcoholics Anonymous meetings. When she was discharged and resumed her treatment with me, she no longer drank or engaged in bulimic behavior. However, she began to feel the impulse to cut herself. And while driving over a bridge, to drive over the railing. When I asked what the cutting would do for her, she said she felt like a balloon, so full and tight; popping it open would release the tension. Further exploration revealed that when she was around ten, her sister teased her about a large brown mole on the back of her thigh, saying that it looked like a piece of shit stuck there. Dina then took a paring knife and cut the mole away. Years later, while looking in the mirror as she applied her makeup, she became transfixed by the crease in her eyelid. She picked up a razor blade and in a depersonalized state drew it slowly across the eyelid crease, watching in excited fascination as drops of blood appeared and dripped down her cheek.

Psychic Functions served by self-harm

These patients tend to be alexithymic, unable to identify emotions or use words expressively (Cochrane, Brewerton, Wilson, and Hodges 1993; Farber 1995, 1997, 2000, 2005; Farber, Jackson et al, in press; Nemiah, Freyberger and Sifneos, 1976; Taylor, Bagby, and Parker, 1991; Taylor and Bagby, 2005). Not surprisingly, alexithymia has been found to be associated with dissociative tendencies (Clayton, 2004 ; Grabe, Rainermann, Spitzer, Gänsicke, and Freyberger, 2000; { Sayar and Kose, 2003; Taylor, and Bagby 2005; Tutkun, Savas, Zoroglu, Esgi, Herken, and Tiryaki, 2004; { Wise, Mann, and Sheridan,2000). Phobic about experiencing emotion, they dissociate and harm themselves instead, which essentially is an attack on language itself and on the process of creating meaning. These acts of self-harm are very creative attempts to serve certain psychic functions, such as self soothing, defining and differentiating inner and outer body boundaries, bodily expression of emotions, and psychophysiological reenactments of past trauma. There is not time to discuss all of them so I'll limit myself to self soothing and psychophysiological reenactments of past trauma.

Self-Soothing

The individual turns to self-harm in much the same way a toddler may turn to his transitional object, usually a favorite stuffed animal or old blanket, when feeling lonely and anxious, thus comforting himself with the illusion that he is being held and comforted by his mother (Winnicott, 1953). This transitional object is a "not me" object, not part of his body. The binge-purger or self-mutilator seizes upon the symptomatic behavior, immersing herself in the comfort it provides. It does calm her for a brief time, releasing serotonin into her system, but it fails as a transitional phenomenon. It does not promote separation-individuation processes ({Mahler, Pine and Bergmann, 1975). It fails to further the capacity for symbol formation. It functions instead as an addiction or a fetish, shoring up a defective sense of self for the brief time that the shoring up lasts, until it is time to do it again, and again, more severely and more frequently. It is like the alcoholic developing a tolerance for the effect of alcohol, progressing to drinking greater volume and with greater frequency. The self-harm episodes may become more severe and more frequent. When even the escalated form of the behavior fails to do what it is supposed to do, another self-medicating behavior that is even more severe may be added to the repertoire. Thus, after even the most severe bulimic behavior no longer is strong enough self-medication, self-mutilating behavior may well be needed to supplement it.

Bodily Reenactments of Past Trauma

The body becomes susceptible to a heightened somatic stimulation in general or in the part of the body that was abused or injured (Terr, 1990, 1994), what is often called body memory. For example, many sexual abuse survivors complain of chronic pelvic pain for which no organic basis can be found. The body memory can be a cue to the therapist of dissociated experience related to that part of the body.

The addiction to self-harm behaviors often represents a compulsion to repeatedly reenact severe childhood trauma on the body (Farber, 1995; van der Kolk, 1988, 1989). For example, in the self-harming behavior in a survivor of sexual abuse, we might see a dissociated reenactment of the trauma she experienced. In the reenactment, she is in control and is active, in a vain attempt to master the trauma. In a depersonalized frenzy in which she identifies with the hateful abuser, she shoves food into her mouth as others shoved a penis, fingers, or other objects into her body. Then as the identification quickly shifts to an identification with her abused self, she vomits the food out to rid her body of those things that were inserted by force. Or she may penetrate her flesh with a razor blade, lit cigarette, or fingernails, as her abuser penetrated her. As she watches liquid oozing from the wound, she feels pleased that the vile stuff that had been inside her, (semen, the hateful parts of herself) is being expelled, leaving her clean and pure. She also has the pleasure of discharging rage and violence onto the abuser. She is both the abuser and the one being abused. She is the sadist and the masochist. She is a cool observer of her own self-abuse, like the parent who was present but failed to protect her. In the self-harming act she is all these, oscillating crazily from self to bad object to good object and back again, traumatically attached to both the affects and her abuser.

Similarly, the individual who was traumatized by intrusive and painful medical or surgical procedures may repeat the trauma by sticking himself or others with needles, and/or getting others to stick him with needles. It was striking in my study that quite a few of the subjects who reported a history of childhood medical trauma and severe self-mutilation became intensive care or emergency room nurses. The women with this history also reported having acquired professional tattooes and piercings significantly more than those without this history. In fact, two of them earned their livelihood as professional tattoo artists and body piercers.

Transferential Reenactments of Past Trauma

Enactments in the relationship with therapist tend to be around these same themes as in the bodily reenactments, reflecting the childhood relational patterns that have become internalized as dissociated parts of her self experience ({Davies and Frawley, 1994 ; Farber 1997; Miller, 1994). These manifestations, most pronounced in survivors of sexual abuse, can alternate in a dizzying sequence in which the patient tries on various dramatic roles and assigns corresponding roles to the therapist. The patient may cast the therapist in the role of her abuser while clinging to her role as victim, may then cast the therapist in the role of the parent who failed to protect her while demonstrating her need for protection, then will cast the therapist in the role of the helpless victim while she traumatizes the therapist as she had been traumatized, and may cast the therapist in the role of seducer while clinging to her role as the seduced. As you would expect, intense counter-transference feelings tend to be evoked, and therapists should not expect themselves to maintain neutrality. What is more important is that the relationship be vital and authentic.

When dissociation is a major component of the patient's defensive operations against annihilation anxiety, this can actually induce a parallel dissociative process in the therapist (Bromberg 1998), evoked by the therapist's own annihilation anxiety (Hurvich, 2003, 2006). By means of dissociation and the powerful process of projective identification, the patient projects these dissociated aspects of himself into the therapist, causing him to lose his ability to think, contain, and reflect upon the patient's experience, thus annihilating the therapist's mind. This is when the most destructive enactments in the treatment are likely to occur, created by both patient and therapist. The therapist is in danger of retaliating mindlessly against the patient, which can destroy the treatment. If this occurs, and if the therapist can genuinely acknowledge his role, and apologize for it, this allows the patient to begin to acknowledge his own role, and the treatment can be saved.

When the therapist can help the patient to decode the enactment, either through understanding what it communicates via his own countertransference responses or through understanding the enactment on the body, then what had been dissociated can become integrated into the self, to be thought about and reflected upon. Thus, these dissociative defenses are permeable enough to serve as a bridge to a more satisfying object relationship and to growth in the therapeutic relationship.

The Remarkable Power of Self-Harm

The attack upon the self has what may seem like magical power. If a period of depersonalization becomes painfully lonely, as may well happen when accompanied by the feeling that the rest of the world is not real, inflicting pain upon the self can terminate the dissociation. When hyperarousal lasts too long and is painful, inflicting pain upon the self can terminate the hyperarousal. When the raging depression is too much to bear, inflicting pain upon the self can terminate that too. That is why people who inflict harm on themselves often say it makes them feel better.

Kim, a young woman who had been sexually abused in childhood by her father, was no longer his victim but nonetheless reenacted the attacks. Cutting herself was a way of pre-empting his attack as well as triumphing over it. She wrote the following in The Cutting Edge, a newsletter for women who live with self-inflicted violence:

Tonight I've done everything to distract myself from thoughts of cutting. . . I feel angry and I'm not very good at that feeling. They say that behind anger is always fear. So I ask myself: "What are you afraid of?" Well, what do you think?! I'm afraid my father will jump right through my skin and scare the silence right out of me. When I put down this pen, who'll get me first? My daddy or me? I'd rather get there first. This belongs to me! cut, cut, cut (Kim, 1993 470 }, pp.3-4.)

A Multi-Phased Approach to Treatment

The Shakespearean injunction to "give sorrow words" is the key task of psychotherapy with all patients. With patients who cannot use words about their inner life, and whose behavior puts them at such great risk, much preparatory work must be done before they can become able to put words to their sorrow and trauma. Treatment must be a phase-oriented process, roughly divided into three phases with considerable overlap: 1) safety, stabilization and trust; 2) trauma work; and the third, mourning, resolution, reconsolidation, and reconnection (Farber 2000, 2004). Treatment is usually a long, hard road with many detours, regressions, plateaus, enactments, and negative therapeutic reactions, in which progress may be followed by a regressive move backward.

The cardinal rule in working with these patients is safety first, meaning both their physical safety as well emotional safety in the relationship with the therapist. The development of a safe and secure attachment to the therapist is what helps the patient relinquish the attachment to pain and suffering. It is the significant interactions between patient and therapist that ultimately lead to structural psychic change, and so it is these interactions that are emphasized from the beginning.

Before the patient can come to care for himself, he must feel cared for and know that his well-being is paramount in the therapist's mind. The therapist's real presence, reliability, punctuality, attentiveness, empathy-all the elements of support-- are in the forefront for the patient. In the early stages and at times of unusual vulnerability, the therapist must make himself unusually available, to be used as a transitional object, by phone or for emergency sessions. As the relationship develops, the patient becomes more receptive to learning ways to regulate anxiety states on his own.

All defenses must be treated respectfully and cautiously, even when those defenses are potentially life-threatening symptoms. Because the expression of emotions, especially anger, is so concrete, impulsive, and destructive, these patients cannot tolerate analysis of defense; in fact it can evoke more anxiety and more self-harm behavior. They can benefit greatly, however, from ego psychological techniques of ego building and strengthening (Blanck and Blanck 1974), as well as cognitive-behavioral tools for affect tolerance and regulation, such as distraction, postponing the self-harm behavior. When they cannot speak of their emotions, I have found that helping them to write down their thoughts and feelings in the therapist's presence during a session is a very powerful intervention. It can promote freer associations, help them identify and tolerate affect states, and provides containment for their impulses, and promotes more reflective thinking (Farber 2005).

The therapist needs to make himself unusually available, inviting the patient to call at critical times for soothing, even in off-hours or the therapist's vacation, thus functioning as a transitional object. These experiences are extremely potent, and can become mutative, corrective emotional experiences that lead to structural change in the personality. They can also prepare patients to acquire tools for self-soothing and affect regulation from the therapist. Because these patients often turn to self-harm to make their dissociated selves come alive or to calm themselves, bodily techniques that stimulate circulation (exercise, cold showers, touching the skin with an ice cube), will make the body feel alive, or techniques that promote relaxation (exercise, yoga, deep breathing, warm baths) will be invaluable.
Premature exploration of trauma may cause symptoms to worsen, but focusing on eliminating symptoms can do the same. Symptom management, however, is an essential part of the treatment, and is determined according to an assessment of the self-harm behavior along several axes, which suggest points for immediate intervention. The therapist should evaluate: the potential lethality of the behavior, the frequency or repetitiveness, chronicity, the directness of the harm, the extent to which the behaviors are compulsive, impulsive or both, the extent to which the behavior is ego-alien or ego-syntonic, the level of consciousness that accompanies the act, the degree to which the intent is suicidal, sadistic, or masochistic, and the multiple psychic functions served by the behavior (Farber 2000).

The first axis, the lethality of the self-harm behavior, is most critical. The therapist should engage the patient in trying to make his self-harm behavior less dangerous, so that it is safe for him to be treated on an outpatient basis. The therapist will have to rely on his powers of observation, the information he gets from the patient and/or family, which may or may not be reliable, and quite possibly, medical monitoring. To assess the lethality of the behavior, the clinician will need to know how severe and out of control it is. The rapidity of weight loss, the severity of purging (number of purging strategies and frequency of purging), the severity of self-mutilation, and alcohol or drug-related medical damage are indicators of severity. For example, episodes of bingeing and purging twice a week is less dangerous than seven or eight episodes a day in which each binge is followed by several purges; superficial controlled cutting is less dangerous than deep jagged cuts.

When the patient becomes sufficiently stable, the work of deconditioning traumatic memories and responses can begin, which further stabilizes the patient. When the therapist can help the patient restore the links between dissociated aspects of the self, the patient begins to integrate the traumatic experiences and redirects the rage which had been directed at his body. As ego functioning becomes more able to sustain the demands made by a more intensive treatment, the work can shift, to psychoanalytic psychotherapy or psychoanalysis.

References

Blanck, G. & Blanck, R. (1974). Ego Psychology: Theory and Practice. New York: Columbia University Press.
Bowlby, J. (1969). Attachment. Attachment and Loss. Volume 1, New York: Basic Books.
Breuer, J. & Freud, S. (1895). On the psychical mechanism of hysterical phenomena: A preliminary communication. Standard Edition 2, 1-17. London, Hogarth Press.
Bromberg, P. (1998). Standing in the Spaces: Essays on Clinical Process, Trauma, and Dissociation. Hillsdale, NJ/London: The Analytic Press.
Clayton, K. (2004). The Interrelatedness of Disconnection: The relationship between dissociative tendencies and alexithymia. Journal of Trauma & Dissociation 5[1], 77-101.
Cochrane, C., Brewerton, T., Wilson, D., & Hodges, E. (1993). Alexithymia in the eating disorders. International Journal of Eating Disorders, 14, 219-222.
Davies, J. & Frawley, M. (1994). Treating the adult survivor of childhood sexual abuse: A psychoanalytic perspective. New York: Basic Books.
Deutsch, F. (1959). On the Mysterious Leap from the Mind to the Body. New York: International Universities Press.
Epling, W. & Pierce, W. (1996). Activity Anorexia: Theory, Research, and Treatment. Mahwah, NJ: Lawrence Ehrlbaum Associates.
Farber, S. (1995). A psychoanalytically informed understanding of the association between binge-purge behavior and self-mutilating behavior: A study comparing binge-purgers who self-mutilate severely with binge-purgers who self-mutilate less severely or not at all. Ph.D., New York University School of Social Work.
Farber, S. (1997). Self-medication, traumatic reenactment, and somatic expression in bulimic and self-mutilating behavior. Clinical Social Work Journal 25[1], 87-106.
Farber, S. (2000). When the Body Is the Target: Self-Harm, Pain, and Traumatic Attachments. Northvale, NJ: Jason Aronson.
Farber, S. (2003). Ecstatic stigmatics and holy anorexics, medieval and contemporary. Journal of Psychohistory 31[2], 183-204.
Farber, S. (2004). Safety first, interpretations later: an attachment paradigm for psychotherapy with the self-harming patient. Mental Health News. Fall, 29-30.
Farber, S., Jackson, C., Tabin, J., & Bachar, E. (in press). Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation. Psychoanalytic Psychology.
Favazza, A. (1996). Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry. (Second ed.) Baltimore: Johns Hopkins University Press.
Freud, S. (1910). Five lectures on psychoanalysis. Standard Edition, 11, 7-56).
Grabe, H., Rainermann, S., Spitzer, C., Gänsicke, M., & Freyberger, H. (2000). The Relationship between Dimensions of Alexithymia and Dissociation. Psychotherapy and Psychosomatics; 69:128-131.
Herman, J. (1992). Trauma and Recovery: The Aftermath of Violence, From Domestic Abuse to Political Terror. New York: Basic Books.
Hofer, M. (1995). Hidden Regulators: Implications for a New Understanding of Attachment, Separation, and Loss. In Attachment Theory: Social, Developmental, and Clinical Perspectives. Ed. S. Goldberg, R. Muir and J. Kerr, pp.203-230). Hillsdale, NJ/London: The Analytic Press.
Howell, E. (2005). The Dissociative Mind. Hillsdale, NJ/London: Analytic Press.
Hurvich, M. (2003). The place of annihilation anxieties in psychoanalytic theory. Journal of the American Psychoanalytic Association 51[2], 579-616.
Hurvich, M. (2006). Psychic Trauma, Annihilation Anxieties and Psychodynamic Treatment APA Panel "Trauma: Obvious and Hidden: Possibilities for Treatment, New Orleans.
Janet, P. (1907). The Major Symptoms of Hysteria. London/New York: Macmillan.
Khantzian, E. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 11, 1259-1264.
Kim. (1993). Untitled. The Cutting Edge 4[3], 3-4.
Mahler, M., Pine, F., & Bergmann, A. (1975). The Psychological Birth of the Human Infant. New York: Basic Books.
Marks, I. and Ness, R. (1994). Fear and fitness: An evolutionary analysis of anxiety disorders. Ethology and Sociobiology 15, 247-261.
Miller, D. (1994). Women Who Hurt Themselves: A Book of Hope and Understanding. New York: Basic Books.
Nemiah, J., Freyberger, H., & Sifneos, P. (1976). Alexithymia: A view of the psychosomatic process. In O.Hill (Ed.), Modern Trends in Psychosomatic Medicine, Volume 3 (pp. 430-439). London: Butterworths.
Nijenhuis, E. (2004). Somatoform Dissociation: Phenomena, Measurement, and Theoretical Issues. New York: W.W. Norton & Company.
Nijenhuis, E. & van der Hart, O. (1999). Somatoform dissociative phenomena: a Janetian perspective. In J.Goodwin & R. Attias (Eds.), Splintered Reflections: Images of the Body in Trauma (pp. 89-127). New York: Basic Books.
Putnam, F. (1992). Discussion: Are alter personalities fragments or fiction? Psychoanalytic Inquiry 12, 95-111.
Sacksteder, J. (1989a). Personalization as an Aspect of the Process of Change in Anorexia Nervosa. In M. Fromm (Ed.), The Facilitating Environment: Clinical Applications of Winnicott's Theory (pp. 394-423). Madison, CT: International Universities Press.
Sacksteder, J. (1989b). Psychosomatic Dissociation and False Self Development in Anorexia Nervosa. In M.Fromm & B. Smith (Eds.), The Facilitating Environment: Clinical Applications of Winnicott's Theory (pp. 365-393). Madison, CT: International Universities Press.
Sayar, K. & Kose, S. (2003). The relationship between alexithymia and dissociation in an adolescent sample. Bulletin of Clinical Psychopharmacology 13[4], 167-173.
Stoller, R. (1991). Pain & passion: A Psychoanalyst Explores the World of S & M. New York: Plenum Press.
Taylor, G., Bagby, R., & Parker, J. (1991). The alexithymia construct: A potential paradigm for psychosomatic medicine. Psychosomatics 32[2], 153-164.
Taylor, G. & Bagby, R. M. (2005). New trends in alexithymia research. Psychotherapy and Psychosomatics 73, 68-77.
Terr, L. (1990). Too Scared to Cry. New York: Harper and Row.
Terr, L. (1994). Unchained memories: True stories of traumatic memories lost and found. New York: Basic Books.
Tutkun, H., Savas, H., Zoroglu, S., Esgi, K., Herken, H., & Tiryaki, N. (2004). Relationship between alexithymia, dissociation and anxiety in psychiatric outpatients from Turkey. Israeli Journal of Psychiatry and Related Science 41[2], 116-124.
van der Kolk, B. (1988). The trauma spectrum: The interaction of biological and social events in the genesis of the trauma response. Journal of Traumatic Stress 1[3], 273-290.
van der Kolk, B. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12, 389-411.
Winnicott, D. (1953). Transitional Objects and Transitional Phenomena. International Journal of Psycho-Analysis 34[47], 510-516.
Wise, T., Mann, L., & Sheridan, M. (2000). Relationship between alexithymia, dissociation and personality in psychiatric outpatients. Psychotherapy and Psychosomatics 69[123], 127.

My interactive case study on this subject is available online at www.PsyBC.com.


Sharon Klayman Farber, Ph.D., B.C.D.
Sharon_farber@psychoanalysis.net]]> Ghislaine Boulanger writes: Should we withhold .... Ghislaine Boulanger writes: Should we withhold .... http://www.sectionfive.org/?permanent=5.69 Henry M. Seiden 2006-10-26T09:36:55-08:00
Should we withhold our 2007 dues to the American Psychological Association?

There has been a lot of discussion recently about whether to withhold dues from the APA in light of the continuing use of psychologists in Guantanamo and other sites in which 'enemy combatants' are being tortured. Some have been categorically opposed to withholding dues, arguing that it is better to stay within the organization and work from there, saying that not paying dues is poor strategy; others have urged a wait and see attitude. For some of us this is not a question of strategy, it is a question of conscience. Which is not to say that sometimes acts of conscience cannot also be strategic. Be that as it may, let me speak for myself, I simply cannot in good conscience continue paying dues to an organization whose ethics code supports the use of psychologists in facilities that do not observe international human rights law.


I cannot support an organization whose spokesmen do not speak for me (recall Stephen Behnke, APA's director of ethics, telling a reporter from the NY Times last June that "helping military interrogators made a valuable contribution because it was part of an effort to prevent terrorism"). I do not wish to be associated with an organization whose president publishes columns on the question of psychological ethics that are at best naive and at worst disingenuous (see Gerald Koocher's President's columns in the February 2006 and July/August 2006 Psychological Monitor).

I have watched this struggle for several years believing that good sense would prevail. I hoped that it would this summer, and thought, briefly, that it had, only to watch as the 2006 resolution against torture was subverted by the addition of a clause rendering changes meaningless. Worst of all, the APA continues to support the use of psychologists in facilities that contravene the Geneva Conventions, making American psychologists vulnerable to charges of unethical conduct and poor judgment in the international community.

Some psychologists opposed to these ethics are continuing to work actively within the APA to change the policy. Others, in an act of 'civil disobedience,' are opting to withhold dues. I do not believe that those of us who are withholding our dues are in any way questioning or undermining what those who are working within the system are seeking to accomplish. At best our action can add further impetus to the argument that current policies are offensive to at least some of the memberhsip.

A number of us who are interested in withholding dues want to reach as many like-minded psychologists as we can. To that end we have set up a listserve which interested psychologists can join in order to discuss how to organize as a group and how to maximize the impact of our decision. If you are interested in exploring this direction, we invite you to join the listserve. This is how to do it: To join the Withholdapadues listserve, you have to have a Yahoo account first. If you don't have a Yahoo account, it takes less than five minutes to go through all the steps (and it's free), if you have a Yahoo account, you probably know that it takes less than 60 seconds to join a specific group). In either case, go to: http://groups.yahoo.com/group/withholdapadues and follow the directions. Once you have made it into the group, please send us a message to withholdapadues@yahoogroups.com to tell us that you have joined the group. If you have any trouble going through this process, please send an email to our webmaster, Rachel Kadushin, at Kadushin@aol.com and she will make sure you get onto the listserve.

Please register, and log in if you'd like to comment.]]> Board member and editor David Lichtenstein starts .... Board member and editor David Lichtenstein starts .... http://www.sectionfive.org/?permanent=5.64 jim 2006-09-25T02:39:18-08:00 Board member and editor David Lichtenstein starts off our Open Forum with this question:

Register, and log in if you'd like to comment.

Also, general comments and questions are most welcome. Send them to:
Henry M. Seiden
Secretary

Are psychoanalysis and psychology different disciplines?

The discipline that is concerned with the formations of subjective identity, with its rigidities and its fragilities, its illusions and its functions, seems to be a discipline that is particularly susceptible to the vagaries of its own collective identity. This has been the story of psychoanalysis. We all know the history of excommunications, of debates on the one true way, of wrangles about membership played out, and still playing out, in our professional organizations as well as outside of them in the legal domain.

How should psychoanalysts view the history of their own confused identification? Can we analyze our self as a field, treating our confused self identity as a symptom, or is this an invalid category error, confusing the collective with the individual? In order to better frame this question, let me expand on what I mean by our confused identity.

Every professional discipline must either implicitly or explicitly address two questions about its identity:

Does the discipline have a distinct and separate domain?
What is the relation between its domain and that of the other professions?

From its birth, psychoanalysis has addressed both of these and although it seems to have done a little better with the first, neither are truly settled. It may seem clear that there are distinct psychoanalytic questions in both theory and clinical practice yet there has always been a tendency and it is still very active to fold our discourse into a generic clinical field, such that we become simply another treatment option, even an option that can be mixed into an eclectic model.

The second question follows from the first. If we don't constitute a distinct and separate discourse, then perhaps we are a sub-discipline of another: psychiatry, psychology, the tri-disciplines of mental health, etc. It remains an unsettled question. There are experienced and well-regarded psychoanalysts who argue strongly on each side of this issue, for and against the proposition that psychoanalysis should be regarded as a separate independent clinical discipline. Indeed the official position of our organization, Division 39, is that psychoanalysis is a subspecialty of the traditional mental health disciplines. Many of us question this view.

Why can't we resolve this dilemma? Like the enigmas encountered in treatment, is there a kernel of truth hidden within this impasse? And like those inhibitions, would speaking this truth expand our field of possibility? My hunch is that this is so: a question that repeats itself marks the place of an unrecognized truth. My hunch is that there is something about our independence that is threatening to our collective status and that the nature of this threat is related to the unrecognized truth. Furthermore, I think it is more than that as a fledgling profession, psychoanalysis has had a healthy fear of annihilation and hence tries to prop itself up by leaning against older and stronger fields.

I think the hidden truth that speaks through our confused identity is the fear of our own distinct and radical ideas. We recoil from declaring our separate identity and instead try to blend in so as to be less threatening to the collective resistance to our ideas themselves. Converting our identification from a noun to an adjective softens our position, not psychoanalysis but psychoanalytic. We are not other, we are the familiar therapist/psychologist/psychiatrist/social worker, just with a bit of a psychoanalytic interest. Nothing too challenging. Nothing to fear. However, the distinct and radical nature of psychoanalysis is robust. It will keep insisting on being heard as long as psychoanalysis is practiced. Just as will the efforts to tame that nature by bringing it under the roof of a more familiar dwelling.


David Lichtenstein]]> With the passage of a law in NY State that establi.... With the passage of a law in NY State that establi.... http://www.sectionfive.org/?permanent=5.14 root 2006-07-15T04:00:00-08:00
Indeed, the efforts to establish psychoanalysis as a licensed independent profession under state laws governing professional practice have created a perplexing philosophical or, in the fullest sense, ethical problem for psychologists who practice psychoanalysis. While many agree with the proposition that psychoanalysis can and should be viewed as a distinct and independent clinical discipline, that in both its theory and its practice, it stands on its own, related to but independent of the three disciplines of clinical mental health (Psychiatry, Clinical Psychology, and Clinical Social Work), invoking the regulatory powers of the State seems like a poor way to recognize this independence. The philosophical principle itself--that psychoanalysis is an independent discipline with its own history and identity--seems valid, the political action, that it be licensed as an independent profession seems ill advised. Nevertheless, this change in the law is exactly what is happening (and has happened) in a number of states.

One of the immediate consequences of bringing psychoanalysis under the law of professional licensure is that the training of psychoanalysts becomes a legally governed action. It is no longer a question as to whether a given training program will be affiliated or not with the American or the International Psychoanalytic Association. It becomes a question as to whether that training program can, under the law, claim to be training psychoanalysts at all. This first consequence quickly leads to another: those who decide which training programs are acceptable and which are not, and those who define the principles by which that inclusions/exclusion shall occur have the real political power to define psychoanalysis de jure in their particular state. These facts clearly have the potential to profoundly affect the de facto character of psychoanalysis in the coming years.

Between five and ten years ago, becoming aware that these changes were being considered by various state legislatures, Members of the Division of Psychoanalysis (Division 39) of the American Psychological Association were understandably concerned about this new certification power. As a response, Division 39 was instrumental in forming, together with representatives from Psychiatry and Social Work, a group that has come to be known as the Consortium on Psychoanalytic Training. The Consortium produced a report on its recommendations for training standards that was released in 2004. However, the standards that were used in the development of the NY State Law that passed at about the same time were not those of the Consortium but rather those developed by The National Association for the Advancement of Psychoanalysis, a group that takes a stand independent of the "tri-disciplines."

In political terms, those groups (including Division 39) who took the position that psychoanalysis should be governed under the (combined) authority of the mental health professions lost in NY State to a group that was arguing for the position that psychoanalysis can stand on its own as an independent profession. It is of more than passing interest that this political debate echos the debate about "lay analysis" that has been a part of the history of psychoanalysis from nearly its inception. Initially, the debate was about medical vs. non-medical practitioners, but the arguments are very nearly the same when the question is between mental health vs. non-mental health trained practitioners.

One thing is certain: this whole matter has become such a tangle of ethical, philosophical, and political concerns, that it is extremely difficult for many of us to find a clear and coherent point of view. In response, many established psychoanalysts who are licensed within their respective mental health professions have essentially thrown up their hands, safe in the knowledge that they will not be directly affected. However, can anyone who is dedicated to the field of psychoanalysis not be concerned with its social and political fate?

Section V was established within Division 39 to represent and foster diversity and pluralism in psychoanalysis. While this is a point of view sanctioned by the Division as a whole, it is the specific mission of Section V to be especially attentive to the interplay between orthodoxy and innovation in our field. The debate about standards of training, governance of the boundaries of our field, and the political power to define the legal status of psychoanalysis touches upon the central concerns of this section.

It is our view that we can no longer afford to simply oppose the efforts to license psychoanalysis as an independent profession but instead should work to influence the way that licensure is governed. We should no longer simply assert that psychoanalysis is a specialty within the mental health field, but work to influence how it will be conceived as an independent discipline. We have an ethical responsibility to enter the debate regarding the conception of this independent profession, not retreat into the illusory safety of our professional status as psychologists.

How can psychoanalysis survive as simulatenously rigorous and innovative? How can it continue to be open to the contributions that come from outside the mental health disciplines without being diluted in its clinical intent and efficacy? Can we turn the decisions made by State legislatures into an opportunity to strengthen the field rather than viewing it as a defeat?

The Section V Invited panel at the Spring 06 meeting of Division 39 featured a discussion of the questions raised here by editor David Lichtenstein

"The Licensing of Psychoanalysts: Re-considering the Question of Lay Analysis" a round table discussion with Nancy McWilliams as moderator, and with Lewis Aron, Virginia Goldner, David Lichtenstein and Laurel Wagner participating.]]> By Victor P. Iannuzzi, PhD New York, NY This e.... By Victor P. Iannuzzi, PhD New York, NY This e.... http://www.sectionfive.org/?permanent=5.15 root 2005-07-15T04:00:00-08:00 By Victor P. Iannuzzi, PhD
New York, NY

This essay shared shared Section V's 2006 Morton A. Schillinger Prize

Among psychoanalysts, the postulate that there is such a thing as the "unconscious" at all is a stance that originally and most directly derives from Freud. Freud's realization that human mentation proceeds predominantly from outside of subjective awareness stands as his most valuable contribution, surpassing even his comprehensive methodological approach to investigating the nature and effects of unconscious mentation (Gedo, 1999). The idea of an "unconscious," of one form or another, has remained central to psychoanalysis throughout its evolution. The "unconscious," it seems, was not only the de facto invention of psychoanalysis (de facto because the idea of automatism had been around for about 50 years before Freud) but, for a good part of the past 100 years, it seems to have been an almost constant preoccupation. It has been exhaustively surveyed and studied by psychoanalytic historians and cognitive psychologists (Ellenberger, 1970; Kihlstrom, 1987, 1995, 1998, 1999a, b; Kihlstrom, J.F., Mulvaney, S., Tobias, B.A., & Tobis, I.P., 2000; Westen, 1998a, b, 1999), apparently received not one but three "new looks" followed by "another new look" (Bruner, 1992; Greenwald, 1992), and at one time was considered to have been found, lost and regained (Kihlstrom, Barnhardt, & Tataryn, 1992). On at least one occasion, the specific question posed in this essay was asked and answered (Shevrin & Dickman, 1980); yet we continue to ask the question, revealing something of the remarkable metamorphosis that continues to take place in the discipline of psychoanalysis.

The "unconscious" was born into psychoanalysis as a mythopoetic metaphor that included imagery as diaphanous as the well known "cauldron full of seething excitations," but also included notions of topography and, as Freud revised his theory, the idea of specific structure. As psychoanalysis evolved as a discipline, there were many departures from Freud's early emphasis, not the least of which was his notion of the unconscious and its structure. This brief essay does not permit a detailed history of the evolution of psychoanalytic thought (see Ellenberger, 1970; Greenberg & Mitchell, 1983; and Gedo, 1999 for a few particularly informative historical treatises), but clearly the evolutionary developments stemming from the influences of ego psychology, self psychology, object relations and Interpersonal theory, as well as the influence of the Klienians and Lacanians have, in their own particular ways, constituted turning points in psychoanalytic history. Many of the newer approaches, some of them drawing on the rapid expansion of infant observation findings, have tended to relegate concern with endogenous structure, if not unconscious content, to a back seat. Still, throughout this period, the construct of an "unconscious" persisted, and continued, for the most part, to be construed in verbal and symbolic terms, and as inferior to consciousness. The further shift in clinical psychoanalysis over the past 20 years, accommodating a more relational perspective, represents yet another significant turning point in the intellectual evolution of the discipline. Departing from the hermeneutic tradition of uncovering the endogenous truth of an individual's experience, many contemporary relational analysts have been inclined toward a more phenomenological approach, depicting experience descriptively, and implicitly insinuating new meanings into the metaphor of the "unconscious." Although the differences in implied meanings are far from shallow, the vocabulary of psychoanalysis remains embedded with terms that have lost their original signification. Among psychoanalysts today, the concept of the "unconscious," for those that don't ignore it altogether, has morphed into such a diverse array of implied meanings that it often seems we don't mean what we say, even when we say what we meant. The concept of the "unconscious," once "the unifying concept for the understanding of mental processes" (Schwartz, 1999, p.135) has become a soft, wooly idea lacking any particular meaning; so muddled and devalued that it is in danger of becoming a narrative tchotchke.

There seems to be a tendency in psychoanalysis that once a structure or function of the mind is named (e.g. unconscious, id, ego, superego, transference, resistance, compromise formation, sublimation, etc.) it tends to become reified in our language and thinking until, before long, we lose sight of the origins of the metaphor. Yet, every theory – new or old, needs to be reexamined in light of the emerging data of observation. If we fail to do this, then theory as an allegorizing metaphor becomes an encumbrance to effective clinical work. As Donald Spence (1994) has said, we will have confused what we know with the metaphorical rhetoric we use to explain ourselves, confusing the map (the metaphor) with the territory which it is intended to describe (Korzybski, 1958). While it's generally wise to tread warily among epitaphs, it is worth noting that it was Freud, a century ago, who reminded us that the temporary expedient of metaphor needs to be replaced once phenomena can be observed more clearly (Spence, 1994). As Freud cautioned: "We are justified… in giving free rein to our explanations so long as we retain the coolness of our judgment and do not mistake the scaffolding for the building." (Freud, 1900, p. 536; quoted in Spence, 1994, p. 79, as quoted in Wurmser, 1977, p.473).

If psychoanalysis is to remain a vital interlocutor between conscious and unconscious experience, then the metaphor of the "unconscious" needs to be rescued from the oblivion of inconsistent and anachronistic meaning. With the utmost respect for the plurality of our varied psychoanalytic traditions, language – even psychoanalytic language – is symbolic of thought, and a referent as foundational as the "unconscious" ought to have more than a modicum of consistency of signification within the umbrella of psychoanalysis. If we want to be able to share understandings as psychoanalysts, then the terms we use need to have greater consistency of meaning; failing this, we may one day be seen claiming scornfully, like Humpty-Dumpty in Lewis Carroll's Through the Looking Glass, "When I use a word, it means just what I choose it to mean – neither more nor less."

Emerging Developments: Unconscious Re-visioned

The metaphor of the "unconscious" has served psychoanalysis well. At a time when the present day advances in neurobiology and cognitive neuroscience were unknown, the original scientific project of psychoanalysis had to be abandoned. Metaphorically described metatheory served as the connecting tissue between observable behavior and an inferred agency (the "unconscious"). All great scientific discoveries begin this way. But, at some point, evidence replaces metaphor; tentative theoretical models are revised or supplanted by empirically observable findings. The "unconscious," of course, has been considered unobservable and there has been scant hard scientific evidence to the contrary. But neuroimaging technologies, such as functional magnetic resonance imaging (fMRI), that observe brain functions as they operate in real time are now coming of age. They presage the dawning of a new era for the psychoanalytic conception of the unconscious and the clinical treatment models to follow. This is not to suggest that the "unconscious" is now directly observable. The proposition is simply that the notion of an inferior "unconscious," as an agency or container for unacceptable affect, needs to be overhauled because just about everything that psychoanalysis has ever assumed about the unconscious is being altered in fundamental ways by current advances in the neurosciences.

To a large extent, the scientific stage was set, or has been in the process of setting, for some time. Over 30 years ago, M.H. Erdelyi (1974) made a strong case for theoretical connections between cognitive psychology and psychoanalytic conceptions of unconscious cognition. Similarly, Drew Westen (1998a) concluded unconscious processes were not psychoanalytic voodoo, but good science. Evidence in cognitive psychology has been slowly eroding the myth of the unconscious as an entity or a place serving as the exclusive repository for repressed content; the unconscious mind revealed in cognitive studies of automaticity and implicit memory bears little resemblance to the unconscious mind of psychoanalytic theory (Kihlstrom, 1999a). Advances in cognitive neuroscience and the compelling recent neurobiological discoveries have resulted in observable phenomena that at one time could only be thought of as part of an ineffable "unconscious." Clearly, scientific study of unconscious mentation has come of age and is here to stay.

The field of cognitive neuroscience has repeatedly demonstrated the existence and separable functioning of two forms of memory, commonly labeled implicit and explicit, or procedural and semantic memory. As psychoanalysts, this is important because implicit forms of memory are not encoded in words initially; the verbal form is not how the mind usually functions (Siegel, 1999). Instead, what is encoded may be thought of holistically – the sum total of the vast array of semiotic and affective signals, hidden prosodic cues and visuoaffective exchanges that occur unwittingly, prior to deliberate thought. Again, implicit memory is always nonconscious and includes the vast array of knowing that everyday life is based on (Stern, D.N., 2004). There is no suggestion in the neuroscience literature that implicit nonconscious memory serves merely as a container for the unacceptable. On the contrary, the thrust is toward implicit, nonconscious experience that is all-inclusive – capturing intersubjective affective experience through the automatic operation of the right hemisphere of the brain. Early life experiences, all of them, are affectively registered, and encoded into the developing right hemisphere (Stuss & Alexander, 1999). Current neuroscience makes clear that implicit, nonconscious forms of representation are fundamental to complex adult functioning as well as to infant functioning. Furthermore, complex new learning continues throughout our lives through implicit mechanisms not mediated by translation of implicit knowing into symbolic or conscious form, even though words or images may be involved as part of the learning that is implicitly represented (Lyons-Ruth, 1999).

Converging work in the neurosciences now point toward the impact of early interpersonal relations on the brain structures that both process interpersonal interactions and also regulate intrapersonal experience. At the beginning of life, our relatedness to others is primarily through somatosensory stimulation, through face-to-face, skin-to-skin interaction consisting of processes that are visual, auditory, olfactory, gustatory, and vestibular (Tatkin, 2006). Within this secure relational system begins the planting of seeds necessary for social-emotional development, such as capacities for trust, empathy, love, playfulness, humor, patience, creativity, and vitality. This developing social-emotional system largely involves the right hemisphere of the brain, which has deep connections into the limbic system and body and is dominant for non-verbal communication, processing of emotional communication, and processing of the somatic aspects of communication (Tatkin, 2006). The right hemisphere dominates during overwhelming stress and activates the hypothalamic-pituitary-adrenal axis and production of stress hormones such as cortisol (Sullivan & Gratton, 2002). Siegel (1999) sees the constructed representational world of the right hemisphere as derived from intersubjective affective exchanges with others. Research continues to uncover more of the right brain mechanism of social-emotional cueing and the critical function of attending to implicit nonverbal social-emotional cues and shifts of arousal within a dyad (Schore, 2002). Schore has further suggested that the implicit self-system of the right brain, evolving from the preverbal phase of early life, "represents the biological substrate of the dynamic unconscious" (Schore 2005, p.831).

Allan Schore's Boston Change Process Study Groups in developmental affective neuroscience and clinical practice bring a developmental and attachment theory perspective to understanding current research on unconscious processes. Their focus on infancy has resulted in a turning away from the traditional view of an "unconscious" formed by repression, and toward behavioral patterns (e.g., of attachment or other relatedness) imprinted procedurally as implicit memories that are revealed through enactments and altered (as they were generated) in present, here-and-now relational encounters (Litowitz, 2005). Schore (2001) views attachment as fundamentally the interactive regulation of emotion, specifically the right brain-to-right brain regulation of biological synchronicity between psychobiologically attuned individuals. Right brain mechanisms, activated in dysregulating stressful interpersonal interactions, are seen to play a central role in the rapid, nonconscious appraisal of the positive or negative emotional significance of social stimuli. In addition, the right hemisphere, the base for implicit learning, is known to be dominant for affect regulation, the perception of nonverbal emotional expressions, and the processing of bodily based visceral stimuli. The rapid, nonconscious assessment of negatively charged social stimuli by the right hemisphere via the limbic system often underlies triggering of dysregulating affect patterns in relationships (Siegel, 1999). In early life, complex non-verbal right brain-to-right brain communications between mother and infant generate internal working models that may encode strategies of affect regulation and guide interpersonal behavior later on. These interactional exchanges become implicit, nonconscious procedural memories and at a later point may be evoked in interpersonal experiences, particularly attachment relationships.

Presented with the latest developments in cognitive neuroscience and neurobiology, the concept of an "unconscious" as a container of repressed wishes derivative of primitive impulses, or unacceptable affect, or rejected selfobject configurations, can hardly be sustained as the only way or even a necessary way to understand the intrapsychic domain. Current developments are radically altering the way many psychoanalysts think and value the study of unconscious mentation, but little has changed in the theories that guide and inform them.

Theoretical and Clinical Implications for Psychoanalysis

A workable contemporary theoretical basis for considering neurobiological perspectives has yet to be fully articulated. However, the shift in clinical psychoanalysis over the past 20 years, accommodating a more relational perspective, has left the door open to developing a model of the unconscious that reflects the latest developments in the neurosciences using new language with meanings that fit current developments. Typically, contemporary relational analysts have avoided universal truths and the prescriptive formulaic assertions that follow, preferring a more provisional way of thinking (Hirsch, 1998). Perhaps as a result, relational analysts often seem to have more of a revisionist stance and, in a kind of reverse imitation, the relational movement seems to have been defining itself as much by what it is not as by what it is. Through processes of abstraction and conceptualization, theory provides a framework for developing our thinking and a sense of safety within which to deepen our applied experience. Lewis Aron (1998) suggests that our theories paradoxically serve two distinct and seemingly contradictory purposes. A principle may guide us either because it's concordant with our beliefs or because it complements them. On the one hand, good theory opens up possibilities, new ways of understanding and intervening, providing us with options when we've become stuck. On the other hand, theory helps us to narrow our options, establish priorities and become more consistent. Good theory doesn't require a comprehensive system of rules, but rather a set of dynamic clinical concepts serving as a framework for the analyst. Within this framework, we evaluate the potential benefits and drawbacks of any form of behavior within any individually unique interactive matrix. It is here that the analyst's sense of direction, some theoretical orientation of what to recognize in the patient's behavior, is operationalized, allowing in all of this an inescapable core indeterminacy in doing what we do.

New conceptual and descriptive approaches require new terminology to capture meanings specific to them. It is clear that most of the established psychoanalytic vocabulary has strong conceptual links to the dynamic unconscious. Traditionally, the dynamic unconscious, construed as verbal or symbolic, and as unconscious only by reason of repression, has been the locus of all affectively meaningful representations. As we have seen, this concept of an unconscious of repressed affect can no longer be sustained. Instead, we need to be thinking in terms of multi-determined processes by which experiential phenomena remain out of awareness. Such an approach could accommodate implicit knowledge that is nonconscious, has no verbal or symbolic label, and does not require repression to remain out of awareness (Stern, D.N., 1998). This approach suggests that shared verbal understanding of interactions between patient and analyst are likely to be insufficient in promoting meaningful change; instead, affectively rich implicit processes (which may or may not be explicitly verbalized) may be what brings about change in the moment (Stern, D.N. 2004). Perhaps one clinical implication of all of this may be the reformulation of the notion of a "talking" cure (left brain to left brain) to one that more broadly encompasses the totality of the human exchange including every aspect of being with another (right brain to right brain).

Among contemporary analysts, Edgar Levenson, drawing on the work of Daniel Siegel (1999) and Alan Schore (1994) among others, has added an unequivocal current neurobiological perspective to his understanding of the psychoanalytic process, offering the perspective that change in psychoanalysis arises from a deep out-of-awareness flow of affectively intense right hemisphere activity (encompassing the whole experience – visual, spatial, sensory) that is subsequently organized by the left hemisphere into a coherent narrative (Levenson, 2003). He explains psychoanalytic inquiry as essentially a non-linear, impressionistic use of language that conveys imagery recognized by the pattern recognition center in the right hemisphere of the brain. Psychoanalytic inquiry calls us to an act of curiosity in relation to experience that has remained unformulated (Stern, D.B., 1997), a way of knowing experience that is mitigated through the right hemisphere, allowing us to know the patient from the inside out (Bromberg, 1991). Yet, for many, psychoanalysis remains fundamentally a process of replacing irrational unconscious processes with consciousness, based on the premise that we are defined by intellect and language, and cured by our capacity for conscious awareness (Levenson, 1998). Even when we no longer require that the patient understand the process, we still expect that the therapist's interventions—implicit or explicitly defined—will be directed by his or her conscious awareness. Because we consider awareness as the superior state, we do not dare to think of the possibility that unconsciousness may, at times, be an advantageous state that is interfered with by consciousness (Levenson, 1998). The relevance for therapy may well be that the function of the transference-countertransference enactment is to supply the experiential component to the analytic discourse. As Levenson (1998, p.244) said "The interactional field of the therapist and patient obviously involves not only language, or even language qua behavior, but also a subtle and intricate choreography of affect, expression, semiotic cues …. It is possible that patients resist interpretations, not because of negativism or anxiety, but because no one learns anything by being told. When interpretation works … it is because it is reflecting a felt experience. Perhaps that is why interpretations only seem to work if they are mediated through the transference, where what is talked about is being simultaneously experienced… striking [a] correspondence between language and behavior." Perhaps the psychoanalyst's function may now be conceived as one in which she attends primarily to nonverbal cues and affective shifts within the therapeutic dyad, with understanding as a sort of afterthought – an idea which has radical implications for our concepts of insight and change (Levenson, 1998).

It's becoming increasingly difficult to remain a mentalist in this period of rapid neurobiological discoveries. Today, the emerging findings in neuroscience offer complex and overlapping neurobiological correlates to psychoanalysis and challenge us to integrate them in our theories and practice. Psychoanalysts of all persuasions are facing the challenges of integrating these new findings and can no longer afford to respond to current neurobiological developments with awe followed by amnesia. Some, wedded to the dogma of their traditions, will manage to overcome their anxiety and indifference to current developments simply by bending science in the direction of explaining worn out metaphors. While metaphor that relies heavily on static theoretical interpretation may indeed be comforting, it's a bit like looking at old movies – all repetition, no surprise. The unconscious, as we once thought of it, can no longer remain safely ensconced among the furniture of old metaphors. It is time to separate from the dogma of theory and to attempt embracing the unconscious from the standpoint of empirical findings. Today, the broader, deeper questions relate to how experience becomes unconscious and how unconscious processes function. There is substantial physiologic evidence suggesting that basic principles of unconscious processes be retained, although they must be reformulated. The time has come for psychoanalysis to adjust its focus on the unconscious to a level closer to the scientific data as we now know it. As always, the difficulty is to do so without feeling as though we have to dissociate from our psychoanalytic sensibilities. Psychoanalysts have the opportunity to avoid a conflict of cultures and, in its place, set the foundation for a renewed psychoanalytic sensibility rooted, not in past metaphors, but in present empirical findings; shifting our horizons to the frontiers of neurobiological discoveries. This implies we must learn to see more, to hear more, to feel more. If we do, then psychoanalysis will be well positioned to provide a renewed promise of an inclusive and comprehensive model of the essential capacity to enter into fulfilling relationships with others.

Conclusion

To paraphrase Jean Baudrillard, psychoanalysts have carried on for a long time doing our conjugal duty to the original metaphor of the unconscious – long after the surprises have worn out. There will always be a dialectical tension between the poetic (metaphor) and the pragmatic (science); however, continuing the status quo increasingly constitutes a retreat from the real world. The aim of psychoanalysis should be to make experience more, rather than less, real to us. We risk perpetuating a concept and indeed an entire vocabulary weighed down by its history-mindedness, a language that is becoming irrelevant, except for its vague nostalgic value. When the language of psychoanalysis fails to reflect the action of what we do, our lived experience as psychoanalysts, then we will only succeed in obfuscating, instead of illuminating the mutative value of psychoanalysis. Instead of looking backward and defending our traditions, we could be looking forward and generating more complex models of change that explore the mutative effects of psychoanalysis in terms of current neurobiological data integrating evidence from the mind, brain, and body. The new neurobiological findings are not a threat to the psychoanalytic enterprise. On the contrary, they promise to enliven it. As Schore (2005, p.830) has said: "The current dialogue between biological and psychological sciences is allowing for a realization of Freud's prediction of a rapprochement between psychoanalysis and the natural sciences." This dialogue constitutes a scientific basis for an emerging pragmatic consensus. We are presented with a rare opportunity for a convergence of world views among psychoanalysts of all persuasions. The opportunity is here to integrate psychoanalytic understanding of how the mind works with new knowledge of how the brain works. The only real question that remains is whether we will embrace it with timidity or temerity. The future of psychoanalysis may well belong to those whose sensibilities incorporate and reflect the compelling findings of today's research.

REFERENCES

Aron, L. (1998). Clinical choices and the theory of psychoanalytic technique: Commentary on papers by Mitchell and by Davies. Psychoanalytic Dialogues, 8: 207-216.

Bromberg, P.M. (1991). On knowing one's patient inside out: The aesthetics of unconscious communication. Psychoanalytic Dialogues, 1: 399-422.

Bruner, J. (1992) Another look at new look 1. American Psychologist, 47: 780-783.

Ellenberger, H. (1970). The Discovery of the Unconscious. The History and Evolution of Dynamic Psychiatry. New York: Basic Books.

Erdelyi, M.H, (1974). A new look at the new look: Perceptual defense and vigilance. Psychological Review, 81:1-25.

Freud, S. (1900). Die Traumdeutung. Standard Edition, vols. 4 & 5, London: Hogarth Press.

Gedo, J. (1999). The Evolution of Psychoanalysis. Contemporary Theory and Practice. New York: Other Press.

Greenberg, J. & Mitchell, S. (1983). Object Relations in Psychoanalytic Theory. Cambridge, MA: Harvard University Press.

Greenwald, A.G.(1992). New Look 3, unconscious cognition reclaimed. American Psychologist, 47: 766-779.

Hirsch, I. (1998). The concept of enactment and theoretical convergence. Psychoanalytic Quarterly, 67, 78-101.

Kihlstrom, J.F. (1987). The cognitive unconscious. Science, 237, 1445-1452.

Kihlstrom, J.F. (1995). The rediscovery of the unconscious. In H. Morowitz & J. Singer & (Eds.), The mind, the brain, and complex adaptive systems (pp. 123-143). Santa Fe Institute Studies in the Sciences of Complexity, Vol. 22. Reading, Ma.: Addison-Wesley.

Kihlstrom, J.F. (1998, August). The emotional unconscious. Paper presented at the annual meeting of the American Psychological Association, San Francisco.

Kihlstrom, J.F. (1999a). Conscious and unconscious cognition. In R.J. Sternberg (Ed.), The concept of cognition (pp. 173-204). Cambridge, Ma.: MIT Press.

Kihlstrom, J.F. (1999b). The psychological unconscious. In L.R. Pervin & O. John (Eds.), Handbook of personality, 2nd ed. (pp. 424-442). New York: Guilford.

Kihlstrom, J.F., Barnhardt, T.M., Tataryn, D.J. (1992). The psychological unconscious found, lost, and regained. American Psychologist, 47: 788-791.

Kihlstrom, J.F., Mulvaney, S., Tobias, B.A., & Tobis, I.P. (2000). The emotional unconscious. In E. Eich, J.F. Kihlstrom, G.H. Bower, J.P. Forgas, & P.M. Niedenthal, Counterpoints: Cognition and emotion (in press, pp. 30-86). New York: Oxford University Press.

Korzybski, A. (1958). Science and Sanity. An Introduction to Non-Aristotelian Systems and General Semantics. 4th ed, Lakeville, CT: International Non-Aristotelian Library Publishing Co.
Levenson, E.A. (1998). Awareness, insight, and learning. Contemporary Psychoanalysis, 34:239-249.

Levenson, E.A. (2003). On seeing what is said: Visual aids to the psychoanalytic process. Contemporary Psychoanalysis, 39:233-249.

Litowitz, B. (2005). When "something more" is less: commentary on the Boston Change Process Group. Journal of the American Psychoanalytic Association, 53(3): 751-759.

Lyons-Ruth, K. (1999). The two-person unconscious: Intersubjective dialogue, enactive relational representation, and the emergence of new forms of relational organization. Psychoanalytic Inquiry, 19:576-617.

Schore, A. (1994). Affect Regulation and the Origin of the Self. The Neurobiology of Emotional Development. Hillsdale, NJ: Lawrence Erlbaum Associates.

Schore, A. (2001). The effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health J., 22: 7-66.

Schore, A. (2002). The right brain as the neurobiological substrate of Freud's dynamic unconscious. In: The Psychoanalytic Century: Freud's Legacy for the Future, ed. D. Schaff. New York: Other Press, pp.61-88.

Schore, A., (2005). A neuropsychoanalytic viewpoint. Commentary on a paper by Steven H. Knoblauch. Psychoanalytic Dialogues, 15 (6): 829-854.

Schwartz. J. (1999). Cassandra's Daughter. A History of Psychoanalysis. New York:Viking.

Shevrin, H. & Dickman, S. (1980). The psychological unconscious: necessary assumption for all psychological theory? American Psychologist, 35: 421-434.

Siegel, D. (1999). The Developing Mind. Toward a Neurobology of Interpersonal Experience. New York: Guilford Press.

Spence, D. (1994). The Rhetorical Voice of Psychoanalysis. Displacement of Evidence by Theory. Cambridge, MA: Harvard University Press.

Stern, D.B. (1997). Unformulated Experience: From Dissociation to Imagination in Psychoanalysis. Hillsdale, NJ: The Analytic Press.

Stern, D.N. (1998). Non-interpretive mechanisms in psychoanalytic therapy. The 'something more' than interpretation. The Process of Change Study Group. International Journal of Psychoanalysis, 79: 903-921.

Stern, D.N. (2004). The Present Moment in Psychotherapy and Everyday Life. New York: W.W. Norton & Co.

Stuss, D.T. & Alexander, M.P. (1999). Affectively burnt in: one role of the right frontal lobe? In: Memory, Consciousness, and the Brain, ed. E. Tulving. Philedelphia: Psychology Press.

Sullivan, R.M. & Gratton, A. (2002). Prefrontal cortical regulation of hypothalamic-pituitary function in the rat and implications for psychopathology. Psychoneuroendocrinology, 27: 99-114.

Tatkin, S. (2006). A developmental psychobiological approach to couple therapy. Cited in: Psychoanalytic Research #2: Progress and Process Notes from Allan Schore's Groups In Developmental Affective Neuroscience And Clinical Practice. Library Paper published online at PschBC.

Westen, D. (1998a). The scientific legacy of Sigmund Freud: Toward a psychodynamically informed psychological science. Psychological Bulletin, 124:333-371.

Westen, D. (1998b). Unconscious thought, feeling, and motivation: The end of a century-old debate. In R. Bornstein & J. Masling (Eds.), Empirical studies of unconscious processes. Washington, D.C.: American Psychological Association Press.

Westen, D. (1999). The scientific status of unconscious processes. Paper presented on June 13, 1999, at the Annual Meeting of the Rapaport-Klein Study Group.

Wurmser, L. (1977). A defense of the use of metaphor in analytic theory formation. Psychoanalytic Quarterly, 46: 466-498.

Victor P. Iannuzzi, PhD

Victor Iannuzzi's training as a psychologist has emphasized both cognitive-behavioral psychology and psychoanalysis. Following completion of a post-doctoral fellowship at Columbia-Presbyterian Medical Center, he received a certificate in psychoanalysis from the William Alanson White Institute.

Following 9/11, he worked closely with the effects of trauma on various populations, including emergency service personnel. In October 2001, he was appointed Director of the Trauma Response Service for the William Alanson White Institute. He is an adjunct staff supervisor in the Columbia-Presbyterian psychology internship program, and is presently in private practice as a psychologist and psychoanalyst in New York City.]]> This essay shared Section V's 2006 Morton A. Schil.... This essay shared Section V's 2006 Morton A. Schil.... http://www.sectionfive.org/?permanent=5.16 root 2005-06-15T04:00:00-08:00 This essay shared Section V's 2006 Morton A. Schillinger Prize

By Todd Essig, Ph.D.

Although some current versions of the posthuman point to the antihuman and the apocalyptic, we can craft others that will be conducive to the long-range survival of humans and the other life-forms, biological and artifical, with whom we share the planet and ourselves.
(Hayles, 1999, p. 291)

In 1953, at the birth of the information age during the interdisciplinary "Macy Conferences," Warren McCulloch, the noted neuropsychiatrist and researcher, and Lawrence Kubie, the noted psychoanalyst, had a fight. Fifty or so years later, during a treatment that radically changed course when digital communications devices entered a patient's life, I had a similar fight, albeit with myself. A closer look at these two clashes between psychoanalysis and the information age, which this essay endeavors to provide, shows how issues first contested in that infrequently cited episode of intellectual history were also present many years later in my own internal struggles as I worked through a 21st-century clinical challenge. Taken together, these similar issues speak directly to the necessity of the unconscious.

As will be discussed, the first issue shared in both fights is the nature of information, what is it and how does it work. In western culture we currently take for granted a definition of information as being an abstract entity that can flow freely across different material substrates. This definition allows us to treat the thoughts in our heads, the songs in an iPod, and the content of your email as all containing the same stuff, i.e., "information." The second issue shared by the McCulloch-Kubie fight and my later clinical struggle concerns the challenges, and anxieties, presented by the reflexivity of both psychoanalytic treatments and cybernetic systems; those back and forth Escher-like shifts in perspective in which that which was observer becomes participant, causes become effects, and inside becomes outside, and then back again. The third and final issue to be discussed is the delicate clinical balance between expertise and humility when confronting phenomena unimagined(able) in psychoanalytic theory and practice: How do we protect our capacity to appreciate newness or difference instead of sinking into a comfortable defensive protection of what we already know? Across all three issues that characterized this pair of clashes between psychoanalysis and the information age, and probably many others, I will be arguing that concepts of the unconscious have a foundational importance. In other words, because of our reflective participation in and attention to unconscious processes, motivations, meanings, and potentials, psychoanalysts may just be able to find a way to meet the clinical challenges the 21st-century will be throwing our way.
There were 10 meetings between 1946 and 1953 of what were eventually called the Macy Conferences on Cybernetics. Organized by Frank Fremont-Smith for the Josiah Macy, Jr. Foundation, it brought together many, if not most, of America's top-shelf researchers, natural scientists, and social scientists "to explore feedback and circular causality," which was the title of the first meeting. They had the tremendously ambitious aim of developing a general theory of communication, even human nature itself. Along with Kubie and McCulloch, the core group of participants included such familiar luminaries as Gregory Bateson, Norbert Wiener, Claude Shannon, Molly Harrower, Kurt Lewin, Margaret Mead, and many others. Fremont-Smith's overarching agenda in organizing the conference was to create a meta-discipline that would help reconstruct post-WWII society. While this did not happen, and towards the end the participants themselves were pessimistic about having achieved anything at all (Heims, 1991), in retrospect we now see they came closer to achieving Olympian ambitions than they could possibly have seen at the time: "The result of this breathtaking enterprise was nothing less than a new way of looking at human beings. Henceforth, humans were to be seen primarily as information processing entities who are essentially similar to intelligent machines." (Hayles, 1999, p. 7). From our vantage point 50 plus years later, the Macy Conferences can clearly be seen as significant events that helped usher us into the information age.

McCulloch was the chairperson of the conferences. Along with his colleague Warren Pitts, he was well known for developing an abstract model of neuronal function known as the "McCulloch-Pitts neuron." This mapped logical processes onto specific, researchable brain functions. In doing so, it moved neuroscience towards the neural-network, information-processing model that has been so productive. His work helped locate mind in digital logic rather than in messy brain tissues.

Kubie, an orthodox Freudian and well-known analyst from the New York Psychoanalytic Institute, was a regular invitee to the Macy Conferences, a member of the "core group." In addition to this being a time when psychoanalysis had a regular seat at the table of culture creation, e.g., Erik Erikson was an invited guest to the 3rd meeting in 1947, Kubie (1930) had published a paper describing neurotic function in terms of reverberating and recursively looping neuronal circuits. He was a logical invite to the core group. However, to the irritation of many of the "hard scientists" and a harbinger of the fight to come, his first paper at the first conference was not about neurotic loops, addressing instead traditional Freudian energy-based explanations for neurosis. Even so, from the very start, Kubie and Freudian psychoanalysis were very much part of what turned out to be these history-making meetings. In fact, the available transcripts of the Conferences reveal (Heims, 1991) that Kubie spoke more frequently than any other participant. But in the fight that developed with McCulloch he lost, and lost big.

Although fevers ran high, it should be no surprise that the fight never devolved into physical violence. These were, after all, serious men engaged with serious business. No punches were thrown, nor was there any brandishing of fireplace pokers. Instead, they fought with increasingly angry papers, reputation-trashing letters, and whispered questions about personal psychopathology. In other words, and as a way to introduce the first issue, they fought, depending on whose side you took, with either information or with ideas. That difference in how the weapons of engagement could be conceptualized, information versus idea, characterized one of their central conflicts: In any act of communication, be it between organisms, across different sectors of a single organism, or between organisms and a digital computing machine, what was the basic, irreducible unit being communicated? Was it information? Or an idea? In the new meta-discipline they were endeavoring to create, was the core content of communication to be the digital precision of decontextualized and dematerialized information, essentially a probability function, or would the analog complexity of fully contextualized ideas carry the day. In other words, how was information to be defined and measured: Was it to be the relative measure of pattern versus randomness within the message or would it be measured in terms of the effect it had on the receiver, be it a person or a device? McCulloch favored the former, Kubie the later. McCulloch clearly promoted the transmission of measurable decontextualized information that can flow freely across different substrates. Kubie was on the other side, highlighting the irreducible centrality of contextualized meaning, including an unconscious context, as the basic entity for the new meta-discipline the conferees were trying to create. From today's vantage point as participants in an information society, one where we surf the web directing bits of information to flow this way or that across the Internet or use ATMs to move money without ever touching paper, we take the first definition for granted. "Information" today has come to mean a measure of the bits in the message. The definition is no longer contested. However, it is important to highlight that the way we now think about what we process with such apparent ease was once a sharply contested issue, the content of scholarly debate, and the starting point for a breach between scholars.

But the fight, as noted, included other issues along with this fundamental difference of opinion about the nature of what gets communicated, and these other issues helped transform it from a scholarly debate into a fight. At the Seventh Macy Conference, Kubie gave a paper titled "The Relation of Symbolic Function in Language and in Neurosis." Hayles (1999), who along with Heims (1991) wrote the histories on which the current recounting rests, cites this paper as the opening salvo in a battle she termed "Kubie's Last Stand." Freemont-Smith, summarized this paper by saying "What Dr. Kubie is really trying to say is that language is a double coding: both a statement about the outside and a statement about the inside" (Hayles, 1999, p. 71). In a direct challenge to the scientific objectivity cherished by many of the participants, Kubie was seen as brazenly asserting that even scientifically objective statements about the world were simultaneously subjective. He claimed that the subjectivity of the scientist/observer, specifically his/her unconscious determinants, was always part of what was being asserted, even as objective scientific fact. He challenged the conferees to accept that the reflexivity of inevitable subjectivity was an unavoidable feature of all communication.

McCulloch, feeling personally attacked by this, retaliated. In a subsequent paper given to the Chicago Literary Club, he tried to rescue scientific objectivity by fiercely trashing psychoanalysis in a paper called "The Past as Delusion." Basically, he described psychoanalysts as a bunch of greedy sexual deviants who used psychoanalytic theory as a way to express personal pathology. Psychoanalysis, but not science as he understood it, really was an expression of the unconscious conflicts of its proponents. He concluded with a warning never to engage a psychoanalyst in theoretical or scientific debate, all that would result would be an interpretation of your resistance.

Kubie, a true-believer, really did believe he was speaking simple, clear truths. So much so that any sharp disagreement really had to have been due to a resistance. Not only was orthodox psychoanalytic theory of 1953 fundamentally and unassailably true, all this talk about information being made independent of substrate was simply a dead end. So, in what hindsight makes appear almost a caricature, Kubie then responded by claiming McCulloch's paper was an example of his pathology, thereby enacting the very criticism that had been offered for why it makes no sense to argue intellectually with a psychoanalyst. However irresistible this was to Kubie, maybe even inevitable given the time and what was at stake, it is also possible to see that McCulloch's humanity made it easy for him. As noted by Alex Andrew, who worked for a time with McCulloch at MIT, in a recent review of a biography of Norbert Weiner, "It was also true that Warren McCulloch was fond of alcohol and had bouts of overindulgence in it" (Andrew, 2005, p. 1287). Thus, after Kubie learned of an episode that was probably related to such overindulgence, Kubie even went so far as to send a letter to Fremont-Smith questioning McCulloch's health, "... in him the boundary between sickness and health has always been narrow" (Heims, 1991, p. 137). Furthermore, in a move that Heims noted would have enraged McCulloch had he known about it, Kubie even tried to have a Boston area psychoanalyst meet McCulloch socially so he could arrange for treatment.

But it was not until the 9th Macy Conference when Kubie gave a paper titled "The Place of Emotions in the Feedback Concept" that the rift became extreme. Hayles states, "he delivered his final presentation at the ninth conference in what sounds like a state of controlled rage" (1991, p. 72). This is in sharp contrast to his demeanor up till then. Heims writes of Kubie, "his patience with hostile comments can be construed as reflecting his psychoanalyst's habit of tolerating every kind of transference from analysands and trusting that the transference will eventually be broken" (1991, p. 125). But by the 9th Conference, his patience was gone and Kubie's participation can be seen to have had the narrative arc of having conducted a failed treatment. In the paper itself he argued that the psychoanalyst's role is to be a "naturalist" who uncovers and collects the facts that are then to be explained by the mathematicians and theorists. In this telling, the psychoanalyst simply gathers the facts of nature. He was arguing, in his "state of controlled rage," that the reflexivity, the irreducible subjectivity found even in scientific assertions, still applies to all, except psychoanalysts! Caught by his desire to authenticate the scientific status of psychoanalytic propositions, Kubie accomplished just the reverse. He lost the fight. As a result, rather than remaining mid-wives in the birth of the information age, we were sent out to the waiting room to talk among ourselves, taking the unconscious with us.

That, in a nutshell, is the story of the McCulloch-Kubie fight. It helped create a tone of mutual animosity between psychoanalysis and the information society still with us today. I want to turn now to a clinical vignette and the three main conceptual issues present in both; the readily apparent need for humility that allows difference or newness to be separate from resistance or defense, the reflexivity of both psychoanalytic practice and cybernetic systems, and the definition of information as disembodied . My intention is to use these issues to understand my response to a peculiar aspect of this case thereby demonstrating, I hope, how terribly much the 21st century needs the unconscious.

Ms. W was a very talented, professionally successful, self-destructive woman prone to dissociative acting out. That aspect of her treatment I will be discussing is how she found what she said was "true love" and changed the course of her life. During the time she launched and then settled into this enduring relationship I found myself, for reasons that will be discussed, struggling with what I later realized were clinical versions of the same three issues noted above. It seems that her life-changing relationship depended on, and would have been impossible without, emerging information technology; the two of them stayed in constant contact using Blackberries, email, and cell-phones. Eventually, after I fought with myself for quite some time, I was able to hear and genuinely believe that this relationship could in fact be the true love she felt it to be, although unlike any true love I could have imagined. The process of this transition in thinking, my own psychoanalytic clash with the information age, required attention to unconscious processes, motivations, meanings, and potentials. Please note that when discussing the unconscious I intend to be inclusive of the dynamic unconscious, the dissociated unconscious (Bromberg, 1998; Stern, 1997), nonconscious implicit relational knowings (Boston Change Process Study Group, 2005), and even the adaptive unconscious of general psychology (Wilson, 2002).

Ms. W had been in treatment for several years when she embarked on this relationship that she eventually described as having found true love. She was someone never able to hold in mind for any length of time anyone's good feelings for her. Without someone there to see her or love her, and do so in the moment, she often felt herself disappear. For her, the time between sessions were unbearably lonely and terrifying. Weekends were an especially empty, painful time she would fill by gouging her hip, or the area under her breasts, with sharp objects, like the raised foil edge of a medication bubble-pack. But never razors since that, she said, required planning she could not do when those states of mind took over.

When she met him on a business trip their relationship started like many others. Her sophistication, financial independence, and movie-star good looks meant she never lacked for male attention, and she sought it out often, typically from men who were obviously ill-suited for her. Usually, after some initial passion or, from her point of view, desperation packaged as passion, she would grow increasingly disappointed and needy. She would start to make unmeetable demands and the relationship would end in fiery and often rageful disappointment. Her fearful emptiness would always get its revenge. But with Mr. M the good part did not stop. It spread over several encounters while they were each on the road. Months went by and the relationship continued. Then a year. She began reporting new feelings, saying she felt him with her always, always wanting her, always being there for her, always wanting her to be there with him. It was true love, soul-mates. She reported a new feeling of missing him, of being lonely rather than terrifyingly alone. The cutting decreased and then stopped. In describing her state of mind she at first said she felt happy for the first time but corrected that, she had often been happy. What she said was new was that she could remember feeling happy, of feeling safe with him, even when she was not feeling that nor being with him. Some of the gaps in her experience were getting filled in. She even reported in session that she began to feel what she called "emotional links," in contrast to more intellectual, cognitive ones, between her mother's profound, psychotic (and often untreated) depressions, and her own difficulties.

But he was a married man 20 years her senior who lived in another city. He was also troubled, or so she said. Fiercely bright but with a profound history of what she called ADHD, he achieved significant success as a commodities trader and used that success to leverage an extraordinarily successful business. Business was the only place, before her, she said he was able to feel good about himself. When he satisfied or soothed her, she said he felt good about himself. The better she felt, the better he felt. Since they both traveled for business they were able to meet every 2 to 4 weeks or so, sometimes less frequently, sometimes more.

I was quite perplexed as this relationship began to gather importance. I was initially unable to hear either its importance or its potential value, actually fearing she was heading into some sort of catastrophe. It was while I was warily listening that their practice of constant digital contact grew in significance. From almost the beginning, they actually started this practice after their second chance encounter while on the road, they were in constant, and I mean constant, contact using their Blackberries, email, and cell-phones. They exchanged hundreds and hundreds of messages a day. Although they could sometimes go several days without being on the phone at the same time or go several weeks, or even a couple of months, without seeing each other, they rarely went longer than 30 minutes or so without some sort of message, be it email, texting or voice-mail. Some of the messages expressed love, others support. But most of them were more descriptive reminders to the other that the other was there. They would describe the minute details of life such as "going 2 meeting" or "on the bus" and the other would send follow-up questions about the meeting or bus ride, or just describe where they were and what they were doing. Even when there was content, contact was most salient.

There was even a technological dimension to their in-person encounters. When they would meet, even several years into the relationship after his divorce when they had become each other's main relationship, although still living in different cities and seeing each other 2 to 3 weekends a month and on vacations and holidays, Viagra played a significant role. Because Viagra was always a possibility she claimed she never feared him disappointing her, nor did he fear disappointing her thereby reducing what she said were his chronic fears about performance. Whether ingested or not, they used the Viagra to help make each of them feel more comfortable.

As I began to hear the significance that this technologically-mediated relationship had for her I found myself pulled into an internal struggle over how to listen to her. I was starting to fight with myself. My listening and thinking lost a familiar quality of flow, a back and forth between and within participating and observing. Judgemental thoughts kept getting in the way. On the one hand, the relative absence of direct, embodied interaction inclined me to see this not only as a defensive relationship, but a diminished one. Was this a pre-depressive caving-in to what had been a promising but troubled life? I wondered if this coupling was merely a feel-good drug, a "crack-berry" addiction to use some cyber-slang. I was always fighting with the thought, "have something 'real,' don't settle for a simulation!" But I was also fascinated, intensely curious watching those digital sutures hold together a wounded psyche. And she did not have a problem with it, and by all appearances was starting to thrive. Eventually, and thankfully before I started to (mis)interpret a defensive function for this relationship, my judgmental responses lost. I was finally able to realize that this relationship was indeed something real, although a new kind of real. In retrospect, in a way that I will now delineate, my internal fight to find the "new real" in this treatment required me to engage each of the three issues identified in the McCulloch-Kubie fight. But unlike that clash of psychoanalysis with the information age, thinking about the unconscious enabled a different outcome, one in which I believe neither the patient nor I lost.

The first issue I will discuss is that of striking a psychoanalytic balance between humility and expertise when confronting the unimagined, something clearly present in both fights. It would be all too easy in situations such as this one to adopt an anti-technology stance and romantically harken back to an idyllic time of green pastures (Edwards, 1996); back in the garden we could once again be unalloyed experts. We could be like Kubie at the start of the Macy Conferences, comfortably interpreting disagreement as resistance. Then, we would not need to feel how deeply our world is changing. But it is. We are part of a species that has created and built these incredibly powerful tools and, in a process called by some "radical evolution" (Garreau, 2005), we now live in a world in which these tools are re-making us. While radical evolution sees the tools we make remaking human nature, through developments such as neural implants, performance enhancing drugs, and modifications to the human genome, others argue (Clarke, 2003) that being re-made by our tools is what human nature is. For a clinical psychoanalyst this difference is slight, as slight as the difference will be for us and our work between the current situation of Ms. W and her Blackberry and the next generation of neurally implanted communications devices.

I came to see that there are two parts to striking a balance when confronting these new possibilites made real. First, we have to be open to the possibility that we actually are seeing something new and different. Our initial challenge is to see new technologically-mediated modes of experience and relationship in their own terms, and not automatically see them as diminished or shadow versions of the familar. Even frequent letter writing, like the relationship between a breeze and a hurricane, is just not the same as Ms. W's moment-by-moment digital contact. But that is not nearly enough. We then have to hear the meanings a new technologically-mediated mode of experience or relationship has in terms of its unconscious resonance. That is where we as psychoanalysts can bring something unique to the table. It was only when I was finally able to grasp what Ms. W and her now husband were doing with their Blackberries was I able to begin appreciating its healthy, progressive qualities.
As an example of a contrasting unconscious resonance to a new technologically-mediated experience, consider a man I was treating at the same time who had developed a powerful attachment to Internet pornography. He'd spend hours every night in Internet "peep shows" and interactive video services. Like Ms. W staying in constant digital contact, this was also a "new real" and it needed to be apppreciated in its own terms. But though it too was something new, the unconscious resonance was far different. This was a practice that led him to diminished, decreased contact with other real, live-bodied human beings: Why bother with the risks of another person, even one paid to perform, when you have a sure thing flickering there on screen that can get you what you want? Even from this bare sketch, I hope you agree his "new real" really was quite defensive and diminished, even though there was neither more nor less technological mediation. The difference is found in the unconscious resonances of these two different "new reals," one embraced embodied humanity facilitating growth while the other celebrated a schizoid, disembodied withdrawal that made stasis soothing. As technology continues to develop as it will, some say at an exponentially accelerating pace (Kurzweil, 2001), psychoanalysts will need to stay anchored in our ability to hear the unconscious resonance of new experiences, to hear both the human and the antihuman in the "new reals" that will be emerging. In this way we can best help our patients move towards expanding rather than diminishing their embodied humanity as we weather together the technological storms ahead.

Reflexivity, the second issue found in both fights, posed a specific challenge during Ms. W's treatment: How to work within the familiar reflexivity of a psychoanalytic treatment relationship when it gets invaded by an alien, digital component, or at least something that feels like an invasion? Like Escher's drawing of the right hand drawing the left drawing the right, her treatment was facilitating her engagement with new experiences which were facilitating the treatment. Like all reflexive moments, that which was creating the experience could be seen from another perspective to be part of the experience being created. But my thinking along this familar arc kept glitching: I was not sure I wanted to be part of all this technological mediation. It was new and different and it made it hard to work along familar paths.

Providing psychoanalytic care is so familiarly reflexive that, like the air we breathe, we do not usually notice it, unless its particularly sweet or malodorous. Depending on theoretical tradition, and I do not mean to blur the real, substantive differences among them, only to follow the thread of reflexivity they all share, we are professionally comfortable thinking through the figure-ground shifts of an interpersonal or intersubjective field, a relational matrix, the multiplicity of multiple-function, or the hyphenated coupling of transference-countertransference. But with Ms. W there was something in the air and I kept getting stuck trying to switch from figure to ground and back again. I just had no way to think about the apparent power of her digitally-mediated connections, and I was not sure I wanted to be part of it. In exactly what would I be participating? My fight was unlike Kubie and McColloch who were fighting to maintain observational platforms outside the systems they studied, and then fighting because their platforms were incommensurable. My problem with reflexivity was not that I lacked an observational platform that allowed me to stand outside the system. I was not trying to do so. Rather, recognizing my inevitable participation in the system of relationships and experiences under consideration, I was not sure I wanted to be part of what was taking place.

What I eventually came to realize, and what enabled me to once again embrace being a participant, was that given her obvious and evident problems with dissociation and self- and other-representations, the constant digital contact was functioning like an unconscious prosthesis, holding for her that which could not be held in mind. It did not even need to be a transitional activity, a step towards mentalization and healing, any more than an artificial limb is a step towards growing a new leg. Rather, the movement is towards integrating the prosthetic, the point at which "it" becomes "my leg" or, in Gregory Bateson's frequently discussed example, noticing that eventually the cane becomes part of the blind man. Like the increasingly familiar interaction in which someone says "Yes, I know the address" only to then take out their Palm Pilot and use that cognitive aid as an extension of personal memory, an extension that feels and becomes part of self, Ms. W integrated her prosthetic into the functional organization of her unconscious life. In studying problem solving, memory, judgment, and other functions of mind, many cognitive scientists (Clarke, 2003) now see mind as distributed rather than locked within the brain of any one individual. What Ms. W reveals is that unconscious mental life can also become distributed across information processing tools. The functional organization of Ms. W unconscious mental life now included a digitally mediated connection, a phenomenon whose frequency of appearance in our psychoanalytic offices is likely only to increase.

However, even attuned to the life-affirming unconscious resonance of her "new real" and open to the possibility of her integrating an unconscious prosthesis into the functional organization of mental life, the third and final issue of disembodied information was still a powerful irritant in my experience. In fact, this issue seemed to make my resolution of the other two issues into convenient fictions simply because the nature of their contact contained so little of that freely-flowing informational stuff. After all, how could communications that contained so little information, 10-12 text characters, orders of magnitude less information than a picture or the sound of someone's voice, have such a huge impact on someone's life? Even if we take all the information transmitted during the course of a month, lets say 10 or so messages an hour for 12 hours a day for a total of 3,600 messages a month, we would still have significantly less information than that which would be conveyed, for example, in a single 15-minute telephone conversation. There they were, two people spliced together into a single circuit by communications technologies that allowed information to flow freely, and there did not seem to be enough information to account for the massive effects that were seen. There were just not enough bits for the bite. Once again, this time using the conceptual tools of the information society in which I too am a participant, I was being led to see Ms. W as someone engaged in a diminished activity.

What was missing in my thinking at this point was part of what Kubie lost in his fight. Not the belief that we as psychoanalysts have an Archimedean platform on which to stand, nor the perhaps well-intentioned judgments of difference as other people's pathology, but the basic idea of attending to the functional consequence of information, not its abstract measurement. Even though he lost and our information society has been productively built from a definition of information as disemobdied and dematerialized, it is still the idea, including the meaning given to it by its unconscious context, and not just the information that matters. When it comes to the richness of experience, bandwidth is not everything. Perhaps this was a tangle I should have been able to more easily avoid. But if so, my sense is that many of us are starting to struggle with the clinical implications of these new forms of relatedness and new modes of experience. In that struggle, I want to offer a simple reminder that even in, to use the off-putting but commonly used terms, the most cyborgian or posthuman encounter, like true love growing in the soil of text messages and pharmaco-passion, what we can do as psychoanalysts is attend carefully to the personal and immediate unconscious meanings, motivations, processes and potentials. In fact, I believe, harkening back to the quotation from N. Katheine Hayles I used to introduce this essay, we have a responsibility not just to our patients but to our species to do just that.

References

Andrew, A. (2005). Book Review: Dark hero of the information age: In search of Norbert Wiener, the father of cybernetics. Kybernetes, 34-7/8, 1284-1289.

Boston Change Process Study Group, (2005). The "something more" than interpretation revisited: Sloppiness and co-creativity in the psychoanalytic encounter. JAPA, 53-3, 693-729.

Bromberg, P. M. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: The Analytic Press.

Clarke, A. (2003). Natural-born cyborgs: Minds, technologies, and the future of human intelligence. New York, NY: Oxford University Press.

Edwards, P. N. (1996). The closed world: Computers and the politics of discourse in cold war America. Cambridge, MA: MIT Press

Garreau, J. (2005). Radical evolution: The promise and peril of enhancing our minds, our bodies--and what it means to be human. New York, NY: Doubleday.

Hayles, N. K. (1999). How we became posthuman: Virtual bodies in cybernetics, literature, and informatics. Chicago, IL: The University of Chicago Press.

Heims, Steven J. (1991). The Cybernetics Group. Cambridge, MA: The MIT Press.
Kubie, L. (1930). A theoretical application to some neurological problems of the properties of excitation waves which move in closed circuits. Brain, 53, 166-178.

Kurzweil, R. (2001). The law of accelerating returns. Downloaded 2/3/06 from http://www.kurzweilai.net/articles/art0134.html?printable=1 .

Stern, D. B. (1997). Unformulated experience: From dissociation to imagination in psychoanalysis. Hillsdale, NJ: The Analytic Press.

Wilson, T. D. (2002). Strangers to ourselves: Discovering the adaptive unconscious. Cambridge, MA: The Belknap Press of Harvard University Press.]]> By Sally Bloom Feshbach, Ph.D. Emerging from a .... By Sally Bloom Feshbach, Ph.D. Emerging from a .... http://www.sectionfive.org/?permanent=5.18 root 2004-11-20T04:10:00-08:00 By Sally Bloom Feshbach, Ph.D.

Emerging from a taxi in front of the radiology center, I naively stepped into the waiting arms of my handsome leather-jacket clad husband. "Honey," he said, enclosing me in his strong arms, "what I am about to tell you will change your life forever. I'm so sorry!" Those words, harbingers of his mortality, ushered in our new life, and from that day forth, this paper began germinating. How do two therapists, long-time best friends and students of separation and loss, prepare themselves for death?

A fatal diagnosis catapults the entire family on an unwanted journey of unrelenting incremental loss. One day, a once-active father no longer drives his children to school; the next, he can no longer rouse himself early enough to see his first-thing-in-the-morning patients. Before long, he no longer fills the car with gas, or attends nonessential professional meetings. Eventually, the unremitting need to rest and conserve precious energy results in a family dinner hour that converges upon the children's bedtime, and the careful selection of appropriate, and hopefully temporary, substitute therapists for each long-time patient. And by the time three years and thirty-six chemotherapies have been completed, the lengthening silence in the office next door to mine becomes an accustomed reality. Each small change in our familiar long-time routines was screamingly loud to me, attuned as I was to loss. And with each small change, I actively mourned. I cried, I got angry, I distracted myself, I sought comfort, I adjusted. My professional focus on separation, loss and life transitions was coming in handy, in a situation I never imagined I would confront.

Resistance and Catharsis

As therapists we all are well-practiced at identifying our feelings and voicing the unspeakable. But the harsh vocabulary of shock, rage and despair made its way beyond my and my husband's psychotherapy offices, and became our stock-in-trade each night, when the children went to bed. These regular "sessions," in which we consciously worked at dealing with our feelings, became an indispensable help in allowing us to clearheadedly face the daily challenges and to function in somewhat "normal" fashion. I developed a deeper appreciation of defenses—both the vigilant need to maintain their insulating cushion against intolerable affect, and their shocking fragility. I gained better insight into resistance. When a patient had difficulty voicing memories of her mother's suicide, and both of us knew that anger at her mother was the source of her rudeness toward her supervisor, I had renewed empathy for the patient's conscious desire "not to get into it." I now know better how it feels when you think your tears will wash you away, when it hardly feels worth it to express anger when you know that protest will bring no tangible improvement. But I also know first-hand that when you do force yourself to listen to your children's wrenching sense of longing, when you join them in cries and rage, when you are able to allow others to bear witness to your pain, the burden in your heart ultimately grows lighter to bear. Sometimes you must consciously avoid your neighbor, whose expressively sympathetic eyes automatically cause your own eyes to tear, despite your best intentions to control yourself. And sometimes you must consciously force yourself to cry, because you know all too well that your irritable mood is the result of the social gathering you attended alone. As a therapist who has lost a beloved spouse, I am both more empathic toward resistance and more certain of the necessity of relentlessly engaging in the internal struggle to combat it.

Humility

Battling an almost-certainly fatal illness and an equally horrendous treatment process brought me to my psychological knees. There is nothing like a devastating medically un-understood cancer to smash one's omnipotence. It is truly humbling to realize that there is no magic medicine, no omniscient doctor, no loving parent to fix everything. When the person you usually can turn to is the one requiring rescue, the sense of aloneness is acute. My own diligent and determined efforts—former guarantors of good grades, well-adjusted children and successful psychotherapy outcomes—could no longer be relied upon to save the day. Like all of us, I was accustomed to defining myself as a healer, a helper of others, a tackler of problems, a battler of pain, adversity and demons, in whatever guise they presented. This self-view, long shared with my therapist husband, remained a valuable resource in our struggle. But my abiding sense of self faced severe challenge. Clearly, I had to grow and change, or falter badly. The sense of weakness that came along with allowing others to make us dinners, drive our carpools, and sit with my husband during his innumerable lonely hospitalizations, was initially humiliating and difficult to bear. Depending on others for so much help at first highlighted my eroding sense of agency, formerly so crucial to my self-perception. But gradually, and remarkably, depending on others and truly taking in their generous, selfless, and loving care and concern actually began to help me feel stronger and less alone. The sense of being held tenderly in a community of friends, new and old, cast dependency and self-sufficiency in a new light. I felt more kinship with the simple experience of being a mortal human making my bumbling way in this fragile world, appreciating the privilege of breathing fresh air. A surprising sense of fortification emerged, as I grew more comfortable with accepting help and embracing our own small place in the march of humanity.

One particular experience brought this reality home to me. A young friend who had traveled in Tibet and met with Buddhist monks practiced in healing offered to lead me in a meditation. Trusting my friend, and open to all that might help me find peace of mind, I agreed. The meditation entailed imagining all of those around the world who were suffering in a similar way to oneself. We then allowed ourselves to take in, to really feel, the magnitude of that suffering. This aspect of the meditation was excruciatingly painful, as the thought of all the children losing parents, all the wives losing husbands, and all the husbands losing everyone was almost overwhelming. We were overcome with emotion. Finally, we offered our own loving and healing energies to all those who suffered as we did. This experience was incredibly powerful and inspirational. My own family's sadness came to feel less personally tragic. In addition, it felt good to be reminded of the needs of others, and to feel grateful for my many blessings.

Accepting more graciously the help of others shattered the arrogance of being a helper. My experiences further reinforced changes I had made over the years in the direction of truly embracing a two-person psychology. I saw quite clearly how all experience, in the therapy office as in the rest of life, is co-created. As my appreciation of the layers of relatedness deepened, the unconscious vestiges of arrogance that accompanied a sense of myself as therapist/helper/authority began to melt, giving way to a truer embrace of how the wholeness of the two people in the therapy office together shapes every communication. For someone like me who defensively enjoys a sense of control, the grieving process has been a good and steadfast teacher. One learns to control what one can—make sure your hospitalized loved one has someone with him to prevent and correct medical errors, and play an active role in deciding among treatment options. This applies in the work realm as well—seek supervision or consultation when you need help, and don't be afraid to set boundaries that feel comfortable to you. One also learns to relinquish control—no amount of wishful or magical thinking can alter a blood test result. And when a psychotherapy patient remains seemingly mired in a destructive relationship, that is something to come to understand, not something to remedy. The New Age health literature can prove inspiring to those suffering from awful maladies, but the popular notion that positive thinking and visual imagery can cure virulent malignancies has its limits. The longing for control that underlies this perspective can lead to unnecessarily painful self-recrimination.

Regression and Hope

Perhaps the most surprising and certainly the most wonderful legacy of my husband's illness and eventual death was a renewed hopefulness and optimism. These powerful feelings have stayed with me both personally and professionally during all of the phases of my mourning process. I have always held the view that while we cannot necessarily control the bad things that happen to us in life, we are free to make of them what we will. Indeed, one of our major goals as therapists is to help our patients experience a broader range of choices. The psychoanalytic process is designed to help free the psyche of long-held restrictions on functioning, restrictions that inhibit our ability to experience the range of choice that can permit us the fullest actualization of self. In confronting my husband's illness, my choice was clear—it was better to search for meaning in the lessons offered by our situation than to regress into helplessness, bitterness or depression. My long-term therapeutic stance that life should be lived to the fullest, that one must consciously strive for the most happiness possible, took on renewed significance. The battle against despair and anxiety, no matter what the history or circumstances might be, was not only worth waging, but winnable. I was determined not to return to the depressive tendencies that characterized my personality before my own psychoanalytic journey. I was more grateful than ever for my good fortune in having been a psychoanalytic patient myself. The liberating effects of my own treatment—a lightness of spirit, an ability to be assertive, and a greater tolerance for anger and conflict—were, along with the support of my family and friends, my greatest allies in coping with daily disappointments, the relentless rollercoaster of ups and downs, and a newly grueling schedule. Being a therapist also helped me understand that the process of working through difficult affect is itself worthy of respect. This perspective helps me remain patient with my and my children's ongoing struggle with grief and mourning. I remind myself to learn from and cherish the process of growth and understanding, not just to seek its end.

Clinical Work

You may be wondering what it was like to continue my practice amidst the difficult circumstances at home. I have always loved working as a therapist, and during this time, work was generally more of a refuge than a stressor. I tried to keep my practice as stable as possible—for my own sake as well as that of my patients. Fortunately, until the very end of my husband's illness, I was able to plan ahead for his treatment needs, with lots of help from family and friends. The painful emotional processing we both engaged in so determinedly helped me feel, for the most part, clear-headed and able to focus on my work in the same way that I always had. The regularity of the therapy process and the familiar relationships with my patients provided a welcome respite from the stresses and anxieties of my husband's illness. It was a relief to focus on other people's problems—helpable problems—and to think of myself as a therapist and not as a mother facing early widowhood.

The only change I made in my hours was to stop work earlier on the one day my husband had previously spent with the children after school. This necessitated shifting a few appointment times. For one long-term three-times-a-week patient, this meant losing his late-afternoon time, which had fit beautifully into his own schedule. I offered 'changing family responsibilities' as the reason for moving his appointment time. He was furious, and we spent many hours analyzing the intrusion of my needs into his treatment and his resulting feelings of powerlessness and unimportance. As it had been difficult for him to express affect untempered by intellect, this incident proved useful in our work. Three years later, after he became aware of my husband's death and surmised the reason for the appointment change, he felt ashamed of his earlier resentment. That too provided a fertile opportunity for therapeutic work, as he came to appreciate that he had been entitled to his feelings regardless of my circumstances, and went on to analyze the origins of his shame reaction.

Toward the end of my husband's illness, my schedule was briefly more disrupted, as health emergencies became less predictable. For one of my patients, a middle-aged daughter of a schizophrenic mother, with whom I had worked for only a few months before my husband's condition became less stable, a last-minute cancellation by me was clearly problematic. Realizing that I could no longer promise to be as reliable as I had always been, I decided to offer her three options. I told her that I was experiencing a temporary family circumstance that might necessitate other unplanned cancellations. I went on to say that I could see that this was not optimal for her, as she needed not only to be able to depend upon my reliability, but found it hard to contain her feelings when she was anticipating our planned session to work on them. I proposed three options: 1) she could transfer to another therapist, whom I would help her find, 2) we could suspend our sessions for three months and then reevaluate, by which time I felt I would better know about whether I could resume working with her in a more predictable way, or 3) we could continue working as we had been, with the understanding that I could no longer be certain that I would not have to cancel unexpectedly. The patient was very grateful for my straightforwardness and for my appreciation of her historical sensitivity to unpredictability. She chose to suspend meeting for three months, by which time my husband had died and I had resumed my accustomed predictable schedule. This patient never inquired into or became aware of my husband's illness or death, and our work continues to proceed very productively.

When my husband died, I called each patient myself, canceling my appointments for three weeks. I felt this would give me time to be more available and clear. I cited the reason for my cancellations as a "loss in the family." Several people expressed their sorrow, and no one asked me the nature of the loss. Once again, each person received and reacted to this information about me in his or her own way. Several read my husband's obituary notice in the newspaper, and a few attended his funeral. All of those who knew I had lost my husband wrote me loving and very touching notes of sympathy during our hiatus in meeting. Another contingent of patients never knew, never inquired, and resumed their therapeutic work where it had left off, reflecting only on the hiatus in treatment.

Reactions among those who knew varied. One long-time patient could not believe I had made the call to her myself, and allowed herself to acknowledge for the first time that there was a positive affective link between us, and that it went both ways. Never having felt that she mattered to those she loved, she was startled to find that I had thought about her in the midst of my grief. Most patients expressed shock at not having been aware of my husband's illness, and gratitude that I had continued to maintain empathy and concern for them during what they realized must have been a very trying period in my own life. More than one marveled at the blind eye they had turned to the signs of his illness, such as the quietness in the shared waiting room. For one man, this observation gave rise to reflection into his own self-absorption, long noticed by his wife, but never before appreciated as an aspect of himself.

My grief, such a visceral reminder of my vulnerability, elicited a range of reactions. For some, the desire to comfort and take care of me felt empowering or representative of our shared humanity; for others, it was a burden and a resented distraction from their own concerns. For some, my so-called 'steadfastness,' 'resilience,' or tendency to 'make lemons into lemonade' seems to provide hope and inspiration; for others, it increased a tendency to idealize me and diminish themselves, or to see me as arrogant and unreachable. One woman in particular was enraged that I had not told her that my husband was gravely ill. Four years later, this issue reemerges from time to time, as she calls me a phony for keeping such a "secret." I have wondered, both privately and directly with the patient, about whether I should have told her that my husband was ill, knowing how hard it has been for her to trust me. It is possible that I chose to maintain the boundary with her in a futile effort to protect myself from her easily-flared rage or wishes to merge, which may have felt too much for me at the time.

The discussions I had with patients openly grappling with their own reactions to my husband's death shed light on the striking lack of curiosity exhibited by others. I believe that some of my patients simply could not allow themselves conscious awareness of my loss. Such knowledge might have made it difficult for some to continue to give themselves free license to work through issues of their own, feeling that my loss of a spouse in the prime of life made their own problems seem relatively insignificant. 'Not knowing' about my loss, they need not wrestle with guilt evoked by worries about the wish to focus on self. This stance also spared some patients the need to struggle with conscious ambivalence about assuming a solicitous stance in regard to me. Our accustomed roles could be kept intact, and our relationship could proceed unencumbered by the tumultuous events in my life. For some patients, especially those wrestling with mourning of their own, it was important to maintain an image of me as steadfast and solid; might I be too sad to bear any further sadness that a patient might need me to absorb? My attitude was to accept each individual's own way of reacting to and processing my circumstances. As in any clinical situation, this knowledge enhanced my understanding of the person. For many patients, the sadness, selfishness, love, mutuality, ambivalence, and uncertainty about roles stirred by my husband's death offered a powerful opportunity for learning about themselves that deepened the therapeutic endeavor. And for others, these issues were best left to be dealt with at a more appropriate time, governed not by a timetable set by my personal circumstances, but by the patients' own developmental needs. As I stand back from my practice, I feel that, on the whole, my ongoing struggle with loss continues to make me more accessible and attuned to the inner lives of my patients.

I also ask myself how my own mourning process has been affected by my patients' reactions to my life circumstances. In any given session, I may experience a direct stirring of my own feelings, as a patient seeks to discuss the meaning of my loss to them. Accustomed to privacy and self-containment, I have had to adjust to some patients' need to process an aspect of my own life that, at least at first, was quite raw and vulnerable. Sometimes it is a relief not to think at all about my changed circumstances, and to remain relatively detached. But at other times, it is a relief to be able to be more 'real.' Certainly there are moments in which a patient's empathy summons a quiet tear to my own eyes. Such instances have helped me mourn, providing another mechanism for processing loss in small, manageable doses. As I 'switch gears' in tune with my patients, my defenses have become, of necessity, more flexible. Not only do the well-practiced tools of our profession aid my mourning, but the very experience of functioning as a therapist facing personal loss helps me master my grief.

Concluding Thoughts

I will leave you with a few other lessons that have stayed with me as a result of struggling with the loss of my husband. I deeply regret all of the many hours I spent worrying—worrying primarily about what the future would bring. Our textbooks tell us that the function of anxiety is to signal danger. Anxiety that alerts us to take action that will protect us and truly forestall negative consequences is obviously useful. So, anxiety that directs us to buy disability insurance or seek a second opinion is likely quite valuable. Beyond serving this 'signal function,' anxiety serves only to upset us. Would that I had had the wisdom to save all the time and emotional energy I wasted on worrying about my husband's ill-health, and had invested equal energy in enjoying more wholeheartedly the time our family still could spend together. So, for me, the lasting lesson is not to focus too much on fears, until they actually come about. Hand in hand with this realization comes an appreciation of the virtues of distraction. There is a time for processing emotion, and there is also a time for putting upset aside, and living completely in the moment. Having truly limited time brings this lesson home.

And, finally, as therapists we often tend to neglect our own needs and more naturally gravitate to ministering to the needs of others. But one can only be a fully
available caregiver when one's own limits are acknowledged. Whether caring for a sick parent, child or spouse, we must try to be honest with ourselves about our own capabilities. For therapists, this may mean curtailing our schedules, being more careful about the composition of our practices, seeking support from friends, colleagues or therapists, and, finally, remembering always to identify our own needs and to nurture ourselves.]]> By Fern W. Cohen, Ph.D. Some time in the fall, .... By Fern W. Cohen, Ph.D. Some time in the fall, .... http://www.sectionfive.org/?permanent=5.19 root 2004-11-20T04:00:00-08:00 By Fern W. Cohen, Ph.D.

Some time in the fall, our youngest child Josh came home for his first weekend since we had left him, somewhat forlorn (both he and we), a freshman at college. For me, his departure had been the most poignant and difficult of three, heralding as it did an end to the period of mothering that had given me such a strong sense of self and fulfillment. Now Josh was back, casually dragging along a monstrous duffle stuffed with a two-week accumulation of laundry as he entered the apartment. This was not, he said, an unusual time span but one that he had determined would be manageable between washes, an idea he had floated the previous summer when he and I had shopped for clothing and necessaries for school. That he had even thought about that aspect of life away from home was quite in character with this most organized of our children, although I thought I might have detected a touch of sheepishness when he said it was quite by chance that the opportunity to do the wash had coincided with his first trip home.

At least seventy five pounds worth of opportunity.

For me.

And why did my heart surge with joy on this glorious Saturday morning at the prospect of beginning what looked like seven loads of laundry, possibly eight, if one carefully sorted the lights from the darks and kept the shirts separate from the rest? Certainly not because I had won out over our housekeeper whose responsibility the laundry usually was. Josh had not, in fact, asked me to do it. Yet it was mine for the choosing and I was shameless in seeking it out. Just the same, I found myself hoping that any omniscient feminist conscience-keepers would be involved with more serious matters than whether or not I did the laundry since I was sure that I was violating some major code, and with considerable glee at that.

Of course, our other two still occasionally brought their laundry home, most recently, our oldest Elizabeth. Several weekends before, she had brought four full shopping bags to our country home, while Seth, off to travel before starting law school, had left a mountain of clothing on the floor of his room that definitely was not suitable for Africa. He had pointed it out while packing and said he'd "get to it sometime in the late spring or early summer," whenever he returned. However, Elizabeth and Seth were then at different stages and we had dealt with their comings and goings around other matters and in other ways. Josh's duffle of laundry clearly had ancient roots.

To me, it was unmistakably a contemporary version of the soft, pink pillow that had originated with a purple velour bathrobe I had worn when Josh was small. A memory is vivid and poignant: Josh and I are in his room, he, a pudgy eighteen-month tornado suddenly run out of steam; he moves next to me, takes a fold of my robe, strokes it, puts his fingers in his mouth (always the two middle ones) and tugs me towards the crib, signaling that he is ready for a nap. This was a welcome moment, for with the other two children I had often had difficulty deciphering fatigue. But Josh's signals were unmistakable, and when I made him a small velvet pillow in lieu of my bathrobe, he adopted it immediately with intensity and devotion, labeling it at once his nice 'n' soft. And it was.

He used it sparingly and specifically, only when he was ready to take a nap, for from the moment he had learned to crawl, trucks and blocks and motion and noise had been Josh's style. Before that he had been a quiet and easy child whose first year had been a gentle settling in to the orchestration of a quite active and contrapuntal family where the older two had always fought sleep. But now when he became tired, Josh would stand solemnly and quietly by his crib, holding the bars with one hand, the nice 'n' soft between thumb and forefinger of the other, sucking the middle fingers until I came to lift him in. It was a feat of coordination, those hands and fingers signaling me, and impelling him to sleep.

Soon Josh fought it as well, quickly joining the other two in their night time rituals of books, back-tickles and drinks of water—a team of sleep dodgers with the goal of staving off the end of day. Even then, Josh retained his nice 'n' soft. The original had long since been worn to shreds, but, surprisingly, he had accepted replacements as long as they were more or less the same size and soft, pink velvet. Of that there was plenty, a remnant from the matching long skirts I had made for Elizabeth and me to wear at a party soon after Josh's birth, hardly offering the same comfort for her that his nice 'n' soft would give him. Perhaps there could be little or no comfort on the arrival of yet another sibling in her life.

I don't remember when Josh relinquished his nice 'n' soft, but it must have been when toddlerhood yielded to boyhood. Of course, bedtime rituals remained, with each child retaining some unique form of protest. Josh's was (after the last book was read and the absolutely last tuck-in had occurred), "Come and check in fifteen minutes." Check what, I sometimes wondered: that he was still there and hadn't disappeared? show him that I hadn't? say one last good night? At odd moments, it seemed that "checking," though never defined, might be another expression of his developmental push and pull.

As Josh got older, I continued to find vestiges of his nice 'n' soft as well as other signs and verbalizations of his increasingly complex feelings about me and our relationship. While our other two had gone through similar stages, with Josh the signs were more apparent. He may have been more articulate or perhaps I was more attuned to his attachment and separation because he was, after all, the last of the three. He had been the child I had had to have, a surprising and insistent need despite my husband's practical concerns and reminders that we already had a girl and a boy in whom we delighted. But my wish for another had been beyond reason.
Thus it seems likely that my attunement to Josh's comings and goings was more acute or perhaps I looked for signs that confirmed the rightness and inevitability of having him. There are moments that "flash," stunningly accurate reflections of his developmental milestones. Had Josh read the book, I wondered, that told him how and what he was supposed to be going through?

Once, he and I, crossing a street, were holding hands in a moment of companionship. Seemingly from nowhere, he, a six- or seven-year-old asked, "Do you think the reason I love you just a little more than I love Daddy is because I grew inside you for nine months?" What to answer when I was blown away by a kaleidoscope of thought and feeling. Delight that he loved me even a little more, guilt that I was delighted, knowledge that Josh would have to relinquish me for someone else. . . .

And the sheer diplomacy of the little bit more love that he felt for me.

I can't remember what I said for it seemed impossible to articulate anything as succinct as his question that condensed the weighty theme and the issue of a small boy's place in the triangle with his mother and father. The nice 'n' soft was easy: that had to do with Josh and me; his question was complex and bittersweet. Along with my joy, it reminded me that I couldn't hold on to him, that I couldn't fix him in that place of loving me "just a little more than Daddy," for already entwined with expressions of closeness were his growing assertions of separation and independence.

One day, when I was taking him to school on the subway, we had started by sitting together. At the first stop however, Josh had moved to the far end of the car, clearly relegating me behind. I watched his serious face as he stood, holding a pole for balance, announcing with his entire body that he was an independent person traveling on his own, a person unaccompanied by anyone who might resemble a mother. But not quite. At eight years (more or less), the independence lasted for six stops. By then, the car had become crowded and I was lost to Josh's sight; he began, ever so slightly, to panic. So I moved just enough for him to notice me, a visual touch, and he, reassured, continued alone to our stop where we again became traveling companions, walking and talking our way to school.

For me, immersed in these moments, there was often the rueful awareness that they would become less frequent, more buried in the underground of Josh's passage through boyhood. By adolescence, I expected the vestiges of attachment to be well concealed, obscured by denial and declarations of independence along with assertions of difference. Indeed, despite the combined objections of my husband and me, Josh had determined to play football in high school. I, particularly, had no use for football, seeing in it a barbaric acting-out of aggression through brutal body contact, although, admittedly, it was in milder moments also a bonding of brothers in some odd mix of tenderness. Camaraderie notwithstanding, I particularly tried to take a firm stand because I feared its dangers. But Josh had been passionate and articulate in pleading his case and I could not, actually did not, have the courage to say no. After all, he was dedicated to it, willing to arrive early at school, to stay late and to cope with the pressures of juggling academics with the rigors of practice.

And he was very good. So good that weekends found us all cheering and wincing at Josh's and the team's progress or failure to win. In theory, I hated football; in practice, it had become that year's link in our relation to Josh who by now was well away from the gravitational pull of a pink velvet pillow and his mother as his favorite woman. He had a serious girlfriend and a life of his own that included withdrawal to his room after dinner for homework and talking on the phone away from the confines of family life. By high school, he was virtually an only child but at an age when that might have few or none of the advantages of parental availability. And that, Josh clearly kept at a minimum. Besides, we had long since passed the stage of tucking children into bed, and most evenings now found my husband and me nodding off by ten or ten thirty, at which time Josh might come in to say good night to us.

Still, amidst the disconcerting role reversals with a deep-voiced, bearded, six- foot quarterback virtually but not quite tucking us in, there were traces of the toddler who had waited for me to lift him into his crib, holding his nice 'n' soft. Or were they merely routines to which I wistfully attached my own resonant memories of the velvet pillow and my subway companion?

Sometimes, for example, Josh would appear late on a Sunday evening when I had just settled down to read with some task that required my time and efforts as well as his: a paper, barely started, due on Monday after the weekend crush. Among all the other activities, he simply hadn't had enough time. These usually included sleeping late on Sunday and waking up to a brunch of fresh orange juice, a concoction of scrambled eggs with bits of Swiss cheese and a hint of Parmesan, toasted bagels with cream cheese, all accompanied by the Sports section of The Times. The brunch had become a ritual, jokingly acknowledged by Josh and me as a vestige of things that mothers do for their children. We both relished this, he, the familiar comfort and I, feeling important and needed, especially since the balance of my life had so obviously shifted away from availability and doing-for. Finding the elusive mean between not-too-little and not-too-much was sometimes tricky, for instance when Josh would implore me to fine-tune those papers he had scarcely begun. His requirements for my editorial role were so exacting: I might make specific corrections or general suggestions but not the kinds that might require a major rewrite—certainly not the night before the paper was due.

Then there was the matter of the football uniforms that had lain sweaty and muddy on the floor of his room where he had dropped them after the game the previous day. It seemed quite straightforward: washing them was Josh's responsibility, for this pertained to his schedule of games and was not part of the family laundry.

So how come, when he was the starting quarterback on the high school team, how come Josh appeared at least two evenings a week and asked me to come check his laundry? Check what, I'd wonder? The amount of detergent or water, or the temperature? That he had mastered the art of measuring soap, turning knobs and pushing buttons I was certain since I had taught him myself several years before. Why did he persist in worrying about the heat of the water and which cycle of the dryer would best suit the various fabrics of his uniforms? This was the child, man really, who daily learned and executed complex football plays as Coach decreed, who could analyze subtle literary differences, who had rescued me countless times from the intricacies of the computer we shared. Under the circumstances, ordinary logic seemed irrelevant and the only logic I could bring to bear was that of bedtimes, our companionship and Josh's nice 'n' soft. So, it was mostly with pleasure and only mild annoyance that I would put down my reading and accompany Josh to "check," reassuring him that the permutations of water, soap and temperature were appropriate to the amounts of mud and sweat and the number of hours the uniforms had lain on the floor of his room. It was no small feat, all that checking, which I for one, would have been loath to pass up. Indeed, it was enough to make me wonder whether Josh's asking me to check was also his way of taking care of me.

Sometime in the fall of his sophomore year, we visited Josh in his new quarters, a spacious suite in which he and his college friends had proudly built a loft, a home away from home. What a far cry from the crowded double he had shared the first year with two strange freshmen, no traces of that forlorn child we had left then. Now Josh was grounded and confident while I felt on the periphery of his world. Even an afternoon of watching football and having Josh patiently explain the plays did little to alleviate the dislocation and sense of loss that at times threatened to overwhelm me.

Still, there was Sunday brunch. Before our homeward flight, my husband and I had arrived early at the popular campus restaurant where we had arranged to meet, Josh having forewarned us that we would undoubtedly have to wait on line. But ever the diplomat, he had taken care of that. When he showed up a few minutes later, it was with Sunday's New York Times under his arm. After handing the paper to my husband, Josh turned toward me, and with a somewhat sheepish smile, unfolded a faded blue wad. Taking care not to drop the small sewing kit and bandanna he had carefully tucked inside, he held up a pair of extremely torn and faded dungarees. "Would it be possible for you to patch these while we're waiting to eat? They don't have to be perfect but it will take me at least six months to break in my new pair." He hadn't brought a thimble, he added apologetically, but would I mind and could I manage? Any halfway decent patch would do.

Mind what, I thought? patching his dungarees? checking his laundry? accepting this newest version of his nice 'n' soft in the increasing distance as our last child was launched into his universe? No, I wouldn't mind and I did, sew on the patch, that is. When had I ever minded, except perhaps on a Sunday night?

Coda

It is now over ten years since Josh asked me to patch his dungarees or check his laundry, and while he still does occasionally bring a duffle of laundry to the country with his wife Ruth, clearly those days are long gone. Happily for me, in the intervening years, there have been three grandchildren and even a grand-dog to pick up the some of the slack. Attachments, it seems, are where you find them—sometimes, even at work—neither the same as the originals nor as vivid or unique, but if we are lucky, resonant enough.

Take Mrs. Harris, for instance, a patient of mine.

Quite some time ago, early on in a treatment that was to last over ten years, she had become increasingly agitated with the approach of our impending August break. Nevertheless, after weeks that bordered on panic, she was surprisingly calm when the inevitable last session arrived. About five minutes before the end, as the hour began to wind down, she abruptly sat up, clutched one of the small kilim pillows from the couch and asked, "Can I take this home for the month? It would make the separation much easier for me."

I was nonplused. Still in the early stages of analytic training, I was somewhat locked into the very abstinent classical rules of the first analysis I had had years before. At that juncture, I was also locked into believing that only if I could master and follow the rules of the over-idealized authorities who had gone before me could I ever learn to be a good-enough analyst. To give a pillow to Mrs. Harris would be perilously close to breaking a rule.

No one had ever asked me for a pillow or anything comparable before. Nor could I imagine that I could have asked my analyst for such a thing for myself, despite the fact that I had been similarly thrown by his independent comings and goings and power to send me away. The analyst's primary role, I believed, was to cure through unearthing conflicts, through analyzing the transference, through insight and words, not through action or acting out. To allow Mrs. Harris to take a pillow would mean to participate in acting out.

On the other hand, I had been working with her for several years, and it had taken quite some time for her to become less anxious and more grounded, in session or outside. At the beginning our work had been chaotic, with staccato material and sudden crescendos so disorganizing that, more often than not, I felt confused about what was going on in her life and mind.

Mrs. Harris had grown up a poor little rich girl in the vortex of a disorienting mother whose pursuit of her own life and pleasure had led her to ignore her daughter's needs or feelings at any age. For instance, regardless of the calendar, she would arbitrarily pull Mrs. Harris out of school in order to have a traveling companion, someone to whom she could complain when she was angry at Mrs. Harris's father, a passive, if pleasant man. Consequently, Mrs. Harris had grown up feeling not entitled to a life or possessions of her own, a characteristic that had led her to marry a self-centered and dominating man who perpetuated the pattern of her mother's neglect and abuse. She had even had to fight him to remain in treatment just as she had had to fight for just about everything else of value in her life.

Thus when Mrs. Harris asked for the pillow, it seemed that the abstinence imposed by a no would be at the least depriving and more likely cruel, while acceptance of her wish reflected the growing strength of her connection to me. Somehow I knew that I should accede to her request, although in the heat of the moment I could not have articulated why. Nodding my acquiescence, I motioned to Mrs. Harris that she might take whichever pillow she wanted. She did, and broadly smiling her gratitude, left with it tucked under her arm.

On the first day back in September, as if she had kept it there all summer, Mrs. Harris arrived with pillow under arm, thanked me for having loaned it to her and placed it back on the couch. "It was a great comfort to have it," she said, and then settled in to work. For several years into the treatment, she continued to battle her anxiety and distress about separations but she never requested a pillow again.

I can't say for sure, but often I have wondered whether I would have felt compelled to stick to my original version of the rules if Mrs. Harris's request for the pillow had not resonated so powerfully for me. I don't really know. Certainly I had read Winnicott. But why I let her take it, I believe, has to do with a pink velvet pillow and "checking," antidotes to the down side of love with its potential for separation and loss. None of us is immune. For a mother, at least this mother, coping with those can take shape as a seventy-five pound duffle full of laundry, however many loads it might take. And for an analyst, at least this analyst, it might mean letting a patient take a pillow home for the long summer break.]]> By Teresa Rose, Ph.D. Pondering what it means t.... By Teresa Rose, Ph.D. Pondering what it means t.... http://www.sectionfive.org/?permanent=5.20 root 2004-11-20T03:00:00-08:00 By Teresa Rose, Ph.D.

Pondering what it means to be a psychoanalytic psychotherapist has prompted a great deal of free association and deep thinking. It touches me in many profound ways, and to try and tease out the meanings has been a challenge, albeit an exciting one. Overall, my analytic identity is so tightly entwined with my personality that it is hard to separate them. The more I learn and study, the more I apply analytic concepts to most aspects of my life, not just in my practice. In fact it is impossible not to do so. Writing about this topic, I found it difficult to focus on any one area of my life, so I gave up, and embraced all the ways it affects me.

I am a new psychoanalytic candidate as of 2003, although I have had 2 years of prior analytic training, over two years of analytic supervision, and some years of analysis. The formal four year training program is the next logical and eagerly met step. I have been analytically oriented for some time, and thinking back, was primed for that since early childhood. I was always a curious kid, wanting to know why, how does that work, what's the root cause, what is the real reason for that, why do people do what they do, why do people keep repeating things over and over. I recall a great deal of confusion growing up when people stated conflicts or ideas in reified black and white. Everything always felt complex, multi-layered, and gray to and kept me asking all those "why" questions. Those questions have been an endless source of fascination for years, and psychoanalysis is a perfect fit. In fact, I'm still awed and delighted that people will pay me to do what I love the most, for it doesn't feel like work very often, even after 9 years of doing therapy with people. As someone once said, I get to live a dangerous and exciting life without ever leaving my consulting room. What could be better than that!

As I mulled over the topic of life as an analytic therapist, I realized I had been contemplating the death instinct, as it applies socio-politically prior to the announcement of the contest. Even though this concept was one of Freud's more unpopular ones, it is hard for me not to believe in the death instinct as I watch and as I am traumatized by world events, such as 9/11. And the death instinct hardly seems exhaustive enough to explain all of the events and dynamics occurring in the world. Basic schizoid mechanisms seem to be rampant in the 2000's.

To watch as this country's president demonizes people, and ruins or severely damages relationships in the world, or even in our country, that have heretofore been strong has left me reeling. It is too easy to want to cast him in a flat, similar two-dimensional way in return, but viewing him through a paranoid schizoid lens says something about how he could lead the country into a war that many of us vehemently disagreed with. If everything is viewed as a part object, only a small leap is required to demonize people, cultures, and countries. And death and destruction unfortunately sometimes easily follow. It's also hard not to analyze the president in terms of his father, and the notion that he is carrying the "banner of loyalty" as Peter Shabad so eloquently describes. The war in Iraq to me always felt a pre-determined, personal battle of the president's that was going to be carried out, no matter what, no matter what the cost. The scariest thing about all of that for me is that the president's personal psychodynamics can be acted out on such a grand and terrifying scale. Of course that is true of any person that wields such enormous power and controls vast resources. Viewing politics and social situations through an analytic eye provides some small comfort that comes with understanding, but little comfort as I watch tragedies unfold.

On a level closer to home, I almost find it impossible now to experience people close to me without considering their psychodynamics, their attachment histories and their internal workings. Sometimes it almost plagues me—I wish to not know or to guess certain things, but I can't shut it off. As someone I'm very close to said, it is almost this feeling that I'm a superhero action figure with magical seeing powers. Even though it sounds and feels like my own omnipotent fantasy, being psychoanalytically informed means that I have a huge range of possible theories and explanations available to me about why someone might be the way they are or might do the things they do. The more I learn, the more I come up with theories, hypotheses and multiple reasons for people's beliefs and actions. I find myself even applying analytic concepts to me and my dog! Even though that feels a bit silly at times, it highlights for me how much psychoanalysis forms a large part of my self-identity.

My psychoanalytic identity has recently begun to coalesce around an intense need to make analysis available to a much larger audience. One of my struggles with psychoanalysis as a profession has been that we have done the public a disservice by not making it more understandable, accessible, and touchable. Because of its often insular, and mysterious reputation, many people have no clue that analysis is still a very viable and useful process. One of the ways I'm invested in analysis is to try and help get the word out—it's a wonderful, comprehensive treatment that can address deep, long-entrenched issues like nothing else can. I've been somewhat amused at my fervor, for it truly feels like a mission. However, as we analytic folks say, knowing that keeps me tempered. The wonderful thing is that I'm afforded several opportunities to educate people about analysis, and I hope I'm doing it in a considered, balanced way.

One of the most exciting ways I'm informing people is by writing a weekly column called Relationship Matters for a suburban newspaper. It has been an outstanding opportunity to take many concepts and ideas psychoanalysts take for granted, and to distill them into a form that reaches a wide audience. Even though many of my columns are specifically about relationship concerns, such as communication, romance, vulnerability, and intimacy, I'm in the process of completing 3 columns on therapy—the therapy relationship, the process of change (which of course I describe in analytic terms), and what kind of therapist and therapy to choose. As you might imagine, psychoanalysts top the list as the most trained, informed professionals available for psychotherapy. I know I'm biased, but I believe that to be true. In fact, most other mental health professionals often choose a psychoanalyst as their own therapist when they seek treatment. I feel it is critically important in this day and age of managed care and intrusion into the therapy relationship that people really understand all their options, particularly such a human one as psychoanalysis. I'm fortunate enough to have found a public forum, an understanding and supportive editor, and a way to present the profession in a credible way.

Another way I feel compelled to educate people regarding psychoanalysis and psychotherapy is by teaching in two adjunct faculty positions. Given that psychotherapy is so important to me, teaching graduate school in doctoral and masters level Counseling Psychology programs enables me to consider and to communicate my experiences and my understanding to my students. I continue to be horrified that students believe psychoanalysis stopped with Freud, that it's a dead, dusty, historical anachronism. In my own graduate school training, psychoanalysis was presented in a just such a way. That is so far from the truth, even in the Midwest! It is an unfortunate occurrence in many graduate schools, but there are ways to engage students in learning about such an active and vital discipline. It is a delight when you find a student that resonates with all that psychoanalysis has to offer. The future of our profession hinges on finding just such students.

Finally, as a psychoanalytic psychotherapist, I feel like I have truly found my professional home in the psychoanalytic community. Analysts I know have been highly supportive of me and other developing therapists. When most of the world seems to be chasing quick fixes, medical solutions, and manualized treatments, connecting with a group of people that still believes utterly in the search for meaning and value has nurtured me. I so strongly believe in the worth, dignity and value of the individual life, and the search to integrate and live that life, especially in relationship with others, in as full a way as possible. No matter what theoretical orientation feels congruent to a psychoanalyst, the underpinnings seem to be that search for meaning, understanding, connection and love. It is an honor to be a small part of that. The rest of my life stretches ahead of me as an exciting journey, greatly informed by psychoanalysis. I truly feel I'm living large because of it.]]> By Dora Ghetie It is 7 p.m. on a Friday night. .... By Dora Ghetie It is 7 p.m. on a Friday night. .... http://www.sectionfive.org/?permanent=5.21 root 2004-11-20T02:30:00-08:00 By Dora Ghetie

It is 7 p.m. on a Friday night. I am sitting at the bar, in one of my favorite restaurants, waiting for my date. This is my first date with Andrew. Normally I would be nervous but I have been on so many first dates lately, I feel totally confident. Being on a first date is strangely similar to conducting an intake. I cannot help it-as a fifth year doctoral student, soon to become full-fledged psychologist, I am immersed in therapy: doing therapy, being in therapy, and reading about therapy. This is my life. My fondness for psychoanalytic therapy is a further problem. All day long I listen for what is not being said and I try to look for patterns and how they show up in the transference. I cannot turn it off. So before long I ask my dates: tell me about your family. What's your earliest memory? What kind of relationships have you had? Do you dream? Just like an intake. Hmmm…maybe that's why there have been so few second dates.

Andrew arrives. After the initial awkwardness, we get down to it. Tonight, I tell myself, I will not act like a psychoanalytic therapist. I resist the impulse to ask lots of questions and instead I volunteer information about me. I keep going even when I feel I've talked way too much. I force myself not to take care of Andrew. Yet I notice that he is playing with the silverware. Nervous, I say to myself. I also notice that when I comment on the silliness of the whole dating process, he interrupts me to say he thinks it is great fun. Defensive, maybe? A bit histrionic? Later, he tells me in great detail about how much people at his job like him. Red flag here, narcissism alert! Well, at least he seems to be using higher-level defenses. No, no, no, don't do this, stop it. This is not an intake! I keep these thoughts to myself, confident that I have perfected the art of the blank screen. He will never know what I'm thinking. I do feel a bit guilty though, like I have this special knowledge. Of course, I could be wrong.

An hour later, I am feeling pretty good about this date. He hasn't even asked me how I can sit and listen to people's problems all day. On my last date, just for fun, I answered that it's because I get sadistic pleasure from it. Never heard from him again. Eventually though it happens-Andrew is talking about his last girlfriend and I say, "wow, she sounds a lot like your mother!" Oops! Luckily, he takes my comment in stride, jokes about me playing therapist, and moves on. But I am deeply disturbed. Can I please have just one date without thinking about dependency conflicts, castration anxiety, and character structure? Without reading between the lines? Without noticing body language and wondering how it relates to what's being said? In the beginning, I used to think these skills were very useful because I could use my clinical intuition to assess a potential mate. But now I feel burdened by trying to figure out how to be, just be a woman and not a therapist. I just want to be on a date!

Towards the end of the evening, Andrew does ask me one inevitable question. "So, have you been analyzing me all night?" Well…yes. I am exposed. I use a classic technique: "What do you think?" Andrew smiles and nods. "So what's the verdict?" I appreciate his sense of humor but somehow I don't think a full explanation of Alice Miller's theory on narcissism is appropriate. Instead, I smile and tell him it's too soon to tell. He seems satisfied. At the end of the night, he kisses me good-bye. In that brief moment, I forget to think. At least for five minutes I stop being a therapist. Then, I am driving home and back in therapy mode: I wonder what his father is like? Was he acting too confident because of anxiety or an inferiority complex? What did it feel like to sit with him? It never ends.

Dating is only one of the many challenges I have encountered in my quest to become a psychoanalytic therapist. My worldview has become fundamentally different over the past few years. I have always been curious about people, about the unconscious, about the things we do that do not make any sense. But now, it seems that I literally see the world with special glasses. And strange glasses at that. A month ago a friend visited from out of town. As I was rushing to get to my therapy appointment, she seemed puzzled. So what if you're a few minutes late, she asked. No, no, then I have to talk about it, who knows what it could mean. What?? I explained to her that actions often have hidden meanings. She looked at me as if I were an alien. Of course, I had already diagnosed her as an obsessive character, with much isolated affect and poor insight. So, I knew her dismissal of my explanation was defensive.

Family gatherings have become an opportunity to practice family therapy. Actually, I served as my family's therapist long before discovering psychoanalysis; I suspect this is true for many of us. But now it is quite a different ballgame. I am equipped with knowledge of boundaries, alliances, enactments, and transgenerational patterns and they are ready with one simple phrase "Stop psychoanalyzing everything"! My family members are the reasonable sort-they are scientists and avid believers that what you don't know can't hurt you. I have always been an oddity among them, with my desire to know more than was being said and my need to acknowledge feelings. Thus, I found it very comforting to discover through my training that they're the weird ones and not me! My world is richer, more honest, and filled with insights.

Sometimes I wonder though about this world I am now living in. A world in which people fall in love because their neuroses are compatible, in which altruistic acts are motivated by anxiety, or a depressive character, or even repressed sadistic urges. A world in which faith in a supreme being exists to defend against existential anxiety. In this world, people often say one thing but mean another, act in ways that contradict their explicit desires, and are often unaware of what they are really feeling. This is a strange world indeed. As one my clients recently said to me "are you saying that I could actually be angry at you but not know it? Now that's a mind-f***"!

I spend most of my time surrounded by fellow psychoanalytic clinicians. Our reality rests upon many assumptions that we take for granted. Assumptions about human nature and the value of self-awareness guide us. Therapy seems to be the answer to every human struggle. Can't find a meaningful relationship? Problems in your marriage? Difficulty at work? Go see a therapist, or better yet, consider psychoanalysis. Mourn your past losses, understand your inner conflicts, and work through the therapeutic relationship. I find it paradoxical then to discover clinicians whose ability to self-reflect appears to be severely impaired. Surely we all have our blind spots but hopefully they are not too large. Most psychoanalytic clinicians have participated in long-term therapy or analysis, but clearly with limited results in some cases. Maybe they had a bad therapist. Or maybe they were even less aware before therapy. But maybe it is wrong to assume that therapy is always the answer.

I don't know how to give advice anymore. Within our psychoanalytic community, conversations with friends are easier because we operate according to similar principles. A problem occurs, we empathize and analyze. We speak the same language. But I still have non-psychologist friends. They appreciate my willingness to listen and my desire to be helpful. However, I am finding it increasingly difficult to be a friend and not a therapist. I cannot listen to someone relate a story to me without relating it to what I know about him or her and wondering what would be the helpful thing to say at any given moment. I have lost a great deal of spontaneity. "Why does this always happen to me?" a friend might ask. I have some ideas about that, but should I really tell her? Would she be able to hear it? Should I empathize with her or would it be better to comment on her role getting herself into the situation? I do not know. What I do know is that I feel less genuine because there are all these things I am thinking that I cannot share with her. Another time she tells me she is in love. She is happy. I feel certain the relationship is doomed; I look ahead and feel confident in my predictions of what will transpire. But she is happy right now. If she were my patient, I would not hesitate to share my reservations, even as I validated her current feelings. As a friend, I don't know what my role is. Of course I know that friends often tell each other things that are difficult to hear and I believe if I were not a therapist, I would not hesitate to tell her my concerns. The very fact though that I am a therapist makes me cautious and self-conscious about sharing my knowledge of her.

Sometimes I wonder if my current struggle to exist as a psychoanalytic therapist is a function of my status as a student. As I have tried to learn all I could about the theory and practice of psychoanalytic therapy, I have often felt overwhelmed. The lack of simple answers is difficult to tolerate for a beginning clinician. The desire to impose some structure upon the therapeutic relationship has encouraged me to give too much weight to diagnostic issues. I find that the longer I work with someone, the less able I am to give a clear diagnostic conceptualization. The uniqueness of the individual emerges over time and takes precedence over any attempt at categorization. This is as it should be. But the drive to organize complex information is quite strong. Perhaps this is why it has taken over my life and led me to hypothesize about my dates, my friends, and my family members. Armed with this new body of knowledge, I have come to know myself and those around me in a different way. However, I realize that I am at times using my new skills to avoid being present. Beginning treatment with a new client is difficult and so I search for artificial categories to guide me. Having relationships with other people is also quite challenging and so I analyze their dynamics in order to feel a sense of control. And, I must say, it can also be great fun.

I find myself standing in the corner at a party and watching people. I become fascinated by their interactions. Ideas about relational patterns and group dynamics are swimming in my head. Being a psychoanalytic therapist has provided me with a unique kind of knowledge. I always suspected that appearances are deceiving and that what lies beneath the surface is what really counts. Discovering that there is a whole community of people that share this belief and that there are thousands of books and articles written about this made it real for me. I was so excited to delve into the different theories and to experience first-hand, as a therapist and as a patient, the power of the unconscious. Every once in a while I have come home, after a particularly powerful session, and thought to myself "wow! They are not kidding. This stuff really exists, and it really works". Despite my (hopefully) humorous questions about the nature and value of psychoanalytic thinking, I know it is often right. I can step away and notice how it fits with my personality, and I can wonder if that's what makes it feel right to me. I can also look at psychologists who are vehemently opposed to anything psychoanalytic and see how other approaches suit them better. In doing that, however, I am being a psychoanalytic therapist. The constant wonder of what motivates all of our actions is the essence of psychoanalysis.

However, it is lonely sometimes. At this party, I feel privy to a world to which my fellow non-psychologist party goers do not have access. It is an interesting world but quite different than the one most people live in. Sometimes I feel privileged and superior, other times I feel like a lunatic. All psychologists are crazy, aren't they? It is not hard to see how this popular belief arose. There are certainly enough psychologists who are crazy, even by our standards. But even those of us that consider ourselves more or less "normal" can appear quite odd to the outside world, with our talk of unseen forces at work, hidden meanings, and defense mechanisms. The first time I heard about projective identification I wondered if my professor was losing it. Put feelings into someone else? Then elicit them by compelling the person to feel a certain way? In order to recreate a past dynamic? Excuse me, I wanted to say, but I just learned about psychotic processes and this sounds vaguely familiar. At a later time I was taught about parallel process. Let's see, I feel a certain way about my patient but I am not aware of it. However, my behavior in supervision stimulates the very same feelings in my supervisor, and it is all related to the patient's childhood relationships, and maybe to my own. It is like transference and countertransference, but weirder. Yet, over time, these and other such mysterious concepts have come alive for me because I have experienced them. Aside from the possibility that I am slowly slipping into psychosis, I have to believe that no matter how strange some psychoanalytic ideas may sound at first, they do describe human interactions quite well. So I don't think I'm crazy. Still, I wouldn't want to be the one to explain the theory of Melanie Klein to a roomful of non-psychologists or even non-analytic psychologists. The layperson would think that it's true, all psychologists are nuts, and the other therapists would feel comforted that they chose a more reasonable approach. After all, who is ever going to prove in an experiment that projective identification and parallel process exist?

Living as a psychoanalytic therapist can be a lonely existence even among psychologists. We are a minority and we are dismissed and even despised by a large number of fellow clinicians. We are forced to justify ourselves in so many ways. A great rift exists within the field of clinical psychology. There are those psychologists who have science on their side, manualized and empirically-validated treatments, specific techniques, concrete methods of evaluation, and claims of short-term success. We are on the other side. We have some research too but it is not great. We will never be able to prove in a scientific way that there is such a thing as projective identification, or even something as fundamental as transference. We have become more creative in our research but still, we cannot compete. Our therapies are long, ambiguous, without much structure. We believe they work because we have seen it. But we will never be able to come up with an empirically-validated treatment. Even if we could somehow operationalize our concepts and design complex long-term research studies, we do not want to. Nancy McWilliams (1994) points out that in general, clinicians have very different temperaments from researchers. We prefer studying people one at a time. More importantly, we are not willing to subject our patients to that kind of scrutiny. All healers struggle to balance the need for giving people treatments that work with the need for privacy. Using human beings for research may be necessary but it raises a profound ethical dilemma. I believe that most psychoanalytic clinicians have resolved it by choosing to implement treatments that make sense theoretically and have proven efficacious in their work. It is most definitely not a perfect solution but it does afford the kind of freedom that is sacrificed by the scientific method.

One other major advantage of seeing the world through psychoanalytic glasses is that greater understanding fosters a non-judgmental attitude. Every day I see how the inability to take another person's perspective results in heartache. People hate one another without stopping to wonder why. Relationships end because of lack of communication. Parents abuse their children in so many ways and feel entitled to it. Over and over I am struck by how primitive emotions combined with limited self-awareness lead us into personal, social, and political failures. Maybe I do see love as two people fulfilling each other's childhood needs, or altruists as closet sadists, or religious fanatics as driven by the failure to acknowledge existential realities, but I also know that all these things are part of human nature. Furthermore, the understanding of what may be operating under the surface does not diminish the rapture of love, the value of an altruistic act, or the experience of religious faith.

Ironically, psychoanalytic therapists are often seen as very judgmental. We are accused of pathologizing people. Although some clinicians do use psychoanalytic theory to justify their authority over others and to create distance, I believe the vast majority of us have become more empathic and tolerant as a result of practicing psychoanalytic therapy. We understand that human beings need to come up with solutions to somehow resolve intrapsychic conflicts or developmental deficits. Such solutions are sometimes misguided or destructive, but they represent an effort to negotiate the vicissitudes of human existence. Thus, we do not judge and we make an effort to reach out and see the world through different eyes. Surely we have our own biases that at times impact our personal and professional lives, but our guiding philosophy teaches us to respect differences among our fellow human beings. We know that human emotions are often powerful and seemingly undesirable for they threaten our preconceived ideas of how we should be.

Psychoanalytic theory challenges us to accept that well-being is not about happiness, strength, moral fortitude, or perfection. Instead, well-being has at its foundation compassion for oneself and for other people. Such compassion arises naturally when we understand that our fears may represent desires and our wishes may conceal past hurts. Though psychoanalytic thinkers are often criticized for holding a negative view of human nature, this criticism arises because of the very fact that certain human emotions are judged to be inherently negative. In fact, the ability to have complex and often contradictory feelings is what makes us human. Ethel Person writes:
We are all too easily seduced away from the truth, the reality, of our own inward experience, which may often seem beyond communication and hence beyond respect or value. Too easily, in the name of the good, or the rational, or the moral, or the Christian, or the democratic, or even the merely socially acceptable, we blink away the actualities of our condition-the feelings, drives, dreams, and desires that express, with painful accuracy, the depths at which we really live. Not where we think or imagine we should live, or where society advises us to live, but where our lives are fueled and our deepest satisfactions experienced-this is what we disregard (Person, 1988, p. 19).

And so, what shall I conclude about the perils and joys of living as a psychoanalytic therapist? It seems silly to conclude anything considering that I am such a neophyte. As I look over this essay, I wonder whether my feelings of alienation, which have accompanied my development as a psychoanalytic therapist, are especially salient because I felt isolated within my own family. I have to shake my head and smile-obviously, I am now stuck with this new way of being in which seeing connections and asking questions is automatic. There are certainly times when it is cumbersome and perhaps even costly. Yet, I would not have it any other way. Being a psychoanalytic therapist has enriched my world in a myriad of ways and has enabled me to live authentically. So, to all my future dates I say, be forewarned: I will analyze you and I will say really strange things sometimes. But you will see, life is much more interesting this way.

References

McWilliams, N. (1994). Psychoanalytic Diagnosis. New York, NY: The Guilford Press.

Person, E.S. (1988). Dreams of love and fateful encounters: The power of romantic passion. New York, NY: Penguin Books.]]> By Jill Salberg, Ph.D. For many first and secon.... By Jill Salberg, Ph.D. For many first and secon.... http://www.sectionfive.org/?permanent=5.22 root 2004-11-20T02:28:20-08:00 By Jill Salberg, Ph.D.

For many first and second generation American Jews the Holocaust stands as the defining event in their lives. Much like the list recited at Yom Kippur: Who escaped, who didn't, who went to Palestine, who to South America, who was hidden, who was revealed. The list could go on and on but the fundamental event defines it all: who lived and who died. For me the story is more ephemeral, about what was lost, sacrificed in order to live. And this story started thirty years before, while the seeds of the Shoah were growing, during the resurgence of anti-Semitism in Europe. This era brought thousands of Jewish immigrants to America while the doors still remained opened. I always felt I was one of the fortunate ones, my grandparents left long before Hitler, long before an Anschluss, a final solution. I have only begun to fully comprehend that their good fortune was mixed with great separations, hardships and loss.

Marianne Hirsch (1997) has coined the term "postmemories" based on her research on children of Holocaust survivors and survivors of other traumas. She defines postmemories as deferred effects on persons or even communities who are at least one generation removed from the actual trauma. In American Imago Fall 2002 she states, "Children of refugees inherit their parents' knowledge of the fragility of place, their suspicion of the notion of home." She starts the essay with a quote from "Buried Homeland" by Aharon Appelfeld: "Czernovitz expelled its Jews, and so did Vienna, Prague, Budapest, and Lemberg. Now these cities live without Jews, and their few descendents, scattered through the world, carry memory like a wonderful gift and a relentless curse."

This memory becomes the fabric of nostalgic longing, which parents then relate to their children about "the old country" and grandchildren hear fragments about over family dinners. In "The Future of Nostalgia" Svetlana Boym suggests that, "Nostalgia (from nostos-return home, and algia-longing) is a longing for a home that no longer exists or has never existed. Nostalgia is a sentiment of loss and displacement, but it is also a romance with one's own fantasy". My grandparents left Europe at young ages, under difficult circumstances. For them America was considered a better life and longing for the old life was unacceptable, unthinkable. Instead it was not thought about and couldn't be mourned. But that past life gave colors to stories and tales, which became part of my family myth.

This essay in many ways represents my beginning attempts to come to terms with experiences and memories, which were never clearly formulated or stated in my family. They are my grandparent's gifts, curses, hidden memories and, ultimately, their legacy. They have crossed the Atlantic packed in plain wrapping, carried ashore at Ellis Island, to the Lower East Side and transmitted from person to person, generation to generation.

Where Is This Place

Where is this place whose name I don't know? My grandfather said, "I came from Prussia", but I thought he was Polish. He arrived in America when he was 18, before the First World War. "One day I had a vision in Prussia. The vision was that life was over in Europe and that life is in America". I thought this sounded so mystical, a vision. What kind of place is it that one can have "visions"? He, like so many others, worked countless hours just to save enough money for the steerage fare to sail to America, the "Goldene Medina". He told me very little about the old country, as if life really started upon landing here and following his dream. He was the first of his family to come here. He left his parents, many sisters and brothers and his memories.

"Do you remember seeing the Statue of Liberty?" I asked. "Yes, yes, we all knew about it back in Europe". I thought he would've had more of a reaction, more to say. Was she not a vision? Upon arriving he immediately got a room in a boardinghouse on the lower east side of Manhattan with all the other immigrants scrambling for work and a better life. He had already worked on a sewing machine back in Europe and so easily got a job in a sweatshop, working long hours. "In the morning I would stop at one place, three cents for a roll with meat drippings, of course you paid more for the meat. I paid for the room by the week. I had to be careful, I was saving for my own business". But I never heard the name of his town, his shtetl. Where was it, near Warsaw, near Germany, how will I ever find it without a clue? I hear his voice saying to me life was over for me there, why do you need a name? Hitler destroyed what I left, why does it matter?

He had a "rags to riches" story, which he loved to tell me. Mostly I wanted to hear about the dreams, the elusiveness of his life. What did the shtetl look like? I have no idea, although I now have seen countless photos of shtetls throughout Poland and the Pale of Settlement but not one photo has his face, or his family. Were you happy then? Who thought about such things, everyone worked, I went to Cheder until I was 9 then to work to help the family. That was life then, we didn't ask such foolishness. But somewhere, if life was over in Europe you must have felt something akin to loss, need, desire and some belief that it was to be found elsewhere. How else could you collect the inner resources to leave it all behind and strike out alone, uncertain of ever seeing your family again? He would probably shrug, say something like I planned on being a very rich man, I was going to make it happen for me but I also planned to bring my mother and sisters over. How could I know they wouldn't leave? I even went back before Hitler invaded and pleaded with them, gave them money, Ach. It's done.

My grandfather's life here followed a path, one that he worked hard on. He workedand saved money to start a business with "two brothers". It was the time of World War I and this business got an army contract to make pants. The two brothers were not related to my grandfather and drew lines of allegiance with my grandfather on the outside. He said they stole his money, two years of scrimping, going without in order to save. He told me he was so depressed he thought about committing suicide. "They stole not just my money but also my dreams".

So Papa, what place is of your dreams? Oh that is easy, it's my home in the Catskills, in Liberty. He told me that when he worked his way up to being a foreman in the sweatshop he, like all the other foremen, received two weeks paid vacation in the Catskills. This was sheer delight for him. He said the countryside so reminded him of home, hills and mountains green and lush, no concrete or buildings like the city and fresh lakes everywhere. He would lie in the sun and swim nude in the lakes, just like he had back home. I have asked Polish people I meet now in my life if there is a part of Poland with lakes and green mountains. I am told there is, it is located in the northern part of the country near Germany. Were you dreaming of home Papa?

He promised himself when he became rich he would build a home here. And that is what he did. After the war in Europe was over he began buying land and building and rebuilding homes. The original house he bought was rebuilt twice. The first stable, for he learned to ride horses and owned a few, later became a home for my uncle. My mother's house was built while she was pregnant with me. I partly grew up in this house, summers and vacations, and after college often would go to visit and stay. I found myself there, both in the encounters with the luscious countryside, the horses, the freedom from parents, and in the dialogues with him, with Papa Max. He recognized my mind and respected my choices. While in graduate school he wanted to understand my work as a psychologist and therapist and said to me, "So the meshuganas, they lie down on the couch and cry to you?" I said "Yes, something like that".

But he also knew that I loved this home and place as much as he did. On the top of the stable he built a pigeon "house". "Once when I went to Warsaw I saw that all the wealthy people, they had on the roofs of their homes the most beautiful doves. I knew that when I had such a home I would have these birds". It is such an idiosyncratic detail for him to have noticed, the doves and their houses on the top of the roofs of the rich. It is odd - for it means he did not notice the people - but strangely appealing to me. I know for him to have noticed this bit he must have been looking upward, upward beyond the doors and windows of the house, beyond street level towards the sky. And I can see him doing that, standing on a street, drinking in every single piece he was seeing as if part of the air he breathed, sketching it all out in his mind, this house, this roof, this life.

In many ways picturing him this way captures a snapshot of his movement, his motion in life was never just forward, certainly not backward as many of us can be vacillating on the fence of ambivalence. He moved forward looking up towards his dreams, up and never down and always imagining. And he moved with a plan, a detailed drawing in his mind of what he wanted. In the living room of his home in Liberty he bought and had installed a white marble fireplace mantel, all beautifully and ornately carved. It stood pristinely on the wall, a symbol of wealth, of class and of status. If he had peered into a window in a fancy home in Warsaw this is the kind of piece he might have seen, or maybe just imagined. The only thing, which belied all of this, was that there was no true fireplace, no real hearth, and no stone or brick chimney. Where the logs should be burning was a make-believe fire "light" turned on and off with a switch. Strangely mannered, empty and sad is a marble fireplace with no place for the fire. Maybe that's what happens when your eye is on the edifice and not on the people.

I don't know if the pigeon house he later built on top of the horse stables replicated in any way the ones he had seen in Warsaw. I don't even remember his building this, only of his taking me up to visit the pigeons. We would be driving around the property in a golf cart, his preferred mode of transportation once he was in his 80's and arthritis made extensive walking painful. We would enter on top of the stables, a building built into a sloping part of the property so the two levels, entered from above or below and from west or east placed you either into the stables directly or the hayloft above. Past the hayloft lies the narrow, steep ladder like stairs to the pigeon coop. We would climb up together and he would open the door to this attic like room where a flurry of feathers, squawking noise and a distinct odor of pigeon would smack you in the face. The floors and walls were sheets of aluminum and made a funny tinny sound as our feet moved across the floor. Some pigeons would immediately fly out through the portal at the tippy top of the coop roof. Many would stay settled on their nests, guarding their eggs. Most of the birds were white, my grandfather's attempt to replicate doves, but a few "strangers" had joined this house over the years and their gray colored offspring could be seen amongst the flock. "You see these birds", he would say to me as he walked around, "they are families, but sometimes a bird goes to the wrong nest; maybe by accident, maybe a troublemaker". These birds obviously knew my grandfather and his tricks. He would walk around investigating and making decisions about who belonged where. I would ask why he had to move the birds, especially if they were warming their eggs but he would insist that these families were mixed up and he knew who belonged with whom. I thought this patriarchal omniscience was funnily absurd; how could he possibly know and know better than the birds!

But that was the tenacity of his sense of mind, the strength of his will. These birds were to do his bidding, follow his rule or escape through the roof hatch to freedom. But freedom meant leaving behind the family. My grandfather's countless re-livings, doings and undoing, endless attempts of making it all work out only to make it all happen the same way, somebody stays on a nest and somebody has to fly away. If only life were that easy, if only we had the power, the ability to rearrange our families, our circumstances. Do homing pigeons always come home? What if they don't, what if they get lost, what if they go to the wrong home?

He died when I was thirty-seven years old. The family held on to the property for a while but many members didn't use it, preferring to go other places. Times had changed and tastes had changed. Most of my extended family didn't get along well enough, if at all, to make family time viable there. How did this happen? His desire, his dream became their burden, their loss. It was sold.

This was quite a few years ago and it was then sold again. This time it was sold to a family of cousins, siblings and their children who love it. I recently took my family to visit, perhaps as a way to say goodbye again. I walked along the roads and grass that I had walked on thousands of times. The grass was as green as ever, the rolling hills filled with trees looked so inviting. I inhaled that wonderful air. It smelled so good there. Only the misted over drizzly day made it hard to keep walking. It felt so familiar and yet surreal, as if I was in a dream only I was awake in this dream. I actually slapped my arm to see whether I was dreaming or awake. How could I be here, on this paved road, near my favorite lilac bush, in my home, my old room and yet not my home? How could I return and not get to stay? And did my grandfather ever dream of Prussia this way; as a memory so embedded in one's senses that you smell, taste, touch it but it eludes your grasp only to disappear in the mist of morning light?

This new family seems to have what my grandfather would have wanted, a family that really enjoys being together. They have undertaken rebuilding the homes, the stables and the property. Just like my grandfather, busy at work building the place. On the higher plane of land in front of hayloft/stable entrance they have built a large in ground swimming pool. At one end is a big slide and all around the pool are chairs and lounges. They tell me they plan on totally refurbishing the stables. They envision a huge family room with a large big screen TV and pool table and at the other end a big working kitchen and dining table. They plan on this building being the "common" house where everyone will hang out, have big family meals together and spend time. The pigeon coop will be left as attic space, no longer needed to house lost families. This new family is turning the place into a refuge and oasis, a place for family to return to and thrive from each other. My grandfather loved this place. He loved his family. Only he didn't know how to build what had to be left behind.

Thoughts on Loss

I have returned to my own memories and thoughts for not only a self-reflective visit but as a further way to understand the "uncanniness" of intergenerational transmission of thoughts and feelings, of loss. My grandparents died in 1989, four months apart as many couples do who have spent lives living bound up with each other. Although the death of my grandparents is not recent in time I have known that I wanted to reflectively think about their lives and stories. They were interesting, colorful people who left their legacy of stories with me. I hadn't realized the full extent of what was embedded in their stories and my own, until now.

I have specifically sought to look at how "postmemories" are an example of transgenerational transmission of trauma, specifically traumatic loss. This concept suggests that there is an unconscious means through which people communicate profoundly felt and yet unverbalized feelings and experiences to those closest to them. Hirsch & Spitzer (2002) further define "postmemory" as "a mediated relation to (in Stefan Zweig's phrase) a lost "world of yesterday" that they themselves had inherited from parents and grandparents . . ." Although my grandfather would often talk with me about his life in Europe and here in America I hadn't realized fully the threads and weaves in his stories about his attempts to create a new life for himself and his growing family. I had always thought of him as one of those tough peasant stock from the old country who weathered a great deal to achieve one of the American dreams of a better life. He built a business and with that built and rebuilt homes for his children and their children.

This external scaffolding distracted one from knowing how great the sacrifice was on his part in order for this kind of life to happen. I have come to realize that in some way what he couldn't build was the connective glue of family. That was what he had lost in the coming to America. His sense of family had been torn apart and his mother and sisters refusal to leave Europe prior to the Holocaust reinforced the breach. He could only try to recreate this externally by owning "homing" pigeons, birds who by instinct always know to fly home. Even his attempt to reconfigure "pigeon families" reveals the deep longing for both "a" home and the "right" home configuration which scar tissue forms over but never fully heals.

Hirsch (2002) speaks of the fragility of place that then is transmitted to the next generation without having experienced this directly. There is the quality of the uncanny in all of this, which I find is best captured by reverie. In allowing myself to creatively "play" with my grandfather's memories I came to realize that I had never known the name of the place that was his home. This became significant as an indicator of what could not be told, nor spoken about; a further example of how unconsciously things get transmitted across generations. Oftentimes what is not told becomes a signifier more noteworthy than what is told.

This untold loss then gets hidden in the mind's attempt to undo the traumatic loss, in this case my grandfather's behavioral actions of constructing homes. The compulsive building and rebuilding of houses and the shifting of pigeon families I understand as the underlying tenacious hold unresolved longings for what was left behind has on the immigrant. In his book "The Texture of Memory: Holocaust Memorials and Meaning" James Young, quoting Arthur Danto, makes an important distinction between memorials and monuments, "we erect monuments so that we shall always remember and build memorials so that we shall never forget." This is exactly the immigrant's dilemma; where one wishes to both remember and forget, to hold onto the past and completely let it go. My grandfather's house building and pigeon "arranging" certainly can be seen as encompassing both; a monument to what he wanted to remember and prove he had achieved, while also a memorial to what was lost and could not be found, nor forgotten.

Despite the compelling need of leaving Europe, a place soon compelled to expel its' own Jews, the mixture of longing, wishing for reunion and rejection left my Grandfather unable to settle the internalized and unintegrated conflicts inside of himself. Boulanger (2004, in press) writes " . . .the loss of contextual continuity immigrants chronically experience creates an absence they are rarely motivated to acknowledge . . .Nonetheless, dissociated aspects of self experience acquired in or representing the culture they left behind continue to break through in the form of affects, dreams and inexplicable enactments." The pigeon families are one such enactment where my grandfather relived and enacted a strange ritual and I held the unacceptable feelings of both disbelief (What in the world is he doing? Creating chaos!) And the wish to maintain order (Can't you just leave them alone? Don't change things!).

I also hold the longings in the form of nostalgia. This nostalgia became part of my own personal internalized experience. I was often told that I had an "old soul". I became someone who both absorbed other peoples longings and actively became nostalgic for a time and a place I could not have lived or seen. Boym states, "For some nostalgia was a taboo, first wave immigrants are often notoriously unsentimental, leaving the search for roots to their children and grandchildren". And so I hungered for stories and books about the life I imagined my grandparents had left in Eastern Europe. Old films from the 30's and 40's are my favorite as are collecting furniture and "tsotchkes" from that period. I feel as if I can create a stage set of what I imagined life was like then. In some ways I have come to inhabit the familial sense of loss and inability ever to retrieve that place called "home".

In Freud's classic paper on the subject of mourning he noticed how loss is internalized, grieved and ultimately gotten over. He believed that ties to objects, to others needed to be let go of so that new attachments would occur. Butler (2003) revisits mourning and subtly improves Freud's ideas by suggesting that, "So when one loses, one is also faced with something enigmatic; something is hiding in the loss, something is lost within the recesses of loss . . . At another level, perhaps what I have lost "in" you, that for which I have no ready vocabulary, is a relationality that is neither merely myself nor you, but the tie by which those terms are differentiated and related". What Butler is saying is that we may lose and love again but the tie, the specific connection from oneself to a specific other is also lost, needing to be grieved and that particular tie is irreplaceable. A new connection means a new tie, not a re-used tie.

With this in mind I want to further suggest that what is transmitted transgenerationally in traumatic loss needs to be thought of as a multiply layered problem. Often the traumatic loss cannot be put into words, either because of the pre-verbal age of the person experiencing it and/or the overwhelming situation it is occurring within. The trauma remains split off, both unknown and unknowable, preventing mourning from taking place. The internal resources, which my grandfather drew upon to cope with and master unbearable loss and distress, helped him survive. But these resources, survival mechanisms such as denial, dissociation and disconnection, could only limit what was available for him to know and process.

I have tried to undo this survival mechanism by both holding these feelings and entering my own mourning with a different intent. Physical survival was not the issue for me as it was for him. Instead I have felt often in my life that the imperative was around the survival of meaning, holding on to meaning in the face of it being denied or destroyed. Psychoanalysis has held the marker for "meaning-making" and challenged me to form a creative mourning process whereby I expanded meaning in the face of loss. Reverie and memoir presented themselves as the vehicles for this creativity, writing as my instrument. What interested me in these stories was the co-mingling of person, time and place leading me into deeply felt and complex layers of meanings to my life and my grandfather's life. Sometimes you need another generation or two to fully capture the lost thoughts, the "postmemories" and painful feelings. In this way we live in, live through and ultimately live without the people we love.

Post-Script

I dreamt that I am on a boat on a river in Europe. It is wide like the Danube only this river flows across Europe, from West to East. The river is calm, the countryside beautiful. In the next scene I am in a café in Eastern Europe. It is the 40's and a table is filled with people talking and enjoying themselves. I notice that two of the people are my grandparents; they are not young but not old, still quite vital. I am talking to the owner about possibly buying this café/restaurant. I awake and realize that this dream is a totally new construction. I have created rivers that don't exist which flow in directions not possible. I have resurrected my grandparents and placed them in 1940's café intellectual society. They were barely educated in real life. I have created a new life for them, filled with some of my own fantasies and delights, good conversations, stimulating ideas and a great cup of cappuccino.

References

Boulanger, Ghislaine (In Prepartion). "Lot's Wife, Cary Grant and the American Dream: Psychoanalysis with Immigrants". Contemporary Psychoanalysis

Boym, Svetlana (2001). The Future of Nostalgia. New York: Basic Books.

Butler, Judith (2003). "Violence, Mourning, Politics". Studies in Gender and Sexuality,
Vol. 4:1, pg. 9-37.

Freud, Sigmund (1900). "The Interpretation of Dreams". S.E. Vol. IV&V.

_____________(1915). "Mourning and Melancholia". S.E. Vol. XIV.

Hirsch, Marianne and Spitzer, Leo (2002). "We Would Not Have Come Without You":
Generations of Nostaligia. American Imago, 59.3, pg. 253-276.

Young, James E. (1993). The Texture of Memory: Holocaust Memorials and Meaning.
New Haven and London: Yale University Press.]]> By Fern W. Cohen, Ph.D. Some time ago, in the m.... By Fern W. Cohen, Ph.D. Some time ago, in the m.... http://www.sectionfive.org/?permanent=5.23 root 2004-11-20T02:26:40-08:00 By Fern W. Cohen, Ph.D.

Some time ago, in the midst of revising an article under consideration by a psychoanalytic journal, I had reluctantly agreed to relinquish a musical metaphor in the concluding paragraph that compared the role of the analyst in the psychoanalytic process to that of a figured bass. It was, the editors had written, a striking analogy, but they believed that it introduced a "discordant" note in an otherwise "mellifluous" paper. In their suggestions for "fine-tuning," they felt that the rather obscure technical term would require explanation in an already longish paper and they encouraged me to end on a different "note." If the bad news was that they stood firm on their editorial ground, the good news was that they had accepted my article for a forthcoming issue of the journal. Furthermore. Since I had been "beating the drum" for my conclusion, perhaps I could come up with another paper and expand on it there?

Elated as I was by the acceptance of my first article ever in a professional journal, I hesitated to yield: the passage had materialized in a burst of energy as I was completing the paper, not unlike an interpretation that floats up after much analytic work. The article had centered on the complex effects on me and a patient of my presenting her case in an ongoing seminar during training, and I believed the metaphor captured much of what I wanted to convey about the unique interplay that might unfold within any analytic pair. Besides, its inclusion, I believed, was not a question of theory but a matter of taste. Having grown up with a father who had settled such disputes with a philosophical shrug as he humorously intoned, de gustibus non disputandum est, as author, I was tempted to make a case for leaving the metaphor in.

Over the course of the unexpectedly felicitous process that had occurred following my submission, I had found the editors' suggestions helpful: the article had become more focused, if, surprisingly, longer than the original. At some point when I wrote that I feared I was incapable of sufficiently containing myself, they had even suggested cuts, thanking me for my generosity in accepting them. The journal's editors had become my editors, or so it seemed to me. However, as a junior analyst and first-time author on the cusp of a professional publication, I did not feel justified in testing whatever prerogative, if any, I might have.

As for the proposal that I come up with another paper to expand on the musical metaphor. However flattering (and it was), it felt too much like an assignment from another lifetime and I was quite certain I could not write an article at someone else's prompting, even to explicate my own. Beyond that, I could not get past the suspicion that it was an offhand idea proffered in the spirit of the duetting that had evolved between us.

This, I realized with some dismay, I was loath to end. For its own sake and also because—already overtaken by the sense of depletion I often felt after completing a piece of writing—I was haunted by the conviction that I would never again find anything of substance to write about, that this first time might be my last. Not that I ever really chose a topic; of late, it seemed that topics were choosing me. Or rather, had started to choose me when I decided to keep a journal some five years earlier, intending to record my dreams.

At the time, I had just resumed psychotherapy, hoping to address a recognizable pattern of mistakes in my work. I had also just learned that my father was terminally ill. The vast sense of distance that had long permeated my relationship to him—a legendary and revered figure in the legal world consumed by his love of his work—was resurfacing. At the same time, although a creeping workaholism also seemed to be invading my own life, I anticipated that twice-a-week therapy would be sufficient to address matters of work and my father's approaching death.

Wrong and wrong again!

Coasting on the memories of a classic psychoanalysis from another era and little recognizing how much unfinished business there was, I was totally unprepared for the wrinkle in time into which the therapy, soon become a four-, then five-times-a-week analysis, would plunge me. Despite all I had learned in the intervening years, I was caught off-guard by a near-overwhelming transference. As distance and separation from my analyst bordered on intolerable, even from session to session, my journal became a diary of containment and a transitional object. And as I struggled with the intensities that erupted in the treatment, mostly about the pervasive presence of my father in my psychic universe, alive or dead, writing became an imperative. Even more recently, I had started to believe that there might be an audience for it beyond my own need to tell all in the best possible way.

In stunning contrast to an earlier period in my life when I felt I couldn't possibly know enough about anything to fill a page and would obsess for days before I could commit a sentence to paper, I now found myself flooded with words and thoughts urgently demanding to be captured lest they disappear. Pressure was a constant and in fact, when my best work emerged: lines, initially scribbled on napkins or whatever else was handy, almost never required revision. I had even learned to keep pad and pen court side when playing tennis with my husband, to claim those promising fragments that, unrecorded, would throw me off my game. With considerable amusement, I had identified this as my Clara Schumann phenomenon, a reference to an ancient film in which Schumann, in concert, rushes at ever-increasing tempo through her husband's new piano concerto to get to her nursing infant who is howling with hunger behind the scenes. Regrettably for me, but much to my husband's delight when we are playing tennis, even with a lead, unlike Schumann, I am not always able to take control to a triumphant end.

I write by hand on smooth lined paper with a favorite ballpoint pen. Usually, I cannot proceed until a sentence or section reads just so, juxtaposing rhythm and tone according to some standard I am hard put to explain. I have been known to use a package of looseleaf paper in a sitting, writing and rewriting, crumpling page after page—proof for me of the vitality of ghosts—my father painstakingly handwrote his legal opinions, revising them over weeks, over and again. Exhausted afterwards, he would often quote Thomas Alva Edison about genius being only one percent inspiration and ninety-nine percent perspiration. Of course, he was identifying with the latter although as I got older, I thought I could detect some element of pride at the many hours he had spent before putting an opinion "to bed." Be that as it may. For me, obsessive struggling is pure impediment. I usually cannot get past it until I have reached midpoint which is when I have a recognizable piece with a beginning and a middle, indexed with "post-it" notes in an informal filing system that staves off a possible panic that I might have lost something essential. Not long afterwards, a conclusion will emerge, as did the metaphor of the figured bass.

Midpoint is also the juncture at which I learned to put into type what I had so compulsively penned. Seeing my writing in print affords me enough distance to feel some objectivity about my creation, which, if not perfect, is definitely loveable to me. To say that the feeling is resonant of pregnancy is stating the obvious, although it was quite some time before the similarity occurred to me. It bears mentioning, however, for it marks the onset of a phase of writing that brings with it the sweet satisfaction and impatient contemplation that allows me to tolerate the working through until my creation comes to term. This is especially valuable in those moments of doubt to which I am prone.

With the printed page, there also comes a profound sense of solidity about what I have written. It is real. I can read and reread it and frequently do, all the while making minor changes and adjustments, battling a teasing counterpoint that what I am writing might only be nonsense, full of meaning only to me. Then I must also throw myself into the arduous task of clarifying what I have articulated initially only for myself; now I want others to be pulled along by the irresistible flow that has seduced me. Worse. At this point, the desire to be published sets in.

For all my efforts, feedback in the form of publication had come but once before. That was a vignette I had delivered at one of many memorial services for my father, along with my sister, Justice Thurgood Marshall and other legal luminaries. Recorded on video, the talks were later compiled in a volume dedicated to my father. Since mine however, was such a very small part of a larger prestigious whole, its publication was considerably diluted for me by the nagging, if familiar sensation, that I might only be a tag-along on the coat-tails of famous men. On a good day, while I could be amused by my princess-and-pea sensitivities, more seriously, I recognized the struggle between my emerging sense of self as a writer and my tendency, somewhat diminished by my analysis, to defer to authority, especially men.

Disagreeing with men was not something I did readily, if at all, and I was just coming out from under issues of awe in relation to men of stature in their field. This was an extension of my childhood certainty that, no matter how much I might learn, I would never know enough or measure up—in the version of the day, to senior analysts who seemed to write as effectively and sensitively as they worked.

As a candidate I had undertaken my current analysis and training locked into a conception of the analyst as the authoritarian one who knew and the analysand as the one who did not. While much of this had to do with transference and my father, it also reflected my experience as an analysand in the fifties and sixties, when the ideal of the analyst as a neutral, opaque mirror had been carried to such distorted proportions that it nearly obliterated the existence of a reciprocal pair. That first analysis, though extremely helpful, was in retrospect, woefully lacking in the mutuality and the development of analytic trust that I had now come to believe were as central to the process as transference and resistance. Moreover, I was discovering a global warming on countertransference which was supplanting the extreme orthodoxy that had taken hold after Freud's initial formulations—which was that countertransference was solely unresolved neurotic conflict on the part of the analyst.

Such expanding perspectives were extremely promising to me. I had come to training convinced that only if I could learn and "master" the rules could I be a good-enough analyst, and by extension, that I would have to shape myself to others' standards to measure up. Along with my analysis, contemporary literature and discussion with colleagues were reinforcing the awesome prospect that I might be able to be my own person and yet be clinically correct in the psychoanalytic situation. I was beginning to recognize that one might use aspects of oneself in a way uniquely tailored to the dynamics of each analytic pair. That realization also signaled to me that I might find a place for myself in theory and practice without feeling slavish or rebellious.

It was all this that coalesced when the metaphor of the analyst as figured bass took shape: the analyst as a constant accompaniment with variations of her own key and tempo, responding to the unique melodic line of the analysand, around which the analysis might play itself out. Whether figured bass or analysis, inherent in the paradigm is the centrality of structure, with elements of freedom and flexibility within. As Freud might say, it is not "wild analysis," or, in the words of Bradford Marsalis, jazz saxophonist: "You don't play what you feel, there's only freedom in structure, my man. There's no freedom in freedom."

Whether the editors had been serious or playfully teasing, in order to write an article elaborating my metaphor, I would have to deconstruct it first and that would run counter to the compelling gravitational force that had become the heart of learning for me: making connections. It was this current that reflected my growing ability to differentiate myself from my father's excessively rational ways and the long shadow he had cast over my confidence in my ability to think. But even glaciers do move and melt, however imperceptibly and incrementally: in-session with patients and in play (my writing), metaphors of surprising fit were starting to surface, another sign that something had started to loosen up in me—the freedom to say less, not more. All too aware of my tendency to say and to explain too much, one liners were what I was after and I wanted to remain faithful to the economy of my metaphor, which after all, had been an impressionistic leap.

I would just as soon have tried to explain why I loved music or Bach as first among many. No way could I find words to articulate what it was that held me willing captive, nor could I possibly explain why I was so moved by the mysterious element of controlled passion in his work. In college, hoping to plumb those mysteries, I had talked my way into an advanced theory course on Bach, somewhat lost amidst the knowledgeable music majors. Although I learned theory, analyzed key progression in chorale preludes, compared differences in musical form and instrumentation, even wrote a chorale, I never came closer to what it was that held me captive in love.

But if I couldn't elucidate the intricacies of that love, I could fall back on taste or my own passion, which, after all, one need not be a scholar to defend. And of course, no one had really asked me to do any such thing. It certainly was not what the journal editors had meant in suggesting, whether seriously or casually, playfully or for the purpose of placating me, that I write an article on the analyst as a figured bass. They did, however, strike a modulating chord—they had called my attention to something I'd never quite registered before—to the consistent use of musical language and imagery, which, permeated my work. Indeed, I was amazed at the degree to which a concern about rhythm and sound pervaded my efforts; even more, at the extent to which my wish to conclude with a musical metaphor was a profound condensation of my love of music, with who I was, and where I was in my development as an analyst and writer.

On some level, it did not come as a surprise to me at all. Having been involved with music almost all my life, it seemed natural and inevitable that its terms should have so worked their way into my writing. After all, was I not the person who had been emboldened to ring the doorbell of a neighbor from whose apartment I had heard the strains of chamber music to ask if he, a skeptical violinist, would consider playing with me, a duet-starved pianist? He did, and our playing had inaugurated another renewal of active music for me immersed with small children and other necessaries of my life.

If at first, I had been tempted to improvise a riff for the editors conveying why I could or would not write the article as suggested, given a tendency to explain myself and a conviction that I must, the editors had, unwittingly or intuitively, had sounded the theme of a fugue. Not only had they exposed me in a most benevolent way, they had lured me back to an essential beginning—Miss Chasins, my piano teacher, a centrifugal force from the start.

An impatient seven year old, I had begged my parents to let me take lessons over their protests that I was too young and should leave the piano to my older sister for a while. Sibling rivalry for sure, but also something more. Having sat in on her lessons with the charismatic Miss Chasins, I could not bear to be excluded from the opportunity to create those magical sounds.

Miss Chasins drew people of all ages into her orbit: she taught by inspiring, by demanding the best, and by the sheer magnetism of her love of music and interest in her students. Key to her alchemy of passion and discipline was her conviction that anyone could learn to play musically and well, whether a simple minuet or a sonata of difficulty and length. Talent helped but diligence counted as much; if one had an ear for tone and rhythm, so much the better, but without musicianship, even the best of technique would sound hollow.

Ask any pupil of Miss Chasins and he would tell you that the greatest shame was to be accused of pie-an-er playing. Piano playing, the real thing, was about coaxing fingers in a seamless legato, mastering a crescendo or diminuendo gracefully, bringing out an inner voice or letting the melodic line speak for itself; it was about the lucid use of pedal, and accenting without jabbing the keys; it was about giving a rest its full due, and about quality instead of quantity, a half-page well learned. And, it was about playing a piece that one might have happily thought "finished," only to be stopped as Miss Chasins fiercely circled an offending passage, penciling in fingerings or instructions until they threatened to obscure the notes below.

Someplace, I still have those old-fashioned lesson books with the speckled black and white covers, in which Miss Chasins would assertively write our weekly assignments: "Work on legato passage in Chopin, make sure to accent the first note in the L.H." "Memorize the first section of the Bach; bring out the middle voice, single hands to the end of the page." "Don't rush!!!" "Watch wrist!" "Sing out left hand in Haydn." "Pedaling!!!" Notations, not unlike a figured bass.

Mention a fiver to any one of Miss Chasins' pupils and he or she will groan: a fiver, a suspense-filled semi-torture, was the remedy for a mistake—playing the offending measure perfectly, five times in a row. It was invariably during the fourth try that a finger would slip and to this day, the thought of a fiver tends to make me hold my breath. One might claim (as I often did) that it was only tension but there was no getting around Miss Chasins' exquisite scrutiny, although there were plenty of times I tried.

Often I approached my weekly lesson with dread. Although I loved to play, I hated the loneliness of practice and frequently was ill-prepared. No matter. Soon enough would come the part of the lesson I loved best, the moment I had worked and waited for. This was when Miss Chasins would play pieces all the way through so I could decide what I wanted to learn next. Then I would be transported: her strong and supple fingers would take over the keyboard, walking a firm legato, caressing a melody or punctuating it with sturdy, staccato strokes, simultaneously filling me up and stirring my hunger to play; then she was playing just for me.

"It ain't what you do, it's how you do it," Miss Chasins would say so often during a lesson, that one pupil had fondly stitched the words on a sampler, wrapping them around notes on a signature bar. Framed, it hung on the wall opposite the keyboard, a loving admonishment to us all. At a memorial service after her death, full of good music and tears, I reminisced about the sampler for I had particularly loved the incorrect grammar and the possibilities of humor it had brought to learning for me. Now I have it, faded with age: several days after the service, it came to me, a special delivery gift from her family.

Unlike many piano teachers, Miss Chasins never held recitals and even though we polished our work, we rarely performed it. An exception was the piece I had learned to perform for my graduation from elementary school—way past memorization until it flowed through my fingers on to the keys. I played it confidently and well. Even now, I could probably still play the beginning staccato chords of Polish Dance by Scharwenka and relive the sense of accomplishment from that day. Miss Chasins was in the audience and I knew I had done us both proud. In those years, it was perhaps the only time I felt special and different in the most positive sense of the words.

It was the first and the last time I performed in public. Soon after, Miss Chasins married and moved away. Though contiguous only in time, performance and loss would irrationally collide in my mind for years. Although I was definitely upset when I learned that my lessons with Miss Chasins would end, at the time, I had little comprehension of the enormity of her impact on me or the loss—except that I continued to be disappointed with the several teachers I tried after she left, even the one to whom she had referred me herself. That inhibition lifted somewhat only when Miss Chasins' brother Abram, a composer and pianist, stepped in and asked me how I was doing. Startling everyone, including myself, I burst into tears. This prompted Abram to turn me over to his wife, a concert pianist who taught me dispassionately for a number of years. During this time, I became quite technically proficient, although I was so awed by her accomplishments in the music world, that I always felt awkward and intimidated during my lessons with her. But I did love music and for a while, that was enough to sustain me.

With the departure of Miss Chasins, clearly I had lost much more than weekly lessons and fivers. I had lost a relationship that had filled a void of whose magnitude I had been scarcely aware. In a family where reason was the standard by which all was evaluated, even had I been able to verbalize my inchoate feelings that something was lacking or amiss, there was no one else in my universe who might have understood. Except Miss Chasins. She had paid attention, she had made demands, and she had made me feel real.

In my senior year of high school, Miss Chasins returned. The event was bittersweet, occasioned by the death of her husband whom I thought I had liked but unknowingly had hated for taking her away. For that one year, we resumed weekly lessons, but they were never the same. In part, life had intervened: I was at a stage where practicing competed with homework, basketball, friends and the anxious requirements of applying to college. Now I understand that I had used that busyness to mask the disaffection and ambivalence engendered by Miss Chasins' having left. Now I understand that I felt abandoned and hurt by a first love along with the anger and sadness attendant on loss.

Still, I continued to play. At college, hoping to translate my enthusiasm into disciplined practice for myself, I had tried for a time to take lessons from the too-remote professor who had taught the course on Bach. Finally I settled down to practice in the music dorm. There, surrounded by music majors who practiced endlessly and talked music into the night, I closeted myself in a sound-proof cubicle, playing old pieces, sight-reading new, practicing for what I wasn't sure. By then I was in the throes of a depression, and other than crying, practicing was the only thing I was able to do.

It was during the height of this depression that some instinct took me during spring break to visit Miss Chasins, still energetically giving lessons, tie-dyeing scarves and offering something to eat. Attuned as ever, she was. Quite ignoring the visible signs of depression that had made me very thin and caused everyone else to respond with either alarm or studied avoidance, she asked, "Do you think you'd have time to practice some duets this vacation?"

Without waiting for an answer, she began to leaf through the pile of music on her piano, then sat down to play, motioning me to join her; it was all so casual and wonderfully irresistible as Miss Chasins pulled me firmly back into her field of force with a parade of lyrical jewels. In a lovely example of the principle of multiple function, my defensive refuge in music had turned me into a proficient sight reader and stood me in good stead.

That experience marked a shift away from the disaffection that followed Miss Chasins' having moved away, but it was many years before I played with any regularity again. Instead, I sometimes practiced, found willing partners by chance, playing only when life and time allowed: I worked my way through a literature of trio sonatas, Handel Organ Concertos, and four-hand arrangements of Bach, finding whenever I could, a flutist or violinist (and once, to my delight, a handsome cellist-lawyer with whom I had hoped to play duets of another kind as well). Occasionally I would arrange a lesson with Miss Chasins in the intermittent pattern that I had adopted long before, that is, until she acquired a second Steinway grand. With their gleaming curves nested within each other, they filled her tiny apartment with possibilities I couldn't resist. It was time to settle down, I thought, with a regular weekly slot—to play two-piano music, maybe even Bach. Or, most especially Bach. Alas, it never came to pass.

Although she was seventy-five, none of us had ever expected Miss Chasins to die, victim of a fatal heart attack and not the chronic assorted minor maladies of which she had complained over the years. By that time, my eleven year old daughter was about six months into her lessons, just beginning to carry on a generational shift.

As for me. This time I mourned Miss Chasins' loss with a depth of feeling and level of awareness that had been denied me when she moved away. Although regular lessons seemed to keep eluding me, as always, I intended to resume when time and life might allow. Did I not keep my fingernails short and clipped, as Miss Chasins did, forever in readiness to seize the moment should it arise? In the meanwhile, other forms of duetting have evolved.

Transference, it has been said, is ubiquitous, as are repetition, enactment and working through. Call it what one will, at what point does it become the real thing? Although my experience in writing that journal article was definitely in the here and now, what really lay at the heart of my resistance to go along with the editors' recommendation to leave out the metaphor, was my reluctance to have the duetting come to an end.]]> by The Unconscious Collective The Unconscious C.... by The Unconscious Collective The Unconscious C.... http://www.sectionfive.org/?permanent=5.25 root 2003-12-01T04:00:00-08:00 by The Unconscious Collective

The Unconscious Collective is a group of ten Duquesne University first year psychology graduate students who have joined together to study and experience "the unconscious", free of constructs or theoretical abstractions. We are clinicians in training, bringing with us influences ranging from psychoanalysis, humanism, existentialism, and phenomenology, to cultural, political, and historical theory. We come from four continents, bear different skin colors, were raised into diverse faiths, and speak different languages as our mother tongues. We have not come together to identify the best theoretical approach for understanding the unconscious, or to synthesize a bridge across the diverse theories that inspire us. Rather, we cultivate the diversity of our backgrounds in order to enrich our exploration of the phenomenon that most intrigues us: the ineffable mystery which is the unconscious.

In this short piece, we would like to introduce people to our questions and method of investigation. Our purpose is to inspire other training therapists to hold similar events and reflect on their experiences in ways that will deepen psychological praxis, as well as engender personal insight.

Our Questions

The Collective is inspired by an unanswerable question, and the auxiliary questions that arise in its wake: What is the unconscious? Where is it? How do we access it? How does a personal unconscious interact, meld, or symbiotically thrive in groups? What is the relationship between the unconscious undercurrents of our shared, historically situated world, and the personal forces that influence us without our awareness?

As psychologists in training, we must struggle with these questions, for at their heart lie our understandings of meaning, freedom, and change. Graduate training offers many theoretical accounts of the unconscious in its vicissitudes. However, unconscious phenomena, such as "transference" and "projection," are characterized by our inability to recognize them as they occur. This is why it is so difficult to access the unconscious directly; it is strongest when we are least aware of it. And without this access, it is impossible to critically assess the theories and constructs we are expected to utilize in our clinical practice.

The unconscious cannot and should not be taken on faith. If we are to work with our clientsí struggles, it is not sufficient to understand how past scholars would recognize certain actions or utterances as indications of unconscious phenomena. Once we recognize the historical emergence of the unconscious in the discourse of human thought, we need to turn to our own experience to assess its use-value. We must come to see what the unconscious means underneath the constructs, free of the therapeutic power structure, and without the theoretical superstructure that academic study demands.

To this end, we inaugurated the Unconscious Collective: a group of clinicians in training that meets regularly for activities designed to illuminate the unconscious. Inspired by the power of projective tests, such as the Thematic Apperception Test, we decided that the Unconscious Collective would be an aesthetic group. Though Freud lived and died a scientist, his ideas have always been widely discussed and embraced by artists. This is not surprising, for every creative gesture is obligated, constrained, inspired, and ignited by unconscious sources.

Our Method

Below is a short description of the three events the Unconscious Collective has held. As with all human phenomena, each of the group members had a different experience, even though the events were all the same. It is in this difference, this personal feeling in regards to an event, where we come to experience the unconscious.

In the first meeting of the Collective, members were asked to sit in a circle and put on a blindfold. A lump of clay and a can of water were then placed in front of each person. The group was instructed to mold the clay into whatever they wished, while Air's "10,000 Hz Legend" album played quietly in the background. For fifteen minutes the members worked in relative silence, playing with the clay and crafting whatever came to mind.

When the blindfolds were removed, we discussed our experiences of the activity itself, including what it felt like to create, view, and reveal something of ourselves in this manner. Seemingly innocent clay toys turned out to hold much cathartic energy, and revealed to us how much is at stake in even the most trivial choices.

In the second meeting, members were randomly assigned a partner in the Collective. Each member was given a canvas board, and each pair was given three tubes of acrylic paint: red, blue, and yellow. The instructions were to collaboratively create a painting, either keeping the canvases separate or taping them together in any configuration. The only conditions were that each member must contribute to his or her partnerís canvas at some point, and that no verbal communication was allowed.

Upon reviewing the finished paintings, one could argue that we were looking at the phenomenon of collaborative unconscious. For, it was clear that (1) each painting was wholly different from every other, and yet (2) each painting was something that each partner could only have accomplished as a pair. Each painting was more than the sum of the individual contributions of the two painters. We looked at each painting, discussing its unique style, character, and content. We reflected upon the experience of creating silently with another person. Finally, we explored some of the unspoken interpersonal dynamics that the activity brought to light.

For a course assignment, one of our members gave the Thematic Apperception Test (TAT) to Pittsburgh sound artist Zak Zibrat. Zibrat was amazed at how powerfully the TAT was able to ignite unconscious connections, and began experimenting with an auditory projective instrument. The result was the Thematic Auditory Apperception Test (TAAT), which we used in our third meeting. The TAAT is a collection of six garbled conversations which the participants were asked to elucidate by telling the assessor (1) who the characters in the conversation were, (2) what the characters were thinking, feeling, and saying, (3) what led up to the conversation, and (4) what would happen next. Each group member was interviewed separately, with his or her descriptions recorded onto minidisk. After each member had described several conversations, we listened to the responses as a group.

The choices that each individual made, in transforming the content-less conversations into full-scale dramas, were testament to the specific ways that each of us makes meaning of the world. In discussing the interpretations, we found that others could see us in our stories. Without realizing what we were doing, we had described our histories, desires, and struggles, through the voices of imaginary characters.

For those interested in reading our individual reflections in more detail, please email us at criticalpsychology@yahoo.com. We also encourage therapists in training and those interested in the unconscious to consider holding similar events. The fruits of these experiential explorations will inspire new questions about the unconscious, profoundly affecting both therapeutic skills and theoretical reflection.]]> by Gabriella Serruya The Section V 2003 Student.... by Gabriella Serruya The Section V 2003 Student.... http://www.sectionfive.org/?permanent=5.56 root 2003-12-01T04:00:00-08:00 by Gabriella Serruya

The Section V 2003 Student Essay Award Competition winner is Gabriella Serruya, Institute for Graduate Clinical Psychology, Widener University, Chester, Pa.

In this beautifully written essay that ranges from memories of her own childhood play to insightful clinical encounters, Gabriella Serruya describes the unconscious as a ghost writer, a "story teller weaving its own logic and its own sequences into a tapestry that mezmerizes all who view it, if they dare." What Serruya has set out to do is nothing less than locate the unconscious processes that underlie Fonagy and Target's current work on the development of attachment and reflective function. In so doing, she describes a uniquely co-constructed intersubjective unconscious, very much in line with current relational models of the unconscious as unformulated experience.

—Ghislaine Boulanger

Part I: Play and Books

My parents are both psychiatrists.

Now, informing some people that your parents are psychotherapists, not to mention medical doctors, is something akin to casually mentioning that you descend from a line of witches. Inevitably, such people respond with an uncomfortable pause and a nod of the head or bland comment that screams the suspicion they forebear to admit. More often, people laugh out loud, and chuckle "So, did they analyze you all the time?" which, when they discover I am a graduate student in psychology, quickly turns to, "So, are you analyzing me?" The notion that one is an "expert" on the life of the mind seems to activate a fantasy in many ordinary, non-schizophrenic people that their thoughts can be read, almost as if thoughts had a bar code which could be scanned into consciousness by those with the proper equipment—namely, therapists.

Nor am I one to scorn this fantasy or even the discomfort that words such as therapy, words which promise contact with the psyche, elicit. As a little girl, I recall sitting in the back seat of the family station-wagon, wondering, as we sped along, whether my thoughts could be read, rather like the splashy signs for suntan lotion, liquor, and weekend getaways dotting the highway. I knew, with all the authority of my seven year old rationality, that mind-reading was not possible. But just in case, in the spirit of prudence, I decided to regulate any possible leakage. While I was thinking thoughts I considered innocuous, I would silently say "GO," visualizing a traffic light on green; when I came to thoughts that seemed more private and risky, I commanded "STOP," and the traffic light turned red. With a not entirely coherent logic, I decided that, though I could not altogether stop others from penetrating my thoughts, I could control their access. I must have imagined thought-readers as a rather friendly lot who would dutifully comply with my mental stop-lights and detour signs.

I no longer engage in what was, truthfully, a rather arduous degree of thought-monitoring. However, I do have moments in which I am convinced that other people can gauge my deepest intentions (particularly when I feel guilty), and I wager to say that most people share in such periodic experiences of felt transparency. There is something about the workings of the unconscious that provokes magical thinking, dramatic fantasy and equally dramatic fear.

I prefer not to believe that this mode of perception, or "primary processing," represents a more primitive, uncivilized, aspect of the self, governed alone by selfish demands. Or, if the unconscious must be characterized in such a way, I maintain that a great deal can be learned from the immediacy and force with which it translates impulses into images and feelings, i.e. in dreams, stories, and associations. And I am wary about attributing the sense of magic and mystery that attends such images and feelings to, simply, the mechanics of repression. To say that the power of a dream—or a poem, for that matter—simply reflects the affective charge of forbidden material seeping through ego-censorship is like saying that Beauty derives its impact from shock-value. I like to think there is a wisdom to the way the unconscious translates feelings into visions.

For instance, take the way my brother and I , as children, interpreted my parent's rather intangible profession. We knew our parents talked to patients, often on the phone in the morning. While we shoveled spoonfuls of Rice Krispies into our mouths, Mom and Dad calmly instructed people to increase or decrease their doses and made scribbly marks with ink pens in important leather books covered inside with times and dates. The medications bore exotic names: Xanadu, Ceyloneril, Marzipan (so it seemed), and they came in mysterious little packages called "milligrams," a word which thrilled my seven year old self with the hint of grown-up power and authority. Little wonder, then, that in the stuffed animal kingdom ruled over by me and my brother we had not only restaurants, shops, an airport and a dentist's office, but also a psychiatrist's office, presided over by an olive-green stuffed dragon with narrow eyes and a red flicker tongue. Dr. Dragon, as we dubbed him, was a wise and officious practitioner who was liberal, if a bit rigid, with his prescriptions: nearly everyone who came to see him was diagnosed with Major Depression and prescribed a hefty dose of "Hyderecees," a medicine whose active ingredient was Helium. This caused the frequent but relatively benign side effect of floating about ten feet off the ground. Psychiatric consultations consisted primarily of instructions on how to control the unwanted levitation. This , after all, reflected our understanding of our parents' profession: the language of mood disorders and thought disturbances was beyond us, but bodily symptoms we grasped. And maybe we were not too far off—somehow, in our enactment of the grown up world, we understood that the role of the therapist is to "lift people" without scaring them.

As I got older, and eventually set my sights on a career as a child therapist, I became more attuned to the subtext of play. Sometimes, the directness with which children announce unconscious emotional needs through "pretend" startles me. I remember, for example, babysitting a little girl of six or seven, whose parents were going though a complicated divorce, in part over the stress of taking care of their youngest, autistic child. The girl, black pigtails flying, entered the playroom in a storm of cheer. With a wide smile and unceasing chatter, she took down all the stuffed animals from the shelves and piled them on the floor. She would begin playing with two or three animals, and no sooner had we settled on our characters and the beginning of a plot, that she would jump up, grab two more toys, and announce, with the same vehement vigor, a new storyline. Dazed by her frenetic pace, and, frankly, overwhelmed, I ventured to admit my exhaustion, indirectly, at least. At that point, I was playing the part of a rhinoceros, and she spoke for a small elephant with a rainbow saddle. Hoping not to upset her, I made my rhinoceros into a severely shy and skittish character who finally implored his boisterous elephant companion: "I am too afraid to play with you. You move so quick and talk so loud, it makes me scared!" I was counting on the medium of play, or "pretend," to buffer any feelings of rejection—I forgot that there is a degree to which play is not pretend, but a direct representation of feelings, all the more so, perhaps, when high anxiety enters the fray. The little girl immediately sobered and turned a long, freckled face to me. She then picked up the elephant slowly, and had it speak, in a doleful tone, to the rhinoceros: "I guess you don't want to be my friend."

Overcome with guilt, I quickly moved the rhino towards her, and had him protest: "Oh, no, no, I do want to be your friend, I do, I do, it's just that I get so scared so quickly, but maybe if you could just talk lower or move more slowly so my slow mind can keep up, oh please…"

I am glad to report that the rhinoceros and elephant did manage a friendship after that. However, the incident made me acutely aware of the intense reality of feelings and the means used by children to protect themselves from their fears. If it were not for her relentless enthusiasm and near hyperactivity (attitudes, which closely mirrored her mother's approach to stress), my young friend would not have been able to stave away the intense fear that her family was dissolving and she would be left alone.

If anything, I wish this little girl could have played better: for longer periods of time, and with more ability to be "transported" into the play-space. In later times I spent with her, she refused to play, a pattern I have noticed in some of the children I saw in an outpatient mental health clinic. One of the positive powers of the unconscious is to help bind anxiety by enacting curative or healing solutions to emotional distress in play. The ability, in turn, depends on the more mysterious ability of the unconscious to weave a spell of "pretend," which removes children from the contents of the play, so that they see it as pure fantasy, and thus frees children to insert the most powerful and confusing aspects of their life into the fabric of the play. This quality of enchantment, of virtual self-hypnosis, amazes me. The unconscious is not just some cavern of loosely floating images and fragments, or a baby's maw, screaming out dreams and hunger; it is a storyteller (a wise old woman, I imagine, like one of the Fates) weaving its own logic and its own sequences, into a tapestry that mesmerizes all who view it—if they dare.

Part II: Attachment

What does attachment theory have to do with play, literature, and the magical unfolding of unconscious processes? It provides a necessary context. It explains that we are social creatures who require not just physical survival, in the domain of the material environment, but emotional survival, in the domain of relationships. This requires not only that we accurately read meaning into the vast lexicon of gesture, expression, and inflection with which people communicate, but also that we, as "readers," connect the behaviors of others to feelings within ourselves. I so like Fonagy's proposal (indebted to the work of Bion and Kohut) that, as infants and young children, we find our "self" via its reflection in the mind of the caregiver. Moreover, he explains, through the dual process of reflection and containment, the caregiver both "gives back" and helps structure the child's experience of selfhood, or way-of-being-with, in Stern's words (Fonagy, 1995). For instance, when an infant, overtired and somewhat hungry, cries, the caregiver, recognizing the signs of distress, generally scoops the baby up, croons something reassuring while looking at the child with a long face, in sympathy with the child's mood. Soon after, the caregiver locates a bottle, feeds baby for a short spate, and puts baby to bed. In loosely mirroring back the child's own distress, the caregiver not only validates the baby's experience, but also brings the experience of distress into the intersubjective domain.

Besides reflecting back the baby's distress, the caregiver's ability to recognize the source of the child's distress, and to act accordingly (i.e. feeding the baby, putting him to bed) contains the child's feeling and sends the message that the child's distress is a logical response to a solvable problem. In Fonagy's words, the caregiver recognizes the child's intentionality, or his active agency in the world (Fonagy, 2002).

Why do I like this theory so much? As a literature lover, I find the emphasis on reading the minds of others, and, in particular, reading the "text" of one's self in the mind of another, powerful, thrilling and deeply promising. If the self is borne out of multiple acts of interpretation—both the parent interpreting the child and vice versa—then there is that much more opportunity for elaboration, modification, and reinterpretation (a.k.a. therapy, for instance!). I suppose I am a product of my undergraduate literature department, where much was made of the connection between constructing a personal identity and writing a story. But I do not believe that any story, or any interpretation, can be made to fit a life or self. In a paradoxical fashion I don't fully grasp, the continuous mutual acts of interpretation that characterize human communication (both verbal and non-verbal) has to honor the core meaning of the other's gesture—even at the same time that a novel interpretation can change the meaning of the other's gestures. An obvious example of this phenomenon is that of a young child who has just fallen while running and looks, wide-eyed, to a nearby adult. The child's face is poised to either contort into a maelstrom of tears or to soften and brighten with a giggle of relief. The adult's response decides which response wins out: does the adult interpret the fall as a disastrous assault to the child's well-being or as yet another incidental casualty of childhood activity, with little harm done? In such an instance, the adult's interpretation may radically shape the child's subsequent reaction. Then again, it may not. If a child starts instantly bawling and clutching his knee, chances are that an adult's casual assertion that "Oh, it's OK, honey," won't carry much weight, as it ignores the child's essential experience. And, yet, even here, generalizations fail, because of the many examples, in clinical literature and personal experience, of how children learn to interpret events—even pain and distress—according to the dictates of important others, even when the interpretation conflicts with their own spontaneous reaction. The essence of an avoidant attachment, for instance, is the child's learning that marked distress will not be acknowledged and thus must be avoided, in order to win needed parental proximity (even while appearing to disdain it). A "false self" indeed.

Part III: Good Ghosts and Bad Ghosts

So, in all of this reciprocal writing and re-writing of behavior which dyads engage in, where does the unconscious come in? I imagine the unconscious like a veritable "ghost author": behind the scenes, he writes stories that paint a reality somehow not allowed, or "edited out," of the person's conscious life. The reasons for such editing are voluminous, but concern some kind of breakdown or tension in interpretation, i.e. in the mismatch between how a person sees and feels himself to be and how another sees (and so treats) him. This discrepancy need not be disastrous; quite the opposite, it may create an essential "playspace," as Winnicot might call it, for growth and change. In fact, young children at play with one another are experts at carrying off interpretations that, at first glance, conflict with their peers' desires. Imagine the following imaginary scene, based on many observations of kids at play.

"I don't want to be the dog," a five-year-old complains in a game of house.

"But we need the dog to bark when the robbers come. He saves us!" coaxes a peer. This naturally casts the role of "dog" in an entirely new light, from passive "extra" to starring role.

The therapeutic maneuver of reframing achieves the same end. In both cases, the re-interpreter, be she playmate or therapist, offers an interpretation that transforms (as opposed to crushing) the other person's perceptions into a richer, perhaps more gratifying and, at any rate, more compelling story. But it can't be the content of the new story alone that lends it its power—I think there has to be some unconscious communication between the two people in the room, such that the one offering up the new story or interpretation does so in a manner precisely tailored to address the concerns and desires of the other person. One person, to draw on Fonagy's model again, must present in his new story a reflection of the other that allows that other person to discover himself in a new light. I like to imagine that, through a process of inter-personal attunement, and under the direction of people's unconscious "ghost-writers" invisibly communing with one another, the text of peoples' characters develop and bloom.

So far, however, I have referred only to the good ghosts, the ghosts who want to share and even change their stories. There are also bad ghosts, ghosts who want to lord their stories over everyone else's. Instead of reading the works of their fellow ghosts and trying to merge stories into a richer whole, the bad ghosts pen interpretations that compete and bitterly antagonize other people's unconscious narratives, or, worse, smother them, until a thin, rigid and impoverished story is all that is left of the other's self. I call this abuse.

Case material and literature provides numerous examples. A mother sees her child as "manipulative" and "seductive," unconsciously interpreting the child's behaviors in light of the mother's own experience of sexual abuse. The child, equally unconsciously, "accepts' the interpretation despite her initial experience of her own actions as innocent. A father authors a story that his son is "lazy" and "ungrateful"; the son grudgingly "accepts" this interpretation, and struggles dutifully to rewrite his life along lines more tolerable to his father. However, the son's unconscious meanwhile rejects the father's story and writes an alternative narrative which renders the father a helpless subject, prostrate before the son's tyrannical anger. This particular father-son dynamic borrows from Kafka's many descriptions of relations between young male characters and older men. The older men, such as the judges in "The Trial" or the father in the short story "The Judge," appear as all-powerful, rather bestial types to whose whims the younger men are subject; yet, there are climactic moments in which the younger men appear to "turn the tables" and assume full control, laying waste to the pitiful forms of their decrepit, aged fathers. With the brilliance characteristic of Kafka's work, the nature of such reversals are ambiguous, such that it is impossible to tell whether they occur in "real life" or in the fantasies of the younger men. This ambiguity captures the essence of unconscious life, where fantasies are realities—stories—rivaling the doings of conscious life.

Where do these so-called "bad" ghosts come from? The attachment literature has long suggested that the caregiver's ability to perceive the child in a generally positive manner consistent with details of the real relationship between caregiver and child (as opposed to seeing the child, unconsciously, as a reincarnation of sorts of some past figure, often an abuser) is critical to the formation of a secure bond between caregiver and child. Fraiberg, in her classic essay "Ghosts in the Nursery," likened the tenacious hold of past abusers to haunting by ghosts (Fraiberg, 1968). I see these ghosts as struggling writers traumatized by their failure to have their stories told, desperate to narrate themselves into life through living vessels. I don't think this metaphor of possession is accidental: there is a magic and a kind of sorcery in the unconscious' ability to write stories that so profoundly shape people's behaviors. In my own, still quite limited, clinical work, I have been amazed to find the accuracy of the ghost metaphor: working with trauma survivors sometimes really does feel like working with the possessed, if only for brief moments. I recall one mother, for instance, who brought her seven year old to see me because of his clinging behavior at home and at school and extreme anxiety about her physical health. The mother had been physically abused as a child and then abused again by her boyfriend, the father of the child, whom she had since left. What struck me most about this mother was her intense calm, as if within the confines of her lowered voice and gentle communications with her son, she were holding at a bay a furious wind that could destroy them both. She identified this wind one day when she described to me her "former self" who had, she described, a terrible temper. She had vowed to prevent this anger from intruding on her relationship with her son because she had learned that it "did no good," and she did not want her son to learn similar patterns of behavior. I applauded her resolve to learn from her past experience and to create the safety for her son she had so sorely lacked growing up. And yet, I could see, without fully understanding, that there was a more powerful force present in the interaction of mother and son. The very pressure of her quiet and the unerring evenness of her tone hinted at a lurking danger, a danger which the son seemed to fear would carry his mother away. One day, in school a teacher's aide at school roughly handled the boy, thinking he had been insolent. That afternoon, as scheduled, the mother brought her son to see me. She was furious. It was with awe and a little bit of fright that I sat across from her as she pored out her anger in near whisper of words, perfectly spaced and arranged in tight sentences that had the chop and edge of military orders. "I will not let my son be treated like I was treated" she intoned, staring past my shoulder as if at an invisible aggressor behind me. I studied her face in rapt attention, feeling as if I could not look away, feeling as if there were a smoldering fire of injustice between us that I had to help her put out.

I never expected that my first clinical experience with hypnosis would have me as the subject and my patient as the hypnotist.

Then there was the physically and verbally abusive mother who brought her two teenage daughters to see me, only to end up slapping one of them, hard, across the face in one of our first sessions. Shock does not begin to describe my reaction. It was not simply the unleashed aggression, the total failure of impulse-control that astounded me about this family in which disputes were settled (or, more aptly, perpetuated) with fist-fights all around. I more or less understood the girls, with their tight-eyed reserve and muscle-taut wariness. It was the mother's mien that astonished me: her doughy lower lip, the dark furrowing of her brow, the big eyes and the taunting, whining words that tumbled from her mouth. It was like seeing a six-year-old charading as a mother! (I am forever grateful to my supervisor who, upon hearing of my anger at the mother, asked me what psychological age I imagined the mother to be. This perspective vastly improved my understanding of the case.) This mother was possessed by an irritable, unsatisfied little girl bent on punishing all those who failed to meet her insatiable demands. Here was a case in which a simple "re-interpretation" of facts did not suffice; it did not help for me to suggest to the mom that her own longstanding experience of hardship and legitimate desire for care and nurture made her children appear ungrateful to her, when, in fact, it was not they who could provide the love she desired. My powers of "authorship" were nil in comparison to the wrathful, hurt, six year old ghost who wielded the pen of this mother's perceptions. However, once, when I saw the mother alone, and asked about her own childhood, I saw even this ghost blow over and away, revealing a wasteland behind the mother's eyes that told me as much about her history as a detailed report. She simply sat, smiling a little, rather insipidly, and staring askance with blank eyes. "Are you spacing out?" I asked with concern, alluding to a pattern of behavior she had admitted to in an earlier session.

"I guess," she giggled in a feathery voice.

She did not describe her childhood, nor did she return to therapy .

Part IV: Accepting the Ghosts

Despite my dichotomous labeling of "good" and "bad" ghosts, as with most psychological phenomena, multiple aspects usually are present at once; ghosts are good and bad, so the stories they tell can be neither accepted full-heartedly or dismissed out of hand.

The struggle and complexity of living with ghosts, those unconscious authors of a wished-for life, is expertly chronicled in Toni Morrison's astonishing book, "Beloved." Here, a mother, Seth, is haunted by the ghost of her toddler daughter whom she murdered to save from slave-owners. I think this book should be required reading for anyone who works with trauma, and not just the trauma of an individual but the trauma of a people. If unhappy ghosts arise where attachment breaks down, then slavery, one of the greatest perversion of attachment imaginable, bred generations of miserable haunting. In Morrison's story, the ghost Beloved, arises from the river one day, the exact age she would have been if she had survived. The ghost-child moves in with her mother and sister, and the family life becomes dominated by the fierce hungers and joys of this returned spirit who does not speak but sings in eerie haunting poetry that captivates the reader as much as her family. Whether Beloved's return is real or elaborately fantasized, and whether it is more of a blessing or a curse, is left, wisely, wide open.

Beloved's voice, a voice of suffering and innocence and blood-thick rage, a voice which has as much power to destroy as it does to redeem, is a voice and embodiment of the unconscious. Stories like Morrison's remind us that the unconscious writes not just the narratives of individuals but of generations, and that letting the ghosts speak—no matter how "bad" or frightening they seem—is the first step to letting the slow magic of healing begin.

Thus has my conception of the unconscious evolved and I do not doubt for a second that this path, through play and books and introspection and various relationships, clinical and otherwise, is itself a haunted one. I know I am not the only writer here. I know that my interest in attachment theory and my fascination with the suffering and love that goes on between parents and children is itself a legacy, a kind of haunting. I believe this haunting is a gift that, when handled with care, offers a means with which to communicate with the past and continuously re-write the future. As a developing individual and as novice therapist, I aspire to court all the ghosts I can find.

References:

Fonagy, P., Steele, M., Steele, H., Leigh, T., Kennedy, R., Mattoon, G., and Target, M. (1995). Attachment, the reflective self and borderline states: The predictive specificity of the Adult Attachment Interview and pathological emotional development. In: S. Goldberg, R. Muir, and J. Kerr (Eds.), Attachment Theory: Social, Developmental and Clinical Perspectives (pp. 233-278). New York: Analytic Press.

Fonagy, P., and Target, M. (1997). Attachment and reflective function: Their role in self-organization. Development and Psychopathology, 9, 679-700

Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery. Journal of the American Academy of Child Psychiatry, 14, 387-421.]]> By Elisabeth Young-Bruehl Author's note: The Ka.... By Elisabeth Young-Bruehl Author's note: The Ka.... http://www.sectionfive.org/?permanent=5.57 root 2003-12-01T03:00:00-08:00 By Elisabeth Young-Bruehl

Author's note: The Kalinkowitz Memorial Lecture that I gave for the NYU Post-doctoral Program in Psychotherapy and Psychoanalysis on March 14, 2003, was based upon the text below. This text is part of a longer work in progress, and it should not be read as a finished piece. Please do not cite it or circulate it in its present form. Thank you, EYB

Part 1: "Child abuse and neglect" (CAN)


Child abuse had to be discovered. People have always known, of course, that some adults beat or rape or starve children; and that some societies have explicitly sanctioned injurious acts and violence against children, even institutionalizing corporeal punishments, child labor or child prostitution, infanticide. Although most of the harm done to children was taken for granted, some of it was condemned or prosecuted even before child abuse was discovered. In the mid-18th century, for example, almost a quarter of the capital rape cases prosecuted at the Old Bailey in London involved victims of less than ten years of age; while three quarters of the men charged with rape in mid-19th century France were accused of raping children. But these actions were prosecuted as rape, not as "child abuse and neglect." That designation had to exist before crimes against children were clearly and consistently distinguished as crimes against children. But even then there was not a concept explicitly indicating that a group—children—was being targeted and attacked when a child was raped as a child. There was not a concept like the concept sexism, which indicates that women are targeted and attacked when a woman is raped as a woman. Maltreatment of people of color existed long before such maltreatment was marked with the word "racism" and understood as prejudice against a group called "Negroid."

Throughout the 19th century, as children became more and more a group distinguished from adults and understood as having a special form of existence and stages of development, scientific and policy literatures distinguished types of children needing community—not just family—protective attention. In America, the 19th century categories were three: destitute, delinquent, and neglected. Starting in the 1870's and continuing into the 1920's, efforts to address destitution, delinquency and neglect were dominated by private groups, not legislatures. Some were socialist groups, echoing the hope of the great feminist-socialist reformer Ellen Key, who in 1900 had confidently proclaimed the advent of "the century of the child." But most were made up of wealthy Americans with Rousseuistic views, people critical of their own evangelical and puritan colonial forbearers for the way they had violently subdued children, preparing them for conversions, steering them to salvation. Philanthropic child protection societies were established in cities across the nation, but the national model was located in New York, and it grew out of a single heart-wrenching story, which might as well have appeared in a serial by Charles Dickens as in the April, June and December, 1874 pages of The New York Times.

Mary Ellen Wilson, an illegitimate child living in the home of a couple who were not her relatives, was brutally treated by her guardians. A neighbor observed her being beaten by her foster mother and sent to school in clothes not at all warm enough for the winter weather. A network of wealthy reformers came into play when, through a well-placed intermediary, the neighbor approached Mr. Henry Bergh, who was the founder of the American Society for the Prevention of Cruelty to Animals (ASPCA). Mr. Bergh, in turn, called in his friend and counsel to the APSCA, Mr. Elbridge T. Gerry, who took the child's case to court. For lack of any child protection statutes, Mary Ellen was rescued from her abusive home by a writ for removing one person from the custody of another, de homine replegando Her foster mother was sent to prison, and Mr. Gerry was propelled on to the founding the first Society for the Prevention of Cruelty to Children.

In the child protection societies that grew up at the end of the 19th century, the reigning idea was that neglected children needed, first and foremost, to be protected from adult violence, and that the way to do this was to remove the children from their families and send the offending adults to prison. With the co-operation of state legislatures, the protective societies had a great deal of power to prosecute—they had functions that later would be carried out by the police and the district attorney. State legislatures made few child protection laws, but they did make it a misdemeanor to interfere with the work of a child protection agent.

"Cruelty to children" was what the neglected suffered from in the era when they were dealt with by philanthropic organizations like the Society for the Prevention of Cruelty to Children. But when broader based Progressive concern with children's welfare began to be asserted in the years just before the First World War, neglected children slowly moved into the hands of social workers and police employed by states and by such federal agencies as the Children's Bureau, established in 1912. Judges and lawyers became involved as a juvenile court system evolved, bringing along with it distinctions between child victims and adult victims of crime. Both child welfare and child protection services were given a great push forward by the 1935 Social Security Act and its later amendments.

A dramatic change came about when the medical profession got involved in defining the social problem of the children who were called "neglected." In the 1960's, a Colorado-based group under the leadership of Dr. Henry Kempe, M.D., a pediatrician. led the way. Kempe was an émigré, trained by the psychoanalyst Rene Spitz, who had himself been a protégé of Sigmund Freud's colleague Sandor Ferenczi in Budapest. Spitz was a pioneer in making psychoanalytic films of institutionalized children., Using radiologic film and building on work done by radiologists in the 1950's,Kempe and his team described in medical terms a syndrome, a disease—"the battered child syndrome"—which they suggested should be approached in terms of treatment and epidemiology as though it were similar to smallpox or tuberculosis,

The Kempe group convened a medical conference in 1961, published their key article entitled "The Battered Child Syndrome" in a 1962 issue of the Journal of the American Medical Association, and then published a wide-ranging essay collection with the same title that is still basic reading for clinicians, researchers, lawyers, and policy-makers. Less than five years after their careful description of how to use X-ray films to identify physical abuse was taken up by the popular magazine press, all of the fifty States had laws on their books mandating reporting of suspected physical abuse. By 1974, there was a federal Child Abuse Prevention and Treatment Act, which encoded a broad definition of child abuse. Money was allocated for research efforts aimed at discovering the national incidence of child abuse and studying various approaches to prevention and treatment. A National Center on Child Abuse and Neglect (NCCAN) was established to monitor the national and states efforts, and it received steadily increasing financial backing up until the Reagan Administration targeted it as a threat to family rights and succeeded in scaling it back considerably. The National Center issues reports on child abuse annually, as do other organizations like the American Humane Association, but since there are fifty different state maltreatment laws, each with its own definitions, reporting procedures, and sanctions, the scope of the problem and the efficacy of various approaches to it are more elusive than is the case with the diseases tracked by the Centers for Disease Control.

In the decade after physical abuse was medically discovered, definitions for reporting and then for prosecuting and treating tended to be based on it: physical abuse was the model form of abuse for social services and legal purposes. But, at the same time, the vast increase in attention given to abuse resulted in more refined clinical descriptions and the identification of sub-populations of victims and victimizers. Particularly as physicians began to delineate "failure to thrive" (which had originally been called "deprivation dwarfism" or "psychosocial dwarfism") as a form of abuse, the way was opened for distinguishing physical neglect from physical abuse. Although physical abuse remained the most studied form of harm to children until the 1980's and popular press coverage of child abuse continued to focus on spectacular cases of bruising and battering, physical neglect was explored.

The new attention to neglect focused on acts of omission (rather than commission), not on effects discoverable on the child's body by x-rays or examinations. Many forms of neglect are less visible than physical abuse and sometimes the effects of neglect are not apparent at all for years. Using the new definition, researchers discovered that neglect is the most common form of abuse, amounting to around 50 percent of reported cases, and also that it is the form most frequently resulting in death, especially among very young children. Over 50 percent of maltreatment fatalities are from neglect.

When it became apparent that treatment programs based on the assumption that all maltreaters of children are alike were very ineffective, the child abuse literature began to reflect the insight that people neglect their children for reasons quite different than those propelling people to physical abuse. Further, although physical abuse comes in many forms, neglect is even more heterogeneous. While physical abuse had been subdivided in a medical manner by pathogens and effects—that is, by the means used to harm, such as beating, burning, whipping, cutting, shaking (as in "Shaken Baby Syndrome"), and so forth, and by the effects on organs and areas of the child's body—neglect was subdivided by differences in the negligent acts and domains of activity. The neglect categories included physical neglect such as deprivation of necessities of food, clothing, shelter, hygiene; educational neglect, medical neglect and mental health neglect; abandonment or lack of supervision; fostering of delinquency ;and intentional drugging. In study after study, two findings were noted about neglect that needed explanation. First, neglect correlates very highly with poverty and with single parent households, while other forms of abuse are to be found in all socioeconomic classes. This means that a majority of neglecters are women, while in other forms of abuse, particularly sexual abuse, the vast majority of perpetrators are male. And second, neglect is usually the sole form of abuse in a neglecting family, while other families tend to engage in multiple types of abuse..

After a decade of increasingly sophisticated reporting of physical abuse and neglect, reports of suspected child sexual abuse became more common. Even so, resistance to discovering child sexual abuse remained very strong, and Henry Kempe felt compelled in 1978 to try to do for sexual abuse what he had done in 1962 for physical abuse –to bring it into pediatric awareness. So he published a survey article in Pediatrics called "Sexual Abuse: Another Hidden Pediatric Problem."

Kempe did not mention it, but in the 1970's feminist exposure of sexual violence against women (as one of the main manifestations of what had come by then to be called "sexism"), had a profound impact on attention to child sexual abuse. Violence against adult women was the model for studying sexual abuse of children—at first, almost exclusively of female children by males. For years, the category "sex offenders" included both offenders against adults and offenders against children, even though both types of offences are heterogeneous and quite distinct causes and conditions underlie their forms. By the 1980's the number of suspected cases of child sexual abuse had overwhelmed the social service agencies charged with investigating them and the facilities available for treating the children.

As soon as the reporting of sexual abuse began to escalate and sexually abusive families were studied, comparisons with physically abusing and neglecting families were made. As a group, families where there was sexual abuse had higher median incomes, fewer external family pressures, and more internal family dysfunction. In comparison to other types of abusing families, they more often had two parents present in the household, with at least one employed full-time. Children reported for sexual abuse were predominantly female (75 percent of all cases), older that physically abused and neglected children (the average age was 8.1), and more likely to have been victimized by someone known to them but not their parent. While physical abuse was committed just as frequently by women as by men, and neglect was committed more frequently by women than by men, sexual abuse was much more common among men than among women. Sexual abusers were more commonly heterosexual than homosexual.

However, as soon as these comparative characteristics were established by questionnaire and survey methods, some of them began to be doubted by researchers with more access to clinical data. More male sexual abuse victims were discovered; more instances of sexual abuse of very young children were discovered, as it often turned out that a child brought into treatment at latency (age 6 to 10) would reveal earlier abuse; and more cases of incest were discovered, particularly as incest became a topic that could be talked about publicly or considered in television films like "Something about Amelia" (1986). Incest is the form of sexual abuse most likely to remain for years undiscovered, as it is the form most likely to be covered up within a family and a community, its victims being responded to with hostility and denial.

What can be said with certainty and generally about sexual abuse is that more secrecy surrounds it than any other form of abuse, so its discovery—in every sense—is the most difficult. Even the physical examinations are more difficult to conduct, not the least because of the invasion of a child's body and privacy they involve. In the late 1980s, pediatricians hoped that use of the culposcope, an instrument that illuminates, magnifies, and photographs the external genito-urinary and anal areas, would make sexual abuse discoverable in ways comparable to those by which x-rays had made physical abuse discoverable. But even with this instrument available, the vast majority of children later proven to have been sexually abused showed no evidence of the abuse when they were examined. And, of course, not all forms of sexual abuse leave physical traces. It turned out that sexual offenders, too, were not discoverable by technological means—for example, by penile plethysmography on males, which tracks penile erectile response to various stimuli—or by psychological testing of males and females. Sexual abuse is the form of abuse that depends most for its discovery on the verbal testimony of the victim, so it is not surprising that in this area of study questions about the reliability of children's testimony have been more important than definitional questions about what actions constitute abuse.

As physical abuse and neglect and then sexual abuse were being investigated, a whole field of scientific study, called CAN—"Child Abuse and Neglect"—took shape. Conferences and journals like Child Abuse and Neglect (1977) proliferated, research and treatment centers were set up, doctors, psychiatrists, social workers, lawyers, police, school teachers, and any professionals in regular contact with children were trained to make their own discoveries of child abuse and neglect. On an international scale recognition of child abuse and neglect increased dramatically as the United Nations declared 1979 the Year of the Child and formulated the Children's Charter, one of the founding documents of the Children's Rights Movement.

CAN was always a multidisciplinary field, because pediatricians, child psychiatrists, social workers, lawyers, police, and social service administrators had to cooperate in handling cases and working for prevention. But it has not always been a multitheoretical field. For its first decade, until the mid-1970's, CAN was dominated by the work of Henry Kempe and his associates, who founded a center in Colorado which became a model for both research and treatment. The field was shaped by their pioneering efforts to explore the psychology—and in about 10 percent of cases, the psychopathology—of abusers and neglecters, but particularly of physical abusers, and their efforts at developing strategies for intervention. For example, following Rene Spitz's lead, Kempe's group made films of mothers giving birth to babies and making their first contact with their newborns: their aim was to be able to predict which mothers, not able to bond or become securely attached, might be at risk for abusing. In the domain of theory, their hope was to describe an abusive type, the product of abusiveness transmitted over several generations, and their approach was psychodynamic, although they were much more open than most Freudians at the time to the work of the English psychiatrist John Bowlby and his associates in America who studied types of "insecure attachment."

The key characteristic that Kempe's associates described in the physically abusive parents they studied was their "underlying attitude of demand and criticism" in relation to their children. In a "role reversal," the children were called upon to give the parents the love and attention—the motherliness—that the parents had not gotten from their own parents. Writing about the physically abused children they studied, Steele and Pollack said:

All had experienced . . . a sense of intense, continuous, pervasive demand from their parents. This demand was in the form of expectations of good, submissive behavior, prompt obedience, never making mistakes, sympathetic comforting of parental distress, and showing approval and help for parental actions. Such parental demands were felt to be excessive, not only in their degree but, possibly more importantly, in their prematurity. Performance was expected before the child was before the child was able to comprehend fully what was expected or how to accomplish it. Accompanying the parental demand was a sense of constant parental criticism. Performance was pictured as erroneous, inadequate, inept, and ineffectual. No matter what the patient as a child tried to do, it was not enough, it was not right, it was at the wrong time, it bothered the parents, it would disgrace the parents in the eyes of the world, or it failed to enhance the parent's image in the eyes of society. Inevitably, the growing child felt, with much reason, that he was unloved, that his own needs, desires and capabilities were disregarded, unheard, unfulfilled, and even wrong. . . . Everything was oriented toward the parent, the child was less important.(pp.97-98)

Steele and Pollack looked at other characteristics appearing frequently among the physically abusing parents they studied. They saw intense rivalries in the past with siblings whom the abusers felt had gotten more parental love; they catalogued "obsessive-compulsive personality traits into which parental criticism had been channeled at an early age"; and they described rivalries in the present tense with a spouse or with the child designated for abuse. But the researchers interpreted all these as manifestations of the abusive parent's underlying feeling of being unloved or badly loved as a child. Abusing parents did not fall into particular character types—although there were hysterics and obsessionals among them—but they were all of a basic type: they were, as adults, still unloved—often abused—children.

Like the Freudian-influenced Frankfurt School social theorists of that time who were searching for a typical prejudiced person, a single "authoritarian personality," the Kempe group hoped to describe a single type programmed or acculturated to be a child abuser. If the abusive type could be discovered, a therapy designed for that type could be developed. But their own research also led them to raise the question of why some unloved parents physically abuse and others neglect.

We occasionally see a child who is both abused and neglected. Yet there is a striking difference in these two forms of caretaker-infant interaction. The neglecting parent responds to distressing disappointment [of expectations directed at the child] by giving up and abandoning efforts to even mechanically care for the child. The abusing parent seems to have more investment in the active life of the child and moves into punish it for its failure and to make it "shape up" and perform better (pp.99).

There was a clue here to what comparative work with parents of different types—or with different types of caretaker-infant interactions—would yield, but Steele and Pollack chose to consider only parents involved in physical abuse, not neglect. And their work preceded attention to sexual abuse or emotional maltreatment.

The work done by Steele and Pollack was so rich and so powerful that it overshadowed very interesting psychodynamic clinical research in this early period of CAN that was not focused solely on physical abusers. This research actually turned up not a single abusive type of person, but three basic types (which I will return to later). The three types did not get further explored, however, before the pendulum of attention in the field of CAN shifted away from psychological study of victimizers

By the late 1970's, when neglect had been more carefully studied outside of the Kempe Center and neglect's relation to poverty underlined, and when the discovery of sexual abuse was bringing millions of children into the nation's child protective services, sociological factors came more into theoretical play. Sociologically oriented researchers tried to compass all the forms of abuse, not just physical abuse. V. J. Fontana, for example, wanted to speak of a "maltreatment syndrome" rather than a "battered child syndrome" in order to include neglect more securely in research set ups and in policy decisions and in order to account for more of the social context of sexual abuse.

Speaking at the 1978 International Conference on Child Abuse and Neglect, Henry Kempe addressed the etiological controversy:

Since our last meeting, there has been lively debate about the relative importance of societal abuse of the parents by suggesting that child abuse is essentially a product of young families caught up in the stresses of poverty, racism, unemployment, poor housing and that these crises trigger the attack on the child and are the primary cause of physical abuse in children. This concept does not, of course, take care of the failure-to-thrive syndrome, or sexual abuse or incest, but it does take the therapist somewhat off the hook by blaming society's shortcomings for the parents' abusive behavior. Without underestimating the importance of external crisis as a trigger phenomenon, let me just point out that we are so very struck with the high incidence and serious nature of child abuse among a group of individuals who do have a job, housing, cheap food, free comprehensive health care, are married, and live surrounded by potentially helpful people. I am talking here about a group of military families who enjoy all these societal advantages and still have a significant problem of child abuse, with five child deaths occurring in a single military camp in my state in the past twelve months, Clearly internal and external stresses combine to trigger attacks.

The psychodynamic work that had been done by the Kempe group on physical abuse was also difficult to build upon and extend into the domain of sexual abuse because of the complex history that sexual abuse had in psychoanalysis. Because Freud had first hypothesized that both the major forms of neurosis—hysteria and obsessional neurosis—had their roots in "precocious sexual experience," that is, what is now called child sexual abuse, and then had withdrawn that hypothesis in favor of one that rooted the neuroses in the childhood fantasies of the oedipus complex, most researchers in the field of CAN assumed that Freudians did not—could not—account for actual, as opposed to fantasized, sexual seduction and abuse.

Freud had acknowledged real trauma, of course, but he put his emphasis on the child's intrapsychic world of sexual desire and fantasized sexual experience, he did not develop a description of how real traumas can effect a child's development. In the late 1920's and early 1930's, Freud's colleague and friend in Budapest, Sandor Ferenczi, did develop very vivid and compelling portraits of the consequences of childhood sexual seduction and abuse, and formulated a rich theory of sexual traumatization, but this work was marginalized in psychoanalysis and almost unknown in non-psychoanalytic psychology and psychiatry until the emphasis in CAN on sexual abuse brought it back into consideration.

But it was, unfortunately, not Ferenczi's trauma theory but Freud's fantasy theory, which many later Freudians made into a rigid refusal to consider actual sexual traumatization, that got most influentially woven into the complex historical discovery of child sexual abuse in the 1970's. This happened as lawyers defending alleged sexual abusers charged the victims with fabricating their stories of abuse and charged child witnesses to abuse with fantasizing. Freudian theory was put in the service of blaming the victim.

It was in the context of early-1980's debates about whether or how children could be psychologically manipulated in sexual abuse cases that a fourth category of child abuse was formulated. At first, it was called "emotional abuse" (a title that had existed for years) and then the preferred terms became "psychological abuse" or "psychological maltreatment." The first International Conference on Psychological Abuse, in 1983, was largely given over to definitional questions, as this form of abuse was and still is the hardest to define for either treatment or research purposes. By 1991, five categories of psychological maltreatment had been identified in standard-setting work by Hart and Brassard:

spurning (belittling, degrading, shaming a child for showing normal emotions, singling out a child for special criticism or punishment or work, publicly humiliating);
terrorizing (placing at risk or in danger, threatening loss, harm or danger if unrealistic expectations are not met, threatening violence);
isolating (placing unreasonable limits on freedom, unreasonably restricting social contacts);
exploiting/corrupting (modeling, permitting or encouraging antisocial behavior or developmentally inappropriate behavior, not permitting developmentally appropriate autonomy, restricting cognitive development);
denying emotional responsiveness (being detached and uninvolved through incapacity or lack of motivation, interacting only when necessary, failing to express affection, caring, love). Some researchers also pulled into the orbit of "psychological maltreatment" as a sixth category the mental health, medical, and educational forms of neglect. Others classified as a type of psychological maltreatment the "Munchausen by Proxy Syndrome," in which parents insist that their children have medical conditions and take them from doctor to doctor seeking verification, eventually making them ill, even slowly murdering them with conflicting treatments.
Almost all researchers who focus on psychological maltreatment are aware that it is involved to some degree in all of the other three forms of abuse—physical abuse, neglect, and sexual abuse. But it does sometimes appear in pure culture—some reports say in 5 percent of cases. Statistics on psychological maltreatment are the most elusive, however, because it is seldom reported and almost never constitutes the basis for intervening in a family's life or starting a legal proceeding. School teachers, private therapists, and other professionals who have on-gong contact with a psychologically maltreated child are the most likely to discover and possibly report the problem. If the psychological aspects of parenting practices were placed on a continuum from good parenting to bad, psychological maltreatment would fall at the extreme negative end of it, where differences of opinion among cultural groups about what constitutes good and bad parenting would be least. Interestingly , a 1987 Harris poll showed 75 percent of the respondents were aware that "repeated yelling and swearing" at a child can have long-lasting emotional consequences while only 42 percent were aware that the same can be said for corporeal punishment.


Part 2: Diversifying subfields and searches for unifying ideas


While the professionals who are part of the CAN research and treatment network have explored the different forms of abuse, the general public, alerted to the discovery of child abuse, and reminded of it by daily news reports of horrifying attacks on infants, children, and adolescents, grew much more aware of the seriousness of the problem. But there was very little further education for the general public. Anyone who is required by law to report suspected child abuse and neglect—from police officers to school teachers to youth center staff to chiropractors—receives some at least rudimentary instruction in how to identify victims of the different forms of abuse. But most citizens, and most policy makers at local, state and federal levels, have no idea that the researchers and practitioners in the field of CAN are studying and treating such a vast range of distinct but complexly interrelated behaviors and phenomena.

CAN is a field in which the subfields, identified by the different populations of victims, have been staked out and diversified. A rough map exists, and now it needs to be further refined. Each segment of it needs deeper exploration, conducted with awareness that the different subfields have been defined only by type of immediate effect or by type of act. The subfields are not defined by type motivation for abuse or by the psychic and social functions served. Both victims and victimizers have been studied in CAN, but the subfields of the field have been defined only by study of the victims and their symptoms. Questions need to be asked now about why, for example, in the domain of neglect some people neglect their children physically, others deprive them of education, while still others force them into criminal activities like begging and drug running (crimes which wold now be called psychological abuse). In the domain of sexual abuse, distinctions need to be made between sexual abuse of children that involves sexual acts, incestuous and not-incestuous; abuse that involves exploitation—like child pornography, child sex trafficking; abuse that involves pedophilia. Particularly in the sexual domain, the age of the victim –whether an infant, a child or an adolescent—makes a great difference in terms of the form of the abuse and the outcome, but so does the age of the victimizer, whether an older child, an adolescent or an adult, and the situation of the victimizer, whether in a family context or not.

CAN is a field that needs further and further diversification and refinement, But, on the other hand, it is a field that lacks a conceptual overview, general or unifying ideas. Feeling this lack, some researchers in the field suggested in the 1980's that the diagnosis Post-Traumatic Stress Syndrome or later Disorder (PTSD) could act as the unifying framework, revealing what all victims of child abuse and neglect have in common. That is, it was suggested that this symptom-cluster, developed out of work with Vietnam War veterans and with survivors of natural disasters and added to the Diagnostic and Statistical Manual in 1980, was an encompassing symptom-cluster. But, as critics have pointed out, many child abuse victims do not exhibit the PTSD symptoms. The PTSD symptoms are most frequently to be found among victims of physical and sexual abuse, seldom among victims of neglect, and only among certain types of victims of psychological abuse (for example, terrorized children).


Efforts to use PTSD as a unifying framework did have the great benefit of connecting the field of "child abuse and neglect" to trauma studies or traumatology. But the CAN field also became at the same time more and more connected to Attachment Theory, a connection that had begun to form in the 1970's when neglect was explored as a subfield. This connection developed further as the consciousness began to dawn in the 1990's that child abuse and neglect is not a disease or even four diseases, but the opposite of—or the absence of, the blocking of—the kind of parenting and caretaking and concern for children that fosters healthy attachment and child development. Child abuse is, most broadly, the failure to establish or the interruption of a caring relationship between a child and an adult or a group of adults that should meet the child's needs and foster its potentialities. Child abuse makes the child "other" and blocks normal maturation into adulthood. The crucial general questions, which Steele and Pollack had raised for physical abuse, were arising for the whole range of CAN phenomena: Are there reasons why abusers of all sorts are unable or unwilling to take good care of children, to supply the ingredients of good child care and healthy development?

This kind of general question was raised as an attitude toward child abusers that was meant to be "compassionate and non-punitive" was cultivated and associated with an effort to unite the psychodynamic and the more sociological theories of abuse origins into a synthesis sometimes called "ecological." In the 1980's at the Children's Hospital in Boston, under the leadership of Dr. Eli Newberger, the "battered child syndrome " of the Kempe group was criticized for putting too much stress on parental intention to harm and not enough on the kinds of stresses that produce poor parenting. Newberger and his associates defined child abuse as "a family crisis which threatens the physical and emotional survival of a child," while they put their treatment emphasis on strengthening family life. But after the discovery of child abuse expanded in this direction of focusing on relationships, a step beyond the bifurcation of psychological and sociological approaches and two steps beyond the medical or disease model, it stalled. And the stall has reactivated among citizens and policy makers when the definitional disputes that have always been characteristic of the CAN professionals reached them and intersected with concerns over professional interference in family life and concerns over the possibility that false accusations of abuse were common.

Researchers, therapists and the general public all routinely now apply the name "child abuse and neglect" to a large range of behaviors, but constant disputing about where to draw definitional lines goes along with the normal usage. Similarly, various kinds of prevention approaches are being tried and tested, but amid great skepticism about their efficacy. Treatments are being offered to some child victims and some adults who were child victims, but there is no agreement about which treatments are most effective for which populations and types of victimization. There is also an on-going struggle about whether to offer physically or sexually abusive or neglectful people treatment or prison sentences—and if treatment, of what sort? And all this discussion takes place in the context of increasingly strenuous attacks on the generous funding for CAN that was available in the 1970's and 1980's, but which (as noted) disappeared in the Reagan presidency, when an ethos of "family values" weighed against state and federal interventions in child rearing.

Generally, although interference with normal development and particularly, recently, with secure attachments and healthy, cherishing relationships , is emerging as the broadest definitional framework of child abuse and neglect, the realization has not even begun to dawn that "child abuse and neglect" names not just a group of four types of behaviors or of anti-growth relationships but a form of prejudice, comparable to sexism and racism. We do not think that there is such a thing as prejudice against children –and we certainly have no word for it. This stall in thinking has meant that only the phenomenological surface of child abuse has really been discovered. The visible (or X-rayable) phenomena have been discovered, the name "child abuse and neglect" has been given to them, and the forms of victimization have been preliminarily mapped, but sources, meaning, and significance in our contemporary world—our globalizing world—of child abuse and neglect remain obscure. There has been a conceptual breakdown, which is our contemporary form of the denial that, for centuries, kept child abuse from being discovered at all We are really no further along than Charles Darwin was when he remarked about infanticide that: "Our early semi-human progenitors would not have practiced infanticide… For the instincts of the lower animals are never so perverted as to lead them regularly to destroy their own off-spring" (Bakan, xi). Darwin recognized that "child abuse and neglect" actions are human actions, that is, actions which distinguish us from the other animals, but he was at a loss to understand this "perversion"—as he called it—of our nature.

Unlike Darwin, most contemporary people, hearing the phrase "prejudice against children" would find it senseless or just shocking. We do not even use the word that was available in Darwin's time for prejudice against children, misopedia ('hatred of children"), which was developed to echo the more common words msogyny, misandry, and misanthropy. "Prejudice against children" makes no sense to most of us because it flies in the face of a conviction that parents (if not all adults) love their children and with ideas about maternal (and sometimes paternal) instinct. Further, we understand a prejudice as a way of thinking about, talking about, and acting against a group and against individuals as members of a group; but most people do not recognize children as a group or think that when a child is attacked the fact that the child is a child is involved as is the attacker's attitude toward children and the attacker's society's attitude toward children. Although other huge portions of the human species are recognized as groups—women and people of color are two—and these groups are represented by social and political movements asserting their rights, children have not won comparable group acknowledgment. There is a fledgling children's rights movement, which presumes rights specific to children as a group, but the existence of the group is not yet part of common consciousness. In 1994, The United Nations issued a Convention on the Rights of the Child –not the Rights of Children (like the Convention on the Rights of Women). But the existence of this Convention is known to very few citizens of the one hundred and ninety countries that ratified it, and only a few citizens of the United States of America know that their government was the only legitimate national government in the world that did not ratify this Convention, claiming that it impinged on our national sovereignty. It is certainly a clear example of prejudice against children to value, as United States governments have, the strictest construction of national sovereignty over the welfare of children.

Everyone who uses the words sexism and racism understands that they refer to prejudices against a group and against individuals as members of the group. Beating a woman is a manifestation of sexism, not just an action against an individual woman stemming from a victimizing individual's individual psychology and social situation. Sexism is the concept that connects the individual psychology of the woman-beater to the social and political context of the act and to the cultural norms that sanction—or even require—woman-beating. Physical, sexual and psychological abuse, and neglect are directed against children as members of their group, too, but even though the name "child abuse and neglect" now exists to designate the effects of these behaviors, most people still think of the harm that befalls a child as befalling only that child. There is no misopedia or "childism" involved.

Because the behaviors comprised by "child abuse and neglect" are not thought of as manifestations of prejudice, little in the whole vast history of social scientific study of prejudices has been brought to bear on these behaviors. The word "sexism" came into existence in 1965, at just about the same time that child physical abuse was being discovered by Kempe's team, but the emergent field of child abuse and neglect did not link up with the study of sexism that then burgeoned with the upsurge of the Women's Liberation Movement and contemporary feminism. There were no theorists or activists to advocate for analyzing and combating prejudice against children, and children do not, of course, appear in public to advocate for themselves any more than infants speak for themselves when they are abused—their x-rayed bones have to speak for them. Children do not have deeds or words—the noun infans means without speech—in the political sense. The vast library of books on prejudice that has built up since the 1960's does not include volumes on prejudice against infants, children or adolescents , although it has begun to include volumes on prejudice against another age-designated population group, ageism.

The lack of a link between "child abuse and neglect" studies (CAN) and studies in prejudice is not just an academic matter of how research is organized in universities or fields organized in the domain of social science. The isolation of child abuse and neglect as a field from other types of prejudice studies has had profound effects on public policy for the prevention and treatment of child abuse and neglect, as it has had profound effects on prejudice studies, which have a glaring hole where the suffering of children should be. The lack of a link between CAN and studies of prejudice has meant that the questions that stop most people who think at all about child abuse and neglect from going very far—How could a person beat a child? Rape a child? Starve a child to death? How can others let this happen?—the questions of motivations and meanings—can hardly get posed. The psychological inquiry that was characteristic of CAN in its formative years never did connect up with the broader field of inquiry into human destructiveness and violence. Recently, for example, while reports of child sexual abuse by Catholic priests have been pouring forth from all parts of the United States and from around the world, and the Vatican has been trying to formulate a policy for dealing with the priests charged with abuse, the media have been very reluctant to ask what moves a priest—a person committed to imitatio Christi, to compassion for human suffering—to abuse a child. To ask: What is pedophilia? What are its forms? How can it be treated? Without understanding, policy is usually made badly, if it is made at all. And without understanding, people tend to throw up their hands in despair rather than thinking in terms of social problems and solutions.


Part 3: Childism: Prejudice against children


If there is a prejudice against children, as widespread as sexism is, what is its message? The message, I think, has two basic parts, which appear in all the myriad forms that childism takes. The first is that children are the property of their parents, which in patriarchal contexts means primarily of their fathers, to be raised and used and controlled and disposed of as their parents see fit. In the medieval European world, this ownership was of children as physical property, like chattel, in the modern world the meaning is custodial. For a childist, child ownership is the natural subordination of children, which is tied to the dependency children are born into. It is thought natural for the dependent child to serve the parent's interests—and it is only a step from that assumption to the assumption that children should give their parents parenting, not just when the parents are old and enfeebled, but when they become parents. The dependency of children seems to give the idea of child ownership even more legitimacy than the sexist's idea that women, even though they are adult and not dependent for their very survival on another adult's care, are naturally subordinate

The second part of childism's message is that children are bad and in need of control or punishment for their badness, which also makes them burdensome. That is, they are born needing to be disciplined, continuously subordinated, and they are born a burden on their parents, especially those who feel that their own needs have not been met. The childist says righteously: "You have to discipline your kids or they will grow up delinquent" (or, in the older language of instruction, "spare the rod and spoil the child") The childist says, with a sense of natural hierarchy and ownership: "Children have to be taught to respect their parents and authorities." And the childist says: "Children should not drain their parents' resources or pull them down." The degree to which this "bad and burdensome" ingredient of the prejudice is spread through any given society varies over time, as does the degree to which it is buttressed with religious argument, mores, customs, legal codes, and educational precepts. Whenever a social movement reflects and promotes rebellion of children against their parents, the prejudice that calls children bad and burdensome waxes defensively; it wanes when children are once again properly subordinated.

The first ingredient of prejudice against children—child ownership—links it to prejudice against women and to racial prejudice. For a great deal of its history, and in much of the world to this day, sexism meant that men could own women, as racism meant that people of one group could own people of another group as servants or slaves. And the various kinds of adult-to-adult subordination, of course, survive elimination of legal ownership and sanctioned slavery, as prejudice against children has survived the elimination of the most concrete forms of the child ownership idea. Prejudice against children is also tied to sexism and racism in that female children are victims of sexism and children of one group are victims of prejudice against their group as well as against themselves as children.

But the second part of the prejudice against children, while it has some elements in common with sexism and racism, also distinguishes childism. Sexism assumes inferiority of women, which can take many forms, sinfulness, sexual wildness dirtiness, cunningness, and so forth; but these forms of inferiority are different than the badness and burdensomeness attributed to children. Similarly, racism assumes the inferiority of a racial group, which is almost always imagined as primitiveness, sexual perversity or anarchism, and intellectual deficiency, not as the kind of badness and burdensomeness attributed to children (although racists do sometimes call their victims childlike or imagine them as uncivilized children). Children may be accused of these types of inferiority—particularly if they are female or of a particular group, or if their sexuality is a focus of attention and fear—but they are specifically bad as carriers into the present of a badness that comes from the past or as carriers of an ill that is going to be manifest in the future, and they are particularly burdensome as competitors for scarce resources in the physical sense and, more importantly, in the emotional sense—resources of survival and resources of love. Their badness and burdensomeness always have a tacit temporal dimension: children are bearers of curses and legacies of failure from the past, or they are potential competitors with or supplanters of adults in the future.

When they are born, children are completely powerless, completely helpless—more dependent than any other mammals—but they are imagined as made powerful by a legacy they incarnate or as preparing to be powerful in the future because of a destiny. Their badness has to do with how they may undermine or overthrow adults, taking away what adults have or want or need. They are a threat to adult power and pleasure. Prejudice against children turns the most obvious fact about adult-child relations, which is that children grow up to replace the generation that gave birth to them, into a frightening and reprehensible badness of the children. Prejudice against children is manifest in all kinds of ways of keeping children down, keeping them children, stopping their growth and maturation, which is felt as overthrow, usurpation, parracide. Children are, as the political philosopher Hannah Arendt put it, "new beginnings," representatives of the human condition of natality, of being born. Childism is rejection of "new beginnings," and thus a rejection of a key existential condition, a key feature of our humanness, natality.

Looked at from the opposite side of the prejudice coin, people who are prejudiced against children imagine that children are good only if they enhance the power or pleasure of adults, by carrying on the past or fulfilling an expectation for the future. They are good if they parent the parent, giving the parent all good things the parent feels have been lacking. Spanking a child who has misbehaved is quite a different action than fracturing the skull of a child who has cried a bit too loudly, but these behaviors are on a continuum of behaviors that have in common the attitude: a child is a being who should make me feel good, and who is bad if he or she does not make me feel good. A child can be sexually abused in many different ways, and the ways lie upon a continuum in terms of the violence that may be involved, but all the ways have in common that the adult abuser enjoys power over the child (a position that the abuser, particularly the pedophile, generally, feels could not be obtained in relation to an adult), and that power makes the adult feel good, feel enlarged, inflated. Types of sexual abuse differ, but they have in common that the sexual abuser makes the child the kind of sexual object he wishes the child to be—the child is like a screen onto which the abuser projects his wishes. The child is, as feminists said of women in patriarchy, objectified. And if the child fails to be the feel-good object, it is punished.

This feature of childism has been observed under different names, including the one given it by Morris and Gould and used by Steele and Pollack in their discussion of physical abusers: "role reversal," that is, "a reversal of the dependency role, in which parents turn to their infants for nurturing and protection." Parents who feel insecure and unsure of being loved turn to their children—or a particular child—as though the children had adult abilities to offer the missing love and security, while not making adult demands or having adult power to command. The parents behave like frightened and angry children, and they have no idea what their own children, as children, need (an ignorance that manifests in cognitive terms as lack of knowledge about children and child development, lack of any sense that children have needs that are different from adult needs). Abusive young mothers, for example, will say : "I never felt loved in my whole life, and when my baby was born I thought he would love me; but when he cried all the time it meant he didn't love me, so I hit him." A pedophile will say: "When I was with her she made me feel that I was special and I felt I gave her a kind of loving she needed for her own good and no one else could give."

The two interrelated and overlapping parts of the childism message that I have been outlining—the part that proclaims children natural subordinates, and the part that declares children bad or burdensome and needing adult discipline—are negations of an attitude toward children, or a belief about children, that can be simply expressed as "I value this child more than myself," or "I want this child to be well and happy more than I want my own wellness and happiness." The raising of children is the natural sphere of altruism. "You, who are totally dependent on me, can totally depend upon me." This non-prejudicial attitude presupposes, I think, the idea that children are sociable by nature, that they are born into the world wanting to love and be loved by their caretakers and that their natural growth and development are the unfolding of this drive. Looked at in the same way, sexism and racism are negations of an attitude toward adults that can be simply expressed as "all people are created equal and should not be deprived of their basic survival needs or prevented from the development of their sociability—their need to love and be loved—in relationships of equality"]]> An appreciation of Stephen A. Mitchell in the form.... An appreciation of Stephen A. Mitchell in the form.... http://www.sectionfive.org/?permanent=5.58 root 2003-12-01T02:00:00-08:00 An appreciation of Stephen A. Mitchell in the form of a book review

by R.G. Kainer

Art pushes back the void. The sudden death of Stephen Mitchell left a great void, and his posthumous book Can Love Last? The Fate of Romance Over Time consoles us. It is the bittersweet fruit of his labors that made him so highly regarded in our contemporary analytic world; one he helped shape through his open mind and his generous spirit. From his now classic book on object relations theory (co-authored with Jay Geeenberg) to this final one, he left a rich intellectual legacy.

I learned of this book from Stephen while it was in progress. In these ethically challenged times, I should make a full disclosure: We each lived, practiced, taught, and wrote in different cities. I was not a part of his New York academic world, nor a participatin