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Saturday, 4 August 2018

Trump and social change in the USA

 I received several emails chastising me for posting my opinion of The President of a country I am not a citizen of. As long as the US claims to be the leader of the Western world (the free world !!) and I live in that part of the world now I have he right and the responsibility to state my opinion of that president, even if in some places I might touch the internal affairs of the US. I was also criticized of giving Trump the diagnosis of autism because most professional either disagree with the diagnosis or have other diagnoses. Most of the disagreements on the diagnosis of autism are  based on the absence of the common behavioral symptoms we usually see in  afflicted children. Autism is not a childhood disease; autistic children grow up to be autistic adults. The degree of disorganization in an autistic person has to measured not by the open symptoms, but by the core problem in autism: External Reality. The autistic person gives the signs that he is unable to put his own reality aside to react to external reality (our reality). What I am going to say is not in any way related to ‘the alternate reality’ that is used in the vocabulary of the white house to cover up Trump's extreme intolerance of external reality. External reality is what stands out of the realm of fantasy, imagination, daydreaming, i.e.. It exists on its own, independent of the person who is perceiving it. 

There are three other realities that also exist but do not conflict with external reality much. The first is the reality of the neurotic and some borderline cases. This reality is formed in childhood and becomes fixed and imposes itself on the subject in certain circumstances. However, it does not affect its 'real reality' or other realities that are formed before or after its formation. In spite of the fixation of that reality the neurotic knows the difference between what he reacts to as reality and the reality of his neurosis. The most demonstrative of that reality is the phobias. The phobic patient panics in the dark yet he knows that there is nothing really out there that justifies his panic. 

The second reality is mainly a problem in character neurosises. The patient of character disorder does not accept or agree with certain external realities because they stand in the way of the functions of his character formation. He tries to change that ‘frustrating’ reality by will and intention (ignore, avoid, fight, lie about, etc.). But, in doing any or all those things he still knows that the reality he does not accept exits out there and that it just irks him. He never forgets its presence.

In all those conditions the subject visits external reality and reacts to it emotionally. The phobic who turns the light in the whole house still complains of his illogical fear. The psychopath tries to gain the confidence of those whom he would like to sheet and react narcissistically to his successes and failures in changing the reality of certain situation to manage his psychopathy.

The third reality is the reality of the autistic. The autistic -child or adult- seems, looks, and behaves as if he is shielded from external reality. External reality does not elicit reactions from him and he swings from rage to apathy if it is forced on him. The autistic does not respond to both external causes of frustration or satisfaction. Yet, the autistic seems to have some sort of reality that keeps him busy all the time. It is what appears to us as sort of ‘him’. An example to that reality is Trumps tweets. they reflect what is occupying his mind which most of the time relates insignificant realities or relates in strange ways.

To be accurate I should say something about 'him'. existence "him"  saying that. For the him to exist there should be some psychological space between the acting self and the observing self . The autistic (Trump) does not have this gap. This shows in always talking about the people who deal with his "him" not of the him.The gap between the acting and the observing him is  necessary for making judgment, taking decision or even feeling  something that pertains to a situation. Trump is undifferentiated psychologically.  He  self-generates reality (the most... in history, the most ridiculous, etc) and stops at that. His reactions to his created realities happen without a sense of ‘will’ (only twitting or so called lying, etc. )The young woman I mentioned before was able to give us a hint of what happens in the mental life of the autistic if he gets moments of release from autism: he sees external reality but it does not create  an impact on his cognitive functions.

Going back to Trump we can easily realize that external reality does not exist for him or even conflict with his self generated realities. There is two features in trumps autistic reality: he is quite content with whatever reality his autism imposes on him at any time (that was why he seems inconsistent or liar). The second is a strong need to exaggerate about his reality. This could deceive us psychoanalysts and we give it a psychodynamic meaning. Exaggeration of autistic reality is an attestation to its lack of importance to the autistic.  The observations that led me to my diagnosis are debatable but undeniable.

He is a person who is oblivious of what others think or feel about him. I do not know a psychodynamic condition that causes such affective deficiency without some psychotic concomitants with it. but I also cannot see any features of psychosis in Trump. This condition is not associated with aggressive or sadistic component to be consider an affective disorder. Few years ago, a British medical journal published a research on autism stipulating the existence (or none existence !?) of a Genetic factor associated with the autistic total lake of emphatic qualities. This is prevalent state in autism and very obvious in Trump's human relationships.

After two years he still has nothing presidential about him (except those funny head posture of grandiosity). The man is not even aware that he constitutes a reality to others and what he says or does is not taken as coming from him personally but from the person he has become (the president).. He is not even narcissistic to be concerned about his image.

All this could be boring or interesting. However, we should not just stop at Trump’s autism. There are tens of millions in the US who do not see how ‘strange’ and unfit Trump is.  The Republican party too supports The President blindly to cover up his  faults. Normally, leaders try to achieve the objectives and aspirations of his people. The situation raises straightforward questions in regard to the trump phenomenon: 

1. Could a country like the US elect someone like Trump by mistake or should we look for other reasons for that the mistake?

2. Could there be social or historical factors behind the Trump phenomenon?

3. If there are what could psychoanalysts say about them?

In the next section I will try to answer the first two questions.

Thursday, 21 June 2018

Trump II

Back to Diagnosis:
I mentioned above, that the psychodynamic diagnoses, even the ones I entertained, did not convince me. There are several reasons; the most important was that they do not take in consideration the mental and cognitive anomalies Trump kept revealing more of every day. In other words, no psychodynamic diagnosis could explain the other none psychodynamic pathologies his behaviour revealed. I did not have any explanation for the glaring deficiencies in Trump’s psychological life, even before the nomination for the elections. However, Dr. Jackson’s suggestion of neuropsychological testing kept ‘teasing’ my thoughts. I never administered a neuropsychological battery in my clinical psychology career. I know very little about them, but some of the symptoms I mentioned above fall within the known famous battery of test in my time The Halstead-Reitan Neuropsychological Test Battery. Only when I though seriously about that possibility I remembered a radio interview and discussion of more than twenty year ago with a young woman who wrote a book about her autism. I still remember my amazement that autism is so many degrees and of several types and not only the typical condition of childhood disintegrated intellectual faculties. She also indicated that she had moments or sort of periods when she was in touch with “your reality” but still was unable to have full contacts with US. I compared Trump’s symptoms to this case and others that I reviewed to prepare for my post. I was more comfortable with the diagnosis of autism than any psychodynamic diagnosis. What encourages me to stick to that possibility is what is known about Winston’s Churchill’s known diagnosis as a child of being autistic. One of the Nobel prize winners (Dr. Nash was a severe case of autism). My internet part of my survey brought to me a memory of a grandmother who told me about her autistic grandson. She said that he sometimes had what looked like clear up of his autism for a couple of hours. During that period, he liked to draw and she showed me some of his drawings. They were of apartment buildings and streets that were very neat and had unusual details. On one of the pages in an article on autism there a drawing by an autistic person which was very similar to that child’s drawings, both in the subject and the details of the subject. I think the young woman’s statement of being in our reality explains the drawing of the autistics: they sometimes get fully if not intensely immersed in external reality. The review of the recent literature on autism gave me the impression that trump could easily fit in this category of psychopathology, but even explain many contradictions in his image as a normal person.
My suggestion that Trump could have a degree or a type of autism which gives this unusual clinical picture is not based on positive neuropathological signs but on the insufficient presence of psychodynamic signs that could also take care of his mental and cognitive symptoms.
3.     Trump the Misfit that Fits Perfectly:
Trump’s inability to navigate a thinking process, to realize the necessity of taking definite positions from the reality he is facing, and his innate limited affective life are truly handicapping factors in his performance as the president of a country with size and importance of the USA. There is no way to avoid two questions: What could that historical anomaly mean in general terms? How could we understand such gross historical mistake?
The election system in the US is not strait forward one person one vote.  There are certain other provisions related to an early (historical) reservation that required creating a checks and balance way to avoid a simple one person one vote system. As a result, Trump did not get the majority votes but was elected by the power of his party. To put it bluntly, according to one person one vote principle Trump did got the presidency the common meaning of the term democracy.  Coincidentally, this result is logical under the general circumstances. I mentioned before that there is another factor in social movements beside the nature of the leader that determines the outcome. At a time when history is at a major general turning point the political succession in the different parts of the world seem to happen in a predetermined way, where the change in political authority gets more systematized according to stable dialectical system.
Since the end of the second world war the world was reorganizing it self in a way that evades world wars again. In a very brief note: the world got organized on the principle of networking instead of hierarchy. There are few large political constellations of countries that are relating globally without the old notion of a leading nation (the principle of empires). The short form of it: for five or six decades the USA was at the summit of the world: the leader of the ‘good’ nations. Now, the USA is one of a worldwide net of nations. This fact is not sitting well with the US political leadership that maintained that the US is the leader of the ‘free world’. The political administration before Obama entered two unjustified wars to exercise its influence. The two wars did not give the desired result. The outcome was electing the antithesis of bush, a savvy internationalist president who endeared the US and himself to the world. Eight years of that was not enough to turn the US around, and the US is back to the phantasy of “America Great Again”. There came the misfit who fitted this idea perfectly. Trump exemplifies and personifies the US reaction to historical change: a muddled up mind, a white house in disarray, an administration that survives on denial and autistic thinking. Americans stumbled over the best leader for the moment. However, the consistency of historical evolution gives us some clues to what to expect next.
There are some political Taboos in the life of the average America citizen that hinders making changes in the status quo.  There are also some Totems that are worshiped and it would be blasphemous to get rid of or replace. The term working class was a taboo because it was associated with the labor parties in the rest of the world, which were left wing and liberal Thus they were against Americans idealization of individuality and some traditional thought related to ‘moral values”. But, unemployment and wages showed that is called middle class is actually a working class. Lately, the word socialism was mentioned with some difficulty but it is no longer a taboo. The clear defined aspirations of the youth in the states is also a sign of the death of another taboo which is the need for more political parties in a country as vast as the US with its population diversity. Till now there are factions in the two parties that seem to be clearly ignoring the social, political, and ideological taboos. The Totem of the forefathers seem to be losing is absolutism and sanctity. There are significant questions raised about the rights of the individual and the authority of the government in regard to social versus moral conflicts.  
Trump is fit for this stage in American and Global change. He is so imposing to let us forget what should be done. Whether the antithesis of Trumpism will com in two years or six is not easy to predict.
What about psychoanalysis!  
Because this posting is written with psychoanalysis and psychoanalysts in mind I wish that what I am concluding from politics (in the US in particular) can be applied to the crisis of psychoanalysis: it has taboos and Totems that need to be examined so we get ourselves rid from our self-imposed chains. We need to get rid of the taboo of training and adopt the natural idea of education. We should get rid of the taboo of personal analysis as therapeutic necessity and accept it as a didactic step in the formation of the analyst. We should get rid of the taboo that the psychoanalysis is a profession of psychotherapy and look at it as a human science instead. We should get rid of the Totems of the old schools and avoid forming new Totems of the new forming schools. We should get rid of the Totem of the training analysts and accept the fact that analysis is not transmitted from generation to generation through ‘master’ but thorough teaching systems.
We should accept that we are not a special breed of professionals because we a closed community of practitioners; no autism.

Monday, 18 June 2018

This posting has two more parts

               Trump outside the circle of psychodynamics.

For a none American who knows the USA reasonably well watching what is happening there, for the last two years, is unsettling. I thought that I can fairly understand historical events if I meant to analyze them, but I am not sure anymore. The election process in the USA with Trump’s role in it, ending being elected by a twist in the process, backed by minority popular voters who became the only recognizable political force in the country, succumbing the will of the Republican Party to its will, creating a cult of Trump, and changing the balance in democracy in the country is too much to fathom. All that need acrobatic political analytic efforts to explain. Understandably, mental health professionals directed their attention to Trump the person. He is a glaring case of “strangeness” that is also difficult to make sense of. They did not ask the question: how on earth could that man-whoever he is - be the president of such an impressive country, accepted by millions of Americans, and become an unchangeable political power. They tried to understand him to understand and explain the phenomena, instead of understanding the phenomenon first to explain him.

I want to explain my basic stand about social evolution. There is no leader (from Moses to Ghandi and Mao) that could initiate a people’s movement which could change the course of history. Those historical movements create leaders or find them and make them lead the people to achieve their aspirations. Germany of after Versailles looked for a Hitler to avenge their humiliation and chose the Jews to project on them their sense of isolation and helplessness. There is another factor that I will mention by the end of the posting which is equally decisive in having a wider view of matters.  Trump looks like that kind of leader. He-as an individual- is of no real qualities to lead the USA anywhere. But what the US aspires to achieve seems to need a period of “Trumpism”. The USA stumbled over him by mere chance. However, there is no doubt that Trump as an individual is a fascinating pathological specimen.

1.     The Problem of Diagnosis:

Mental health professional, and psychoanalysts in particular, have a inclination to giving psychodynamic explanations to human phenomena. They usually get away with that-without any demands for justifying themselves- because human phenomena are engendered by psychical dynamics, which is the domain of their expertise. Sometimes the ease dictates taking this venue in understanding, but most of the time this tendency tempts to overlook or disregard important non-psychodynamic issues in the phenomenon which could be more significant. Trump is a model of this case. He is amazing in magnifying some of the purist psychopathological conditions which analysts and psychiatrists know well. Even a beginner could still get few things right about his personality because of that. As an analyst, and watching experienced colleagues trying their hand in that ‘attractive’ exercise I also tried-mostly silently- to participate. I did not have anything new to add. I was not completely convinced that Trump is just a case of psychopathology of psychodynamic nature. I had two reasons for my doubt. My initial feeling was that he is a facade of a social phenomena that is brewing in the USA, thus working on the individual forecloses on the phenomenon. He seemed to have come-unexpectedly- as a suitable leader for social change. The second is purely professional. As a clinician I was tempted for a long time to use the obvious to categorize Trump. but all my attempts failed to give me a satisfying result.
There is no arguing about the mental unwellness of Trump. Even his ardent supporters could not find in him any signs of mental stability to counter the attack on his mental condition (that is why he is more of a social phenomena than an individual case). Even the notion that he is acting erratically as a strategy did not hold much water because he got himself confused by his own erratics. However, the two main areas of psychopathology the professionals focused on were narcissism and character disorders emanating from narcissism. Trump’s speeches and his compulsive depiction of himself in self-aggrandizement terms made narcissism jump the line in the choice of diagnosis.  However, Dr. R. Jackson was one (to my knowledge) who thought of neuropsychological testing because the man exhibited unmistakable features of lack of contact with external reality, even his own. The man was incessantly talking nonsense about himself to his political base (a bad case of arrogant ignorance, and self-centeredness) with no sign of being aware of what is happening outside his opinions regarding local and international affairs. His opinions were considered by him and by his supporters as realities. All his speeches even those pertaining to important issues were always and quickly turned into personal issues (I said to myself !!!!).

To make it easy to discuss this feature in Trump I will mean by reality ‘issues’. He is totally unable to discuss issues; they instantly change to opinions, his off course. Opinions about issues then become the reality of the issues: “We have the greatest recovery in history”, “this is the worst agreement ever been reached”.  A second feature is the instability of those realities.  Although his realities [opinions] are totally his creation they are unstable and change easily because they are not formed in relation to a real situation in the first place. Trump, and the white house never admit making mistake because in actuality there was nothing right or wrong with the issue; it was only an opinion not a fact. After the fiasco of the G7 meeting he said that he does not care that the relationship with the seven allies has deteriorated and that they are now terrible. The following day, as a reaction to a journalist suggesting that he alienated his best allies, he immediately denied that there is any problem with the relationship with the allies and that they are 10. Changing an issue into an opinion and holding on to the opinion as the substitute for ‘reality’ gives Trump a feeling that whatever he says is real (not noticing that he is not talking about reality). This is what the press and critiques call lies!! It is important to emphasize that this happens not as strategy political maneuver but come as an authentic assessment of matter.
This is the material we clinicians use to reach a diagnosis. It is evident that the only certain and assured element in this picture is its uncertainty and unpredictability of Trumps responses.. 

2. Narcissism and Character Formation

Trump has a difficulty-almost an impossibility- in dealing with anything that is not him. For the last two years he did not discuss, explain, justify one of his grand statements about what he accepts or rejects. “the Iran agreement is the worst agreement ever”. He did not say what was wrong with it, He always followed those kinds of statements with complementing statements about his unmatched ability to do better. The important part in this unfailing observation turns any subject into a personal matter. He changes what is not him into him or his in order to be able to talk about.  I mentioned in another place that Trump does not lie or contradict himself because whatever he says is not coming from judging something that existed outside him but only something different that he ‘now’ considers true. To lie one has to know the truth of what he intends to change, but if he changes it first and then talks about what he changed as the fact you would not be lying.  A lie is an intentional conscious distortion of what is real, thus Trump is incapable of truly lying because he does not know or have any reality. The most vivid moments in his encounters with the media is when asked about his Russian contacts. He vehemently denies the existence of that matter because it seems to him that it did not happen. What confirms this ‘ridiculous fact’ is the lack of intention or preparation or thinking of lying. His so called lies come spontaneously as reactions to the issue raised at the moment. The two features of the absence of reality and the absence of intentionality in Trump’s comportment refute the diagnosis of narcissism or character disorder, but strongly suggest a rather alarming psychopathology of another kind.

Narcissism is an unconscious behavioral condition that in some cases could become compulsive behavior. The narcissist does not talk about the qualities that constitute his narcissism; he lives those qualities preconsciously, but mostly unconsciously. A narcissistic woman who thinks she is pretty carries herself as a beautiful woman; seldom would she mentions that verbally. A narcissist would have an image of himself and develops an affective relationship with that image and lives it instead of living his real life. Narcissism is getting captivated by an image of the self and loosing contact with the true self. This is why there is narcissistic self- hate like the man who is obsessed by his image as a short person. The narcissist has an image of himself and believes others see it and evaluate it the same way he does. Trump has no such narcissistic image. He describes for himself an image of him of him and keep repeating it in order complement his loss of identity. He even describes that image to others to see, almost like someone who is not sure people will notice him spontaneously. No narcissist would tell others “I am so rich, I am a genius, I bet you are so happy that God gave you me to be your president.”. A narcissist would like to hear people say that bout him, though not say it himself. No narcissist would lower himself by telling people what they should see in him because he believes that his narcissistic qualities are self- evident. Trump is not sure of how people see him or even if they see him at all. He keeps painting that picture nonstop. One of the related feature in Trump is the exaggerated adjectives he uses all the time to assure himself that he will be seen as real.

Character formations happen over the time of growing up as defensive mechanisms against external pressures (the parental and social demands) and internal pressures (sexual and aggressive). Character structures reveal the basic childhood experiences and their interplay in structuring the intrapsychical formations. Previously, when the psychoanalytic theory included the psychosexual modality of development, analysts were able to notice the workings of a stage of development (oral for instance) in the formation of a character type (oral personality). Freud has an interesting and thought-provoking paper on that subject (Libidinal Types. 1931).  This way of looking at character formation is long gone. Yet, what replaced it (Ego, Self, Projective\Identifications, Enactment), etc. did not do much more than distorting the concept. Any suggestion of a character formation that describes Trump in those new contexts will face the problem of defining the character. The man has no definable character. Moreover, if he is a mixture of charters we will not be able even to settle on that because the mixture is not even stable enough to allow predictability. Therefore, I have to say that any diagnosis of Trump’s character misses the obvious: the man has no definable stable character formation. The old explanation of character formation would tell that Trump did not deal with neither external nor internal pressure to develop and require a charter formation. This goes well with what we noticed before about his handicap in dealing with reality of any sort. We also noticed his substandard ability to control his inner pressures and act them out uncontrollably, whether with lawyers, women, colleagues, etc.

If Trump is not able to deal and mange reality, and has no character formation that gives him a stable place in the society, at least as a predictable entity, what is the psychoanalytic diagnosis of such condition? We might encounter all those features in any psychopathological condition because they indicate absence and lack of what should be there and not the presence something that could be defined.

Sunday, 6 May 2018

2000 lies

The New York Times says the president lied close to 2000 lies in one year. I think many people agree that ‘lying’ is a main characteristic of the president. However, there is something to say about that, which does not lean on the moral aspect of lying.
No one can lie about something he does not know. Lying is an intentional and deliberate act about something he or she knows but intend to misrepresent, even in compulsive lying. Does the president lie about something he knows the truth about? No, he does not; he is not distorting truths because he has proven many times that he does know what he is lying about. Although going back on what he says is to us considered lying, to him its is not, because what he says is not to him a truth or a fact the cannot be changed. He has given undeniable evidence and proof that his statements do not reflect any assessment of what is happening with him or around him. (Do not rush and think that I am putting him within the category of psychosis or pseudo-psychosis).
The president is neither in touch with truth nor with facts: he is continuously ‘fabricating realities on the spot, at the moment, and reactively’. He does not do that intentionally or consciously (reflecting on what he says). People like us (sophisticated professionals) are giving his lies interpretations and meanings when they are not more than the reactions to the very limited outside reality he could mange.
   Let us examine his world:
His knowledge of the world, as he demonstrated in his views regarding the US involvement in international matters do not exceed the chats in working class places of work or their daily leisure places. His awareness of the agreements the US has with other countries-political or none political- is very tainted by some convictions in certain circles that the US has been taken advantage of since the end of the second world war. His views of what could make the US great again (when the US has been and still is a great country) are the old views of the US before the other nations recovered from the disaster of WW2, and some are great nation in their own right, beside the US. In total, the president exemplifies someone who did not realize, feel, have average desire to KNOW anything that does not pertain to him, himself. The external world does not exit much for him to stimulate his curiosity.
Is he narcissistic?  Narcissus did not fall in love with himself. He loved the boy who was in the image in front of him, thus the narcissist must have an image to love. The president does not have an image. He stands up in front of people and pictures himself to them. He tells them what to see and what to judge of what they see. Everything he does or did or going to do is the most, the greatest, nothing like it, etc. Therefore, narcissism is not a fitting diagnosis, because he believes that the picture he is showing is not a picture.
The most obvious about the president is his exceptionally limited contact with the external world. Nevertheless, he is not a flagrant psychotic person. Another point has to be raised: in all honesty we cannot give him a diagnosis based on symptoms or psychodynamics.
The only thing I think of is Highly Functional Autism. This notion leads to a difficult complex question: How (meaning in what way) could the society deal with an autistic president?
I hope that my remarks about the President of the US - as a foreigner-  are not taken as insults. If I feel that my professional opinion is taken as such, I might be encouraged to try to answer that complex question of how several millions of American cannot see through the title of The President.

Saturday, 10 February 2018

The Need for liberating Psychoanalysis

This post is a slightly modified version of an exchange between a well-versed colleague and me, regarding training, and the need for a serious revision of what needs correction, change, and maybe additions, to the IPA system of training, to catch up with the status of psychoanalysis nowadays. I will start with stating my views about contemporary psychoanalysis, to save the reader the trouble of guessing where I am coming from. 

In 1995, the IPA asked a number of distinguished psychoanalysts from around the world to give their opinion regarding the decline of interest in psychoanalysis.Their response was not- in my opinion- satisfactory but it confirmed that the crisis is real and threatening. I believe-though I haven't got confirmed results yet- the crisis is even worse now than it was more than two decades ago. My view is that all the desperate 'justifications' the IPA and the Regional Associations are coming up with are avoiding the REAL reason. Psychoanalysis as knowledge and practice has deteriorated badly over the years. The deterioration, if not just because of the self-deception of some advocates of new schools of psychoanalysis; it is because the IPA training system is by now archaic and not in touch with the changes that happened in the field since 1926. It was originally flawed because of the circumstances of psychoanalysis then, deteriorated further with the deterioration of the Training Analysts' status, and got even worse with the resistance to look at the problem directly as one issue, and the insistence on patchy solutions to its many dysfunctions. Any plea to save psychoanalysis from deteriorating and the very real possibility of its demise hits a stone wall made from denying some obvious facts about training and the practice under the guise of the new schools. 

My learned Colleague is calling for freeing ourselves from an arcane devotion to certain unsupported ideas about psychoanalysis and its practice, which were inherited blindly. She also advocates questioning what has become of the theory of analysis. I agree with what she is advocating but I wanted to add that it is a duty of experienced analysts to protect psychoanalysis from irresponsible attempts at replacing it with very scanty theories and provide it with better revisions of the basic conceptions of the classical theory.

My colleague calls for freeing ourselves from defining psychoanalysis rigidly by what was established for its practice eighty years ago. That practice of psychoanalysis is outlined for us in a haphazard way. The result is that any deviating from that model would not be considered psychoanalysis. Example, if I do psychoanalysis with a patient twice a weak that would not be psychoanalysis. My colleague argues, and I concur that it is not right to judge what is psychoanalytic by the standards of practice that were established in Berlin ninety years ago. When I expressed my ideas about the practice of analysis (in my book on the Classical Theory) I received -let us say- discouraging remarks from here and from some other parts of the world. This is a very strange situation: we are expected to practice psychoanalysis according to a model (Eitengon) that never had a theoretical basis to explain it nor does it have any current justification. Eitengon's model specifies the number of sessions for practice but does not underline the importance of adhering to Freud's clinical protocol. Even worse, Eitengonh model was established at a time when the theory of psychoanalysis-let alone its practice- was not fully developed to be taken as the ultimate in guiding training. At the same time, many analysts practice some sort of psychotherapy based on their school of thought, but four times a week and call that psychoanalysis. Furthermore, there is no defined link between theory and practice in psychoanalysis except Freud's tripartite reservations that we should stick to.  Yet, the most maligned part of the classical theory is that particular well-defined aspect in practice. We have not agreed yet on the relationship that should be between what we call theory and what we designate as the right way to practice.

The reason I am posting this post is a common misuse of the term psychoanalysis. Most analysts-nowadays-take the term to mean what they practice. They have been using the Eitingon model as the criterion of psychoanalysis whatever was their theoretical stance, which could be very far from the classical theory. My colleague raised the flag: psychoanalysis is the dog and Eitngon is the tail. The tail doe does not wag the dog...period. Therefore, it is imperative, necessary, unnegotiable to have a theory of psychoanalysis, that is not a modification, an update, a version of the original. Once that theory is established it could provide a practice protocol that belongs to it and there will be no confusion: what is a psychoanalytic practice.

Saturday, 16 December 2017

4. A view of the future of learning and training in psychoanalysis:

It would be presumptuous if I thought that my views in this posting is going to effect change in the present state of learning and training in psychoanalysis. The resistance to change in the field of psychoanalytic organization (not in theory) is beyond explanation. As one of the quotes that the publisher of “International Psychoanalysis” generously offers us daily says “It is not necessary to change. Survival is not mandatory”.  I think that the maximum my post might do is make more psychoanalysts reflect on the stubborn fixation on the model and function of the IPA training system, which has outlived its usefulness. In spite of acknowledging, in 1995, that psychoanalysis is in a very threatened crisis (see the report of the House of Delegates of the IPA, in 1995).  The report, which is a set of articles written by senior analysts from different societies, ranged from criticising the rigidity of the IPA theoretical position to its laxity, and from the inflexibility of the training system to its loss of identity and vagueness. The best of it was introducing the report by saying that the crises in psychoanalysis is like the epidemic that inflicted Thebes and that we have murder Freud.

The dissatisfaction with the situation created by IPA’s domination od the psychoanalytic scene justified the emergence of universities and university programs in many parts of the world that educate in psychoanalysis, and provide training in aspects of psychotherapy. They are mostly run by trained analysts but their graduates are not recognised by the IPA as psychoanalysts. I am not confident enough to talk with certainty about the adequacy of those academic institutions to train in psychoanalysis. But from the little I know and the few I had a look at their programs I thinks the only obstacle in considering their effectiveness is the loyalty and reluctance of their professors to compete with (betray) the IPA (they are senior members of the institutions in their cities). Contrary to the common belief in the psychoanalytic circles, the IPA institutes offer very deficient training programs. Let alone the rigid belief  that psychoanalysis is mainly  training with some required theoretical background for its practice, training in those institutes is part time, lacks clear standers of education and supervision, unclear about the degree of participation of its tripartite requirements in the formation of the candidates. There is also a major difficulty in dealing with the extensive literature in the clinical field, and in other related sciences, which is overlooked or chosen for teaching for personal preferences among the faculty.

If psychoanalysis is just training in its usage in psychotherapy, the IPA system would only need some mending of its decaying model of learning and training. and that would suffice. Nevertheless, whether psychoanalysts like it or not, psychoanalysis is a human science and not just a method of psychotherapy. No method of psychotherapy, whatever its uniqueness and distinction, could change the human subject and his society the way psychoanalysis did with the whole Western culture. Freud was very conscious of that when he said to Jung on their trip to the US that the Americans do not know what trouble we are bringing them”. I can point out two features in the history of the psychoanalytic movement that confirms that we clinicians did not pay attention to: every advancement in understanding psychopathology opened the gate for knowing much more about the regular ‘human subject’, and every- thing we understood about the individual resulted in understanding issue that are more encompassing that the individual phenomena. As an example, the early conception of repression of sexuality and its discontents led Freud to write about civilization and its discontents. Better, whatever was discovered in the offices of psychoanalysts proved to be much more important on a social level. This is the proof that psychoanalysis is more than psychotherapy. It is also more of a science of the human subject than it was deemed because it influenced the approaches of several other human sciences. Yet, it has to be clearly stated that psychoanalysis is a special human science because it is about the conscious and the unconscious human subject, when the other humanities deal only with issues of consciousness. Psychoanalysis compliments all other human sciences, because including the unconscious in understanding of the subject requires learning a novel way of thinking: the analytic way of thinking.

Psychoanalysts are supposed to be  taught that every psychical given is the manifest of something latent, and that they were also trained to know how to get the latent content through a process of analysis. There are people who area more gifted in that process than others, that is why psychoanalysis as a human science considers the link between the manifest and the latent a matter of learning and not of training. As an example, psychoanalysts should read The Interpretation of Dreams not to learn how to interpret dreams but to learn how a fresh uncontaminated mind (Freud’s) made those leaps from the manifest to the latent, discovering in the way the workings of the primary process in creating the manifest. Learning the psychoanalytic way of thinking is learning how to consider everything human product of an unconscious process that creates a ‘complex’ human phenomenon; or the human phenomena are complex because they are products of conscious and unconscious contents.  Sociologist with a psychoanalytic learning and training will look at marriage and see that behind all patterns of pairing the marital couples is the law of incest: how to avoid it depending of the structure of the society. There is another even more important aspect of the psychoanalytic way of thinking. Freud’s discovery of the role played by the interfamilial conflicts in structuring the unconscious (the Oedipus Complex) obliges the psychoanalyst to think of the unconscious as the way childhood experiences has influenced consciousness, i.e., past or childhood experiences become unconscious. In the other human sciences, the situation is reversed: past experiences are conscious and their meaning becomes the unconscious of the society. However, the psychoanalytic way of thinking makes possible to understand social events psychoanalytically. Nine -eleven is a conscious memory but it created and activated unconscious reactions that were instrumental in electing a black president two terms.  

Psychoanalysis is a human science, and it has a legitimate place in academia. It should be a subject of education first, then its applications would decide its branching into specialization, of which one is psychotherapy. This conception of psychoanalysis imposes on us the duty of looking into the modalities of its learning and training; a task that would make the honest psychoanalysts recognize and realize the limitation of training in the IPA institutes or the similar but independent ones. Having reached this point I find myself in a very uncomfortable bind: I have to show that I have an idea of what I am preaching (or keep silent) but I know that this the work of teams of people from different specializations and are much more competent than I. My experience in academia goes back sixty years and my experience as clinical analyst also goes back several years.  However, I think that moving learning and training to academia should be on the basis of an undergraduate degree in psychoanalysis that covers its onset, evolution, the main discoveries and the extra clinical endeavours, in addition to expose the areas that analytic thinking is required. Post graduate sturdies should be done with emphasis on training, research, collaborative and joint works as the focus of preparing the analyst to work in those fields (just as an example, child psychology, and sociology of the masses).  Some issues of training in the clinical aspect of psychoanalysis will benefit from other academic programs like psychiatry and statistics, that are not available now in the system of training.

This is the end of my post, which is the last posting I will publish on my blog. Becuas of that, I am using this opportunity to express an opinion about training in the process of psyshoanalytic psychotherapy (not in the common coneception of a diluted psychoanalysis). I feel that is could be helpful in clarifying few problems we encounter the learning of psychotherapy.


 Training in the Clinical Practice of Psychoanalysis should not be called training in psychoanalysis, because it is just part of the whole theory

 The reason for underlining this point is a general trend to discarding what is so particular and specific in training in the psychotherapy in psychoanalysis. For training in the clinical practice of psychoanalysis be meaningful, and to serve the purpose of revealing the unconscious (the workings of the primary process in creating the undesirable psychological condition) we have to give extra care to two points: studying, discussing, clarifying and clearly stipulating the importance of Freud’s ‘clinical protocol’ of Anonymity, Abstinence, and Neutrality, and the importance of the regularity of the sessions and their length of time (not the number per week). I am bringing those two points to attention because they were firstly criticized in the literature badly in the eighties and nineties, and secondly because some analysts made a mockery of them by exaggerating them to a silly degree of rigidity. When we come to clinical practice we should remember of our parent’s wise saying: don’t what I do, do what I say. That applies to Freud: do what he says and not what he did in clinical work. The man who discovered transference and transference resistance tried to analyse his daughter!!

Revisiting the Freudian protocol of practice and his conception of transference is essential in distinguishing psychoanalytic psychotherapy from any other psychotherapy. This is what makes psychoanalytic treatment not any psychotherapy. I am raising this point here and now because ‘in my opinion’ rediscovering psychoanalytic psychotherapy is very timely when a review of training is much needed and its future should be considered. Knowing what is therapeutic in psychoanalysis compared to other psychotherapies that do not follow that protocol, makes training in the clinical application of psychoanalysis defined by its function and not by an abstract theory.

To end my post, we should remind ourselves that something significant, major, and essentially daring has to happen in psychoanalysis. I tried several ways to quantitively measure the effectiveness of ‘a clinical psychoanalyst’ if he worked a full day for thirty-five years. The maximum number of patients he could cure ranges between 120-150. Psychoanalysis is more useful than that.

Saturday, 2 December 2017

Psychoanalysis: training or learning?

3. Revision of Dysfunctional System of Training

The training system of Eitingon and its institutes were “unintentionally” a bubble that protected the early psychoanalytic movement from several dangers. The analytic community grew in a homogeneous way, and got early confidence in its distinction from being an organization that is self-ruling. Anyone who wanted to join had to go through the same procedure. The theory was improving and expanding, and it was transmitted to the new comers and the seekers of membership in an organized manner, which tightened the cohesiveness of the analytic community irrespective of its geographic location. Psychoanalysts were saved from having to deal with the critical and negative views of psychoanalysis, which were strong and widespread at the time. Analysts did not have effective means to deal with them within a budding movement few members in number, an unsettled theory and equally unsettling to its members. There was little external social support from the medical profession, which considered psychoanalysis an imposition on it. The new movement was dependent mostly on the status of Freud. 
That bubble was quite useful at the beginning of the movement, but it had its disadvantages. It gave the psychoanalysis a sense of distinction and superiority that was not founded on anything concrete except their isolation. The isolation was reciprocal, as they isolated ourselves from others, others were also avoiding communicating with them. The protective bubble eventually proved to have negative outcomes. Analysts neglected their responsibility to prove themselves and the public was divided unequally in their views about psychoanalysis; a minority was blindly supportive of the progressive ideas implicit in psychoanalysis and a majority were demanding proofs to what psychoanalysts were claiming. Both sides accepted the bubble created by the particular requirement of training specified by the psychoanalytic organization. 
Freud's death revealed a very paradoxical feature in psychoanalysis. During his life psychoanalysts did not make a distinction between theory and practice, or better between learning and training. Freud's view represented both those two aspects of psychoanalysis. Logically, what should have kept the movement united and intact was a stable theory, that it could engender a training system.  What happened was the opposite: Freud did not leave us a theory to unite us, and the system of training, which has become more or less international, functioned as the force behind the continuation of the analytic movement. However,  there were signs of cracks in the organization everywhere due to the evolution of the theoretical issues in psychoanalysis in spite of a silent belief that psychoanalysts was a unified theory. Once again the system of training was the real force that kept the analytic movement seemingly intact. How could psychoanalysis continue on without a unified theory and survive on system of training? Those cracks were not seen then as problems in the theory but were mostly treated as personal conflicts (neurotic idiosyncrasies).
In the late fifties and the sixties of last century a strange thing happened in a natural way; an explosion of publications, formal and informal meetings and media discussion about the unconscious and indirectly psychoanalysis. Almost, a spontaneous ‘international symposium’ was formed from intellectuals in the fields of philosophy (existentialism and phenomenology), literature, theater (the absurd literature of Beckett, Ionesco, Camus!), literary critiquing of old works (Kafka, Flaubert, Dostoevsky), visual arts, and most of all the promising structural theory in the humanities. It was a decade of very rich revival of mutual interest in the human subject, very much in the style of Freud’s dream for psychoanalysis. It was basically a symposium on the unconscious and its presence in all aspects of human phenomena. Some analysts participated ( Rollo May)in that symposium but did not contribute anything of significance, because they were leery of having non-analyst (non-clinician) in their bubble. They were also unable to talk meaningfully about the unconscious that those “amateurs’ were making an issue of.  Psychoanalysts ignored Freud’s third meaning of Ucs. as a system  and the non-repressed unconscious, as they still do. They also did not pay attention that the unconscious has become culturally acceptable and ordinary people started to integrate psychoanalysis in their daily life. In other words, analysts and the analytic organization did not take score of the changes psychoanalysis has introduced to the world outside the bubble of training. The protective bubble changed to become a salient cell of isolation. There is no better verification to this customarily denied fact than what happened soon after that symposium.    
By the seventies clinical psychoanalysis was well founded and extended its domination on several well-established professions like psychiatry, for instance. It also found a place in academia but not in the programs that could have adopted it to link firmly with the university. Yet, something ‘unexpected’ actually happened: the superficial cracks in the British society were no longer mere personal disagreements but were fundamental theoretical differences. The same happened in France but the Lacanian group gave the splits a different flavour: it was a conflict between something  fascinating but does not promise stability and continuity of staid scholarly revision of the Freudian theory. In the US the ‘schools’ accepted coexistence almost creating a federal system of psychoanalysis, yet there were also very novel approaches to long  ignored psychical issue like the psychosomatics, the narcissistic disorders and the borderline conditions. As far as I know, psychoanalysis in South America leaned toward accepting a coexistence of the Kleinian the Lacanian approaches. The diversities of views in the international scene of psychoanalysis were threatening an imminent disintegration of the psychoanalytic organization. Wallerstein as the president of the IPA suggested to accept in principle of psychoanalytic plurality (1989). The schools, as I mentioned in the first part, where not theories of analysis, or new trends in practice; they were the adopting new aspects of the human phenomenon and working on them as main issues in the psychoanalyzing the human subject (interpersonal relations, intersubjective interactions, with contemporary conflicts, etc. In other words, psychoanalysis was no longer a unified theory, but remained a system of training. What is peculiar about that is neglecting the fact that training cannot stand alone but has to be "training in something". So, if psychoanalysis is not a unified theory then we should end up with different kinds of training. This is not the case. We ended up with three training modalities for several schools pf psychoanalysis. Once again the mere concept of training is the force behind the unity of the psychoanalytic organization. Could we have one way of prayer that fits all our religions?
At this point I need to underline an idea that might not sit well with some (many!). After Freud’s death it did not take long for his ‘presumably’ unified theory to fragment. It is easy to use a psychoanalytic template to relate that to the death of the father, so on and so forth. The fact of the matter is that psychoanalysis came with the finding of the unconscious to make the human subject a viable subject for understanding, thus opened the way for disagreements about his understanding. The maturation of the psychoanalytic movement proved that psychoanalysis is a multifaceted approach to the study of the human subject and not a simple one unified discipline. The notion of psychoanalytic plurality became a licence to form schools, which camouflages the fact that psychoanalysis is the science of the human subject and not the amalgam of points of view regarding him the. It is important to bring to attention that all those schools maintained the concept of training with its tripartite structure, and the society and the IPA as the mother of the institutes. In other but more revealing words: the divisions in psychoanalysis kept training and the institutes model as the bubble that keeps outsiders out of the psychoanalytic community.  The revelation that psychoanalysis is not a unified theory should have made analysts look closely into their basic premises and decide if they should follow the training system of the unified Freudian theory or adjust their training to the future practice of their premises.

There was no time in its history when psychoanalysis when a unified theory engendered agreement between all its members. I think that psychoanalysts upheld the idea that psychoanalysis is a matter of training-whatever their theoretical affiliations-to maintain that it could be done only in the IPA institutes. This attitude admirable as it was and still is came on the expense of psychoanalysis itself: it is no longer of any recognizable features, identity, or even professional weight due to putting the emphasis on preserving the institution and not psychoanalysis itself.  Instead of going on articulating the obvious without clear aim to my effort I will give my opinion as I have reached it over several decades of gradual change from a dedicated and loyal advocate of psychoanalysis to becoming a candidate then an analyst and moving to being a training and supervising analyst and finally, now I am back to where I was at the beginning: a dedicated and loyal advocate of psychoanalysis.

Psychoanalysis would force the honest clinician to admit that it is a science of the subject, i.e. it is not just a technique to be trained to use. Better, since analysts could practice psychoanalysis by choosing different psychological manifestations to work with, then psychoanalysis is a branch of the humanities, i.e., psychoanalysis is a human science that covers the totality of the human subject and not only his interpersonal relations, his intersubjective dynamic, his conflicts, etc. Just because it was delivered by a physician and not a mid-wife it is neither a medical specialty nor just a method of treatment. All human sciences (even physical sciences too) started as a unified field to eventually reveal that it could branch out into specialties. Wundt’s and William James's psychologies are now  dozens specialties with links to dozens of specialties.  Acknowledging that psychoanalysis is human science requires realizing that, as such, it was destined to branch out into specialties that links with other sciences, not only idiographic ones. This idea would not find welcoming ears, not because it is wrong but because to comes close to several sensitive points in us. Psychiatrist would consider it a threat to their established privileged position in psychoanalysis. Other professions like psychology and social work, which are involved in the health providing services, would not like being grouped with other branches of the humanities that are not in the field of health services (education, sociology, politics, etc.). Nevertheless, it is not the lack of supporters for the idea of defining the 'genre' of psychoanalysis as idiographic science that would fail; it is the demand it puts on us (all) to revise the system of learning and training in psychoanalysis if psychoanalysis is considered a science in its own right.  

What would the learning and training in psychoanalysis be like if we, our training institutes, and the IPA accepted the idea that psychoanalysis-on its own- is a science and that training in its technique of psychotherapy is only one of its facets?