The Lifeline for the Existence of Psychoanalysis

         After more than eighteen years of using this blog to express my views ‘freely’ about certain issues in psychoanalysis (despite the language barrier, and the disapproval and disagreements of many analysts) I believe it is time to stop and retire it. Thinking of a topic to end this blog came to my mind in a spontaneous way after days of useless internal debates. A later posting created some interest in Japan which reminded me of the 1981 International Congress of Psychoanalysis in Helsinki. In that meeting- and for the first time as much I know- a delegation of Japanese colleagues was visiting the meeting. They moved from presentation to the next as a group, which attracted attention and raised some ambivalent remarks. I did not see that group again in the next meetings I managed to attend- almost regularly- till 1999 in Chile, or the occasional meetings I attended later. The IPA meetings were occasions to know new analysts from other countries, see again friends from the old acquaintances, and to know about what is happening to psychoanalysis in those countries. Those meetings were a great opportunity to learn and think about analysis from different perspectives.

        The interest in my blog in Asia – although quantitatively not impressive – is interesting in terms of locations. There is even one reader from Korea. This observation made me ask-lately- what keeps psychoanalysis alive till now. It is not the same everywhere, and it has no identifiable theory or even a definable system of practice.  The vocabulary psychoanalysts use is arguable and not of clear denotations. Psychoanalysis- in all measures of validity- is quite easy to ignore. However, pragmatically speaking there is nothing that managed to replace ‘psychoanalysis’ in modern international cultural life. The question, thus, should be: what makes PSYCHOANLYSIS survive almost everywhere despite all those shortcomings? Is it actually surviving, or is it only its name that finds a place in most cultures? Psychoanalysis -with the exception of North America- evolved, academically is approved as a university specialty (not just tolerated or offered it as an elective). There is even a University of Psychoanalysis in Berlin. It became part of the cultural fabric of transformed societies. In some of those countries psychoanalysis is still respected as a psychotherapeutic method, and it is not in the same tight spot as it is in the USA and Canada. In North America psychoanalytic organizations are no longer making the strict puritanical distinction between psychoanalysis and any other psychotherapy for one reason I prefer not get into and another which is a serious dwindling of the people of classical analysis to patients.  

    In the twentieth century this took a new tur 

    But when psychoanalysis was invited and introduced to the USA's guardians of the heritage in 1909 those three lifelines were disconnected and only one replacement was offered to keep it alive: make it useful, expedient, of practical value; make psychoanalysis a profession. It happened and the outcome was slow but drastic: it separated psychoanalysis from its European origin: the Accordion was replaced by some Harmonicas. Putting all that aside we come to the real problem: The USA has One Forth (25%) of all the psychoanalysts in the world. England til1950, had analysts who were also thinker Like Bion, Glover and Klein!! They were psychoanalysts who were turning ordinary talk into ideas that could explain other ordinary talk and turn it into something of striking meaning. France was steaming with ideas that psychoanalysts along with some ingenious thinkers- who were not analysts- revived the philosophical robust vigor of the centry passed.

        In North America the case is different for psychoanalysis, and the efforts to keep it afloat is not very assuring. If I do not hold back my critical psychoanalytic thinking, I would say American Psychoanalysis uses the different efforts to keep it alive as a resistance to really knowing the reason for its decline. But if I just want to offer a suggestion without the courtesy of being a psychoanalyst myself, I suggest (advise) considering this point of view. Psychoanalysis was born and survived in Europe at the end of the nineteenth century. Europe was still the hub of Western culture and philosophy. It was also pregnant with the notion of the universality of human knowledge.  Although it had advanced cultures for many centuries it was able a little later in the nineteenth century to develop the idea that the human subject is still short of being understood and more work must be done to resume the search. The discoveries in the nature of consciousness represented to many a riddle that is waiting for an explanation. The philosophical findings and the great novels that were written by psychologically gifted novelists. Starting by Shakespear passing by many other European novelists and gaining from the great Russian writers proved that Western civilization and cultures got the foundational meaning of the essence (intrapsychic) of the person and his psychology. Before you jump to criticizing the idea, I want to clarify it: psychoanalysis must have a cultural life in its society to mean anything; without which it will be like classical music without the existence of classical literature, art of painting, architecture even good wine making. Psychoanalysis is PART of a general human movement. This is how Western culture, or any defined culture affects psychoanalysis: analysts are products of their culture and with no culture that envelops them and psychoanalysis they will be nothing but professional artisans.

This cultural Europe gave psychoanalysis three lifelines that North America did have to offer when psychoanalysis was introduced to America to stay.

The first lifeline was that analysis that came to Europeans extended its main idea of exploring the human subject to learn about his psychopathology too. However, psychoanalysis of psychopathology started from nonpathological issues (Dreams, parapraxes, and Jokes). It conceded that the human subject-not only the patients-is still a dilemma that invites exploring to extend the philosophical endeavors of the centuries passed.  The second lifeline was that psychoanalysis is not an isolated knowledge, but it is an item in a culture, i.e., it has things to say about psychosomatics as well as about falling in love and understanding what is not said in what is said.  The third line of life is its need to keep an eye and an ear on the flourishing evolution of the surrounding human sciences to stay in line with them, this notion came from the eagerness to apply psychoanalysis to those sciences. Psychoanalysis was born in an environment that had the basic ingredients for its survival and had a place ready for it to occupy.

    But when psychoanalysis was invited and introduced to the USA's guardians of the heritage in 1909 those three lifelines were disconnected and only one replacement was offered to keep it alive: make it useful, expedient, of practical value; make psychoanalysis a profession. It happened and the outcome was slow but drastic: it separated psychoanalysis from its European origin: the Accordion was replaced by some Harmonicas. Putting all that aside we come to the real problem: The USA has One Forth (25%) of all the psychoanalysts in the world. England til1950, had analysts who were also thinker Like Bion, Glover and Klein!! They were psychoanalysts who were turning ordinary talk into ideas that could explain other ordinary talk and turn it into something of striking meaning. France was steaming with ideas that psychoanalysts along with some ingenious thinkers- who were not analysts- revived the philosophical robust vigor of the centry passed.

     In every corner of Europe in the late nineteen century and early twentieth a cultural Kitchen was cooking the mental food that psychoanalysis provided its ingredients. Psychotherapy was one of the nonexciting daily breads.  Psychoanalysis turned the cultural, in its philosophical, artistic, literary, and indirectly orality into a completely different ethos.  The point to make here is that psychoanalysts in Europe considered themselves part of a whole and there was mutual acceptance between the practicing psychoanalyst and the thinkers of all fields of thinking. Psychoanalysis was continuously enriched by and enriching of its culture. 

        This is what is missing in psychoanalysis in North America. In north America psychoanalysis is a profession of psychotherapy, and the psychoanalysts either pretend or actually believe that psychoanalysis is not originally part of another theory. At this point we face the hidden problem of Narcissism and the psychoanalyst's identity. It is difficult to explain that to the narcissist because it hurts his narcissism, but I will try. The human subject with his qualities can only know himself from his reflections…money, success, lake of importance, failures, etc. Psychoanalysts are as narcissistic as lawyers, rickshaw boys, etc. They need mirrors and if there are none, they will invent one. But somehow, they created a fantasy mirror which doe does not reflect their true entity; it reflected uniqueness and superiority. Therefore, we tried and successfully managed to maintain that image for a few decades. But psychoanalysis is a theory of the human subject. Therefore, the thinkers, the intelligentsia, the academicians, and serious amateurs and enthusiastic were able to learn, use, and contribute to that psychoanalysis extremely valuable thought, and better quality. In Europe analysts welcomed those contributions. The mirror there reflected a different image than the psychotherapist. The story is that psychoanalysis in the world (except for North America) is vitalized, enriched, found its place in the intellectual world and Narcissus did not need a fantasy image anymore.

In North America there is no external input in their identity as psychotherapist. They respect only psychoanalysis that is a product of “psychoanalysis”. They would deny that, but I will ask them: would you consider Foucault and Sartre, Vygotsky, and Ortega y Gasset psychoanalysts when you notice that their work on psychoanalytic issues surpasses our work. Would psychoanalysis-or anything else-remain of value if it does not get revived by the minds of other interested thinkers? Could psychoanalysis live on recycling its works? I asked a colleague who knows the American mind better than me if there are American thinkers whose work should have been integrated in American psychoanalysis. He stated that there are no thinkers in the USA who have the same prestige that European thinkers have amongst people in general and analysts in particular. I have no reason to disbelieve him, but how could a nation of more than three hundred million with the caliber and number of the academic institutions it has not produce thinkers in the dozens. 

This could only happen if propel reject novel thinking. Analysts in North America are that kind of people: they lose the foundation of their narcissism if they allow none-analysts to talk and show something their clinical work does not show. Maybe, and just maybe, there are ether social factors that are enforcing that viscous narcissism to be maintained  and north American psychoanalysts are falling victims of them.

 

                I just received a copy of the second edition of Textbook of Psychoanalysis edited by Gabbard, Litowitz and Williams. I deeply regret to base my previous view regarding the lack of textbooks of psychoanalysis on an old impression and a wrong one of the first edition. Th second edition is of great volume and should have its place in the training of candidates. 

        My apologies and regrets. The Textbook of Psychoanalysis-second edition- is a particularly important addition to literature. 

 

This post could be of interest to some of the analysts who also follow another professional blog in one of the countries that show interest in my blog. The comment in this published note is my opinion regarding the possibility of a law- in that country -that requires the psychotherapist to give the patients- beforehand -a tentative estimate of the process of his psychotherapy (time-duration-cost,etc.). I am posting it in my blog because it did not have a place in the other professional blog.

In the old times (fifty or sixty years ago) when psychoanalysis was still starting and forming it was not possible to have a decent idea of how long psychoanalytic therapy could take. We did have a way to foresee the patient’s resistance and his potential benefit from our work. After seeing so many patients (thousands amongst us) and gaining deeper knowledge of both psychopathology and the therapeutic process I think we could assess both the difficulties, the potentials, and the acceptable level of change and have a decent idea of how long and how many sessions needed, to change. That clinical skill is difficult to transmit to a candidate in training!?

Therefore, a law that requires an “effort” to be made to assess our responsibility in the therapeutic process is particularly good for us, the patient, let alone the process of therapy itself.

 Suggestions oF RESOURCEFUL Works

List of Textbooks-like in Psychoanalysis

Those sources came to my mind after a while because in my age memory does not obey it owner’s wishes as

when he wishes.

They are reliable sources to use to teach some aspects of theory and practice too, but they are textbooks as such.

            Ricoeur, P. Freud’s Philosophy: An Essay on Interpretation.

            Foucault, M. The Order of Things.

Matte-Blanco, E. The Unconscious as Infinite Sets: An Essay in Bi-logic

Erickson, E. Identity and Life Cycle

Freud, Inhibition symptom and Anxiety (teaches the psychoanalytic way of looking at the link between cause and effect and how it could be reversed to learn more about the subject.

Idealization and Psychoanalysis

The Underlying Basis of Our Bewilderment

            Are we bewildered! Yes, we are. The proof to that is lacking a textbook (s) on psychoanalysis. No profession could teach and train its new generations without a textbook (s) to make those youngsters pay their attention to the subject matter of their profession and not to the individuals involved-in their apprenticeship and training- whether they and their teachers, their analysts, or their patients. You cannot teach and train a physician without textbooks in the branches of medicine he uses (anatomy, physiology, etc. etc.). Textbooks are the legitimate bridge between the profession and the professionals. There could be some distinguished practitioners and professors in the field, but they will not be idealized as the only source of knowledge if there is a solid textbook in the subject. Idealization is when a quality, characteristic, a feature, etc., stands for the real subject (human or material). To turn someone like Freud or your analyst into an idea, and idealize him, changes the relationship between the you and that someone into mini enslavement. Idealizing a person or any other thing blocks one from realizing that he is not relating to the idealized issue but to an idea about the issue, which is his creation.

I dare to say that we -psychoanalysts-do not have ordinary people in our professional life, but leaders and mentors who are only different in the degree of their idealization. This issue is a basic dilemma in psychoanalysis. Because we do not have textbooks in psychoanalysis, we only have degrees of idealizations of old or new people and think only in terms on pro-anti.

[I happened to know one book entitled ‘Textbook of Psychoanalysis’ edited by G.Gabbard . It is not a textbook that has chapters on psychoanalytic topics like interpreting and reconstructing, analytic diagnosis and deciding the frequency of sessions, or dealing with acting out some implicit meanings in interpretations, I mean issues of psychoanalytic work that we should be teaching and making sure candidates ‘learn the psychoanalysis’ we believe that we train them to practice. 

The ridiculous thing is that after more than a century of psychoanalysis we are still unable to have textbooks on the subject. The rare occasions I spoke to colleagues about that issue they were all against it and raised the flag of ‘free association (which does not exist in the first place) and regulating psychoanalysis which is against its basics. Some even commended the life of idealization instead. I personally believe that we defy, refuse, even sometimes resist giving up idealizing [ Dr. so-so] and direct our efforts instead to build textbooks based on his ideology (Bion, Laplanche, Bouvet, Arlow and Brenner, etc.). People like those are not the only source of Textbooks of psychoanalysis. In Europe, thinkers, philosophers, academicians, and people from other but related fields joined the psychoanalytic movement and made contributions that were of terrific value. After some inquiries and direct knowledge (I am still living in Canada) I found out that the psychoanalytic institutions were actively against none- trained psychoanalysts- participating or contributing to the psychoanalytic movement.  I think it is as it was a reciprocal stand from each other.

The nonexistence of textbooks of psychoanalysis says something about psychoanalysis itself. Psychoanalysis-in the Americas- has not taken its normal course of evolution to become an academic subject. In my opinion. It remained captive of being a psychotherapy and not a new and unique venture in exploring our nature (humans). The analytic psychotherapists are standing lately on very shaky grounds. Whatever they do to improve the reputation of psychotherapy will fail, because the issue is in psychoanalysis that gives psychotherapy its suture. 

 A Personal Experience with Lacanizm

In 1953/1954 I was a second-year student in a new department of psychology, headed by a French trained psychoanalyst. The teaching staff was varied in their specializations and their original places of training. A new member joined that staff and happened to be a psychoanalyst and a close student of Lacan (Safwan). He came with a good translation and study of Lacan’s paper on the “Mirror Stage”. He did not mention -and none of us realized- that this fascinating and pioneering paper related to Freud’s concept of Narcissism. I distinctly remember considering it a paper in child psychology because I had no idea of Freud’s paper on narcissism (at that time we did not have in Egypt a copy of the Standard Edition).

Shortly after Lacan published that paper on the duality of the subject as a foundational element in his identity he introduced the three orders of the Imaginary, the Symbolic and the Real. The paper of the duality of the Moi (me) and the Je(I) entered a new very complex system of “orders” and was lost in a typical Lacnian style of de-mystifications. He was inclined to ‘explain’ his wonderful ideas in a manner that keeps them mystified and no one could claim that they know what the master really meant. He always had something more to say about even what he said.

When I mentioned the origin of narcissism in the Myth of Narcissus (I think around the time of the interest in the idea of OTHERNESS) a very experiences senior analyst (did not take her permission to mention her name) raise a very interesting issue: how different psychoanalysis would have been if the central myth in the psychoanalytic theory was Narcissus and not Oedipus!  The answer as I have been envisioning since (more than a year ago) is no Anna Freud and ego psychology but Melanie Klein and the intrapsychic (instead of object relations). The main issue of interfamily psychodynamics would have changed to serious consideration of the stages of development and the evolution of the sense of identity (the crux of change in real psychoanalysis and less so in psychotherapy).  

The other difference the myth of narcissus could have created is a dependable ability for self-analysis (auto-analysis). The reason is that the duality of I/me is confusion that could be discerned and the analyst as well as the patient have a gap from which the it will be possible to ask and answer too: is it Me that feels…sees… thinks, etc. or is I ? A good analytic work will reveal to the patient that difference which is taken over at the beginning by transference.

  

             B. What is Therapeutic in a Psychoanalytic Interpretation? 

                                 Interpreting the link between the intrapsychic and the interpersonal 

    In a previous part on this subject two issues were highlighted: Interpretation and Reconstruction. It was also emphasized that the unconscious- which is the analysts' main subject of interpretation- is there to hear and listen to within the patient's conscious speech. In a way, we are supposed to accept the patients rhetoric as the conscious\unconscious expression of their psychic condition. This way the act of psychoanalysis is definable, identifiable, and has to be done with the fixed idea that we analysts should not interfere with the free associations of the patient. However, this could also mean that we should not interfere with the patient's resistances. For that reason, it is recommended not to think that there is a structure in the work of psychoanalysis with patients [except the conditions we discuss with the patient before we start the work, like number of sessions, etc.]. The patient's rhetoric contains the unconscious material we need to interpret but we are also trained not to interpret prematurely, yet there is no guidelines to what and how to identify a mature moment to interpret.

    There is though a guiding principle in that aspect. The patient's rhetoric-directly or indirectly- is about himself. That self is the impact of  what was created in the early upbringing of his life and persisted since childhood. The intrapsychic, or the character formation that the patient is living is his basic Self. The patient’s interpersonal relationships, which is the reason (cause) for getting into therapy are basically products of that intrapsychic formations. However, the intrapsychic in psychoanalysis is not the regular relationships the patient has with other. The invitation to the patient to say whatever comes to his mind is not as it was thought before as free association. It is acting out in analysis what is named by Freud transference. Transference is bringing back moments of the process of forming the basic interpersonal relationships of childhood. The very early interpersonal is transferred to the process of psychoanalyzing in the form of “transference”.  Therefor, the issue of when to interpret is not a mater of timing but a matter of what to interpret to connect the present (transference) with the past of that transference. Amazingly, Freud (1912) recognized the phantasmic nature of transference, transference resistance, transference as an obstacle the analyst has to bypass without encouraging it or discouraging it, all that long before having a clear and guiding model of the stages of development (the distinct types of intrapsychic\interpersonal relationship of each stage of building a stable identity). It is amazing because we know now -in supervision- how important to show the candidate what type of intrapsychic inadequacy he deals with in the patient's transference, to know even what best words to you use in his interpretations. A transference of anal aggressive conflicts requires using terminology of anger and explosivity. 

        We come to the point now to say with the confidence of clarity  psychoanalysis is the act on INTERPRETING the patient’s interpersonal relationships by his intrapsychic formation, which we could (with some patience and skill) hear  it entwined in the patient transference and expressed in his conscious rhetoric. As mentioned above: Psychoanalysis is the act of  interpreting the interpersonal with the material we get from transference and reconstructing the intrapsychic from the conscious material the patient uses to talk about himself.

        The issue of timing the interpretation, the words to use to articulate that interpretation in a way that relates specifically to this patient’s rhetoric, making the patient’s  give the discovery of the interpreted intrapsychic a curative  potential, and most of all keeping the patient unaffected by the skill of the analyst, is an important aspect of good psychoanalysis. This note came to my mind just now because I was going to say that the basic and main idea in this post is my understanding of J. Lacn’s seminaire on “L’act Psychoanalytiques” (1967\1968). I did not finish attending that seminar (fifty five years ago) because I did not digest his way mixing in his ‘actually’ brilliant psychoanalytic mind with his personal brillience.