Division Review - Issue #20 by Division Review

REVIEW DIVISION DIVISION A QUARTERLY PSYCHOANALYTIC FORUM

NO.4 SUMMER 2012

A QUARTERLY PSYCHOANALYTIC FORUM

NO.20 WINTER 2020

THE MAZE BEGAN

DIS ORDER

MARANGONI AINSLIE | Willis

DEAN | Vanheule

THE DARKROOM

BIOPOWER BIOPOLITICS

MENDES | Faludi

NOVIE | Neroni

R E M I N I S C E N C E

EAGLE | SILVERMAN

ON AUTISM A DISCUSSION LHULIER | KRASS | BENVENUTO

To Review

David LICHTENSTEIN

As this is the final issue of our 10th year and we will begin the transition to a new Editor, Dr. Loren Dent, I want to take the occasion to reflect briefly on the history of the publication and review its trajectory. We created the Review in 2010, at a time of considerable uncertainty about both the future of print publication and that of our complex and diverse field. While the coherence of society at large may now be more uncertain than ever, our professional field

and our particular society of Psychoanalysis and Psychoanalytic Psychology including its publications has shown an encouraging resilience. I am grateful to the membership and the leaders of Division 39 for supporting this project and for giving me an opportunity to be part of it. Regarding the present circumstance and vitality of the psychoanalytic field, it is not that we have resolved the many internal differences, nor that we agree more uniformly about

our theories and principles, but rather, I believe, we are more articulate about our differences and more prepared to accept that they reflect the true complexity of our field and thus should not be resolved by facile synthesis nor by the dominance of a single school. One of the founding principles behind DIVISION/Review was that diverse schools of psychoanalytic theory and practice should share the pages of a single journal instead of being segregated in publications,

Official publication of Division of Psychoanalysis (39) of the American Psychological Association

EDITOR

David Lichtenstein SENIOR EDITORSw

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

CONTENTS

CONTRIBUTING EDITORS

BOOK REVIEWS 4

Todd Dean

edited and with an introduction by Irene Willis

Dinah M. Mendes

WEBSITE EDITOR

Gemma Marangoni Ainslie Climate of Opinion: Sigmund Freud in Poetry

Psychiatric Diagnosis Revisited: From DSM to Clinical Case Formulation by Stijn Vanheule

Gregory Novie

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

Gemma Marangoni Ainslie

In the Darkroom by Susan Faludi

PHOTOGRAPHY BY

The Subject Of Torture: Psychoanalysis & Biopolitics In Television & Film by Hilary Neroni

Mac Adam, Peter Baker, Bill Beckley, Gina De Naia, Allen Frame, David Humphrey, Corinne Jones, Laura Larson, An-My Le, Mikael Levin, Tim Maul, J. Pasila, Alix Pearlstein, Tiana Peterson, Hrvoje Sloven, Seton Smith, Steel Stillman, Kunié Sugiura, Mónika Szilád Sziladi, Björn Valdimarsson, Emma Wilcox IMAGES EDITOR

Tim Maul

REMINISCENCE 20

Morris N. Eagle

DESIGN BY

Doris Silverman

Hannah Alderfer, HHA design, NYC

COMMENTARY ON AUTISM A DISCUSSION 22

Joanna Lhulier

Michael Krass

Response to Dr. Sergio Benvenuto’s Commentary: Autism: A Battle Lost by Psychoanalysis Response to Dr. Sergio Benvenuto’s Commentary: Autism: A Battle Lost by Psychoanalysis

Sergio Benvenuto

On Autism. Response to My Critics

Michael Krass

Response to Benvenuto’s Response to Krass

Subscription rates: $25.00 per year (four issues). Individual Copies: $7.50. Email requests: divisionreview@optonline. com or mail requests: Editor, Division/Review 80 University Place #5, New York, NY 10003 Letters to the Editor and all Submission Inquiries email the Editor: divisionreview.editor@gmail.com or send to Editor, Division/Review 80 University Place #5, New York, NY 10003 Advertising: Please direct all inquiries regarding advertising, professional notices, and announcements to divisionreview.editor@gmail.com

COMMENTARY Henry M. Seiden, Peter Lin “Ox Herding” and the Art of

& William Fried

DIVISION | REVIEW a quarterly psychoanalytic forum published by the Division of Psychoanalysis (39) of the American Psychological Association, 2615 Amesbury Road, Winston-Salem, NC 27103.

Psychoanalytic Psychotherapy

© Division Of Psychoanalysis (39) of the American Psychological Association. All rights reserved. Nothing in this publication may be reproduced without the permission of the publisher. DIVISION | REVIEW accepts unsolicited manuscripts. They should be submitted by email to the editor: dlichtenstein@gmail.com, prepared according to the APA publication manual, and no longer than 2500 words DIVISION | REVIEW can be read online at divisionreview.com

ISSN 2166-3653 2

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To Review (from page 1) each reflecting a certain school of thought, as had been a tendency in times past. It is encouraging to note that not only have we at D/R been able to maintain this principle of inclusion and conceptual diversity, but that many journals in the field have evolved along similar lines. Vehicles for the one true school of psychoanalysis are increasingly rare, and the discourse of the field itself has broadened to allow for the juxtaposition of multiple perspectives. Both the ability to translate across perspectives and to note where those translations encounter impasses are far more prevalent in our meetings and in our writing than was the case ten years ago. That DIVISION/Review may have contributed in some way to this development is our great satisfaction. As a theory and practice of the human subject divided by an unconscious, psychoanalysis must continue to place its questions against those from a diverse range of disciplines. It both stands apart as a unique perspective on the human subject and rests on other fields. Indeed, the study of the divided human subject is too rich and too complex to operate entirely in its own sphere and ignore developments in the culture, that is, the arts and sciences of the larger society. We recognize more than ever that philosophy

and cultural theory, gender studies and linguistics, the arts as well as the social sciences, neurology and cognitive science all come into play when we try to articulate the problematics of our work. In one sense, recognizing this broad multi-disciplinary framework of our field is not new. Freud argued for much the same when he first addressed the educational and cultural background needed by psychoanalysts. However, those fields are now no longer the classical disciplines they may have been at Freud’s time. As the world and how it is studied changes, our relationship to other disciplines must adjust to those changes. For example, as post-colonial cultural theory has come to recognize more fully the effects of racial and cultural hegemonies, essential categories of psychoanalytic thought involving the transmission of cultural norms such as superego and identification, to take just two obvious examples, should be reworked in light of those historical conceptual developments. How psychoanalysis goes about this reworking of its essential concepts without sacrificing those core principles that both define the field and allow it to change with historical and cultural dynamics remains one of the most interesting and challenging dimensions of our field. It is not enough to recognize the grounding of psychoanalysis

in wider cultural and intellectual fields. We are now challenged to articulate the interplay between our discipline and the others without losing what is essential to us. If our core concepts are valid, then they should be robust enough to address and incorporate the complexity of cultural change and the emergence of new conceptual frameworks for the study of subjectivity and intersubjectivity. Cultural theory is only one such example. Developments in gender theory as well as both cultural practice and medicine related to gender and sexuality challenge our fundamental notions of character structures and their stability/mutability. Not only political philosophy, but the character of contemporary political authority, the exercise of power and legitimation, challenge our ideas of the social order. Cognitive science, neurology, and psychology and the technological changes in the organization of daily life challenge our essential models of mind and of the mind-body relationship. Taken together, these fields continually challenge psychoanalytic thinking and place a demand on our minds to work and indeed rework our foundations. DIVISION/Review was created ten years ago as a platform for this work. It is ready now to continue the project at a time when it seems more important than ever. z

“Life is in color but black and white is more realistic.” Attributed to Wim Wenders A number of years ago, two talented students in my Photography Thesis class at the School of Visual Arts formed a couple and were invited after graduation to give a presentation of their work in the school’s auditorium/theatre on West 23rd Street. They were way ahead of the curve, generating complex images and animations with the then novel GIF format hoping to break into advertising, fashion, and the now quaint term of “rock video.” While I liked them as “people”(?), I could not, attend their lecture and I am glad I did not, for later, in seeking out coverage of the event, they appeared on the podium with the words PRINT IS DEAD in big caps projected behind them in brutalist Orwellian grandeur. I made an strong association with this proclamation with a gun-toting William Burroughs blasting holes through newspapers pasted on wooden boards in his Kansas backyard as part of his late-career collage making, another war on the printed word. When David Lichtenstein offered me the role of “Images Editor” at DIVISION/ Review I immediately agreed, joking that I could not contribute to anything resembling

the literary/poetry journals so prevalent in a certain type of bookstore in a certain kind of city or town with poems trickling down pages and earnest “fine art” photography of shadows, icicles, and winsome grad students. Now I regret this aside. Like the hand held album cover by your favorite folkie or porto-hippie band, these modest volumes are cultural touchstones that, in their own way, hold their own in the bygone flotsam and jetsam of print culture. The black and white images inside Bob Dylan’s Blonde on Blonde double album were/are as compelling to me now as they were then. Colorfree art publications that I was riveted to in the 70’s included Avalanche (NYC 1970-6), Art & Project Bulliten (Netherlands 196889), Art & Language (UK 1969-?), and the 1980 Autonomia issue of Semiotext(e), which had every cool downtown person in NYC involved with it, and whose photography was positioned in the lower right hand corner of each page like a flip-book, sometimes in direct relation to the text and sometimes not. None of these magazines would have resonated culturally if their photographs were in color and neither would D/R. On a 3

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printed page, the black and white text and image share the same ink. For the artists/photographers that collaborated with D/R, the absence of color offered both a challenge and a opportunity to attach itself to the always intriguing (and sometime unsettling) content that composed each issue; I respectfully thank them all. Hannah Alderfer’s sympathetic and accommodating design sensibility is apparent on every page from the terraced cover on. When an image associates itself even obliquely with a text either in subject or attitude (and for some odd reason they always do), we can thank Hannah. I remain thrilled when each issue becomes available and can be perused in hand, usually pulled from an squishy envelope dutifully sent by David. I will cease trading in boomer nostalgia, but I really miss the bookstores, specifically Saint Marks Books that carried D/R. We won’t see their like again. For the 20th issue under editor David Lichtenstein, here is everybody. z Thank You All Again. Tim Maul

BOOK REVIEWS

Diagnosis and How It Got That Way A research paper recently published in the academic journal World Psychiatry (Corcoran et al) makes the argument that, “[u]sing computer-based natural language Psychiatric Diagnosis Revisited: From DSM to Clinical Case Formulation By Stijn Vanheule London, England: Palgrave Macmillan, 2014 256 pp., $81.34 processing analyses,” psychiatrists can more accurately diagnosis people at risk of developing a psychotic illness before they fully meet criteria for such a diagnosis. In addition, the paper argues that such an analysis will consequently validate the need for therapeutic intervention before the psychosis has fully manifested itself, as defined by diagnostic criteria in the DSM-5. This is an obviously interesting thesis, one that might not seem at all irrelevant to psychoanalysis. For example, Jacques Lacan has always emphasized in his work on psychosis the differences between psychotic and neurotic speech (Lacan, 1993). At the very least, this research argument would seem to be a fertile place to investigate the relationship between speech and psychosis from a different angle. One striking element of this study, however, is that it does not concern itself with the meaning of the language disturbances it focuses on, only briefly referencing, in the Discussion, “abnormal task-related activation in language circuits” as characteristic of disturbances in psychotic speech, making these disturbances sound completely irrelevant to subjective experience. Besides which, we are left to decide what makes a “task-related activation in language circuits” – whatever that is – “abnormal.” Several years earlier, the journalist Rachel Aviv did a study of one of the clinics associated with this project (Aviv, 2010), mentioning the lead author of this paper by name (“Cheryl Corcoran, a compassionate, soft-spoken psychiatrist who has studied schizophrenia for her entire career…”) and interviewing several of the clinic’s patients, all of whom were being seen because they were felt to be at risk for developing a major psychotic illness. One patient Aviv discusses at considerable length. This patient, “Anna,” developed a delusion, “slowly and reluctantly,” that “people were made of paper.” Unlike the psychiatrists in the study quoted above, Aviv’s article places this symptom in a context, noting that “Anna had always been the kind of student who would do anything to please her teachers,” and that her troubles started only after she had begun graduate school. Aviv is not

Todd DEAN

interested in making arguments about what causes psychosis; thus, she notes that Anna’s mother had been diagnosed schizophrenic, and comments that “the neurological mechanisms behind mental disorders are too poorly understood to have much bearing on the way the [DSM] separates health from pathology” (p.36), while also dismissing “the psychoanalytic era, when a generation of parents were made to feel responsible for their children’s suffering” (p.40). That said, she also states: “What it means to have a self — and then lose it – is central to any attempt to understand psychosis, but the DSM (and the reams of psychiatric literature it has spawned) does not encourage doctors to probe their patients’ subjective experience. The manual is so concerned with statistical reliability it fails to capture the core of the illness” (p.44; emphasis added). Of course, to anyone who has read Freud on psychosis, it is clear that Aviv here is making a truly Freudian claim about the nature of psychosis: it is the reaction to a loss of a sense of self. For Freud, “the ego is recompensed by the megalomania” (Freud, 1911/2002, p.38; emphasis added) — there were no schizophrenogenic mothers. Thus, Aviv points us toward a likely reason that Anna became psychotic when she did: her sense of herself was very tied to pleasing her teachers; getting to graduate school, where students start to work more independently, would be disturbing to that perspective, because there were no longer teachers to please on a day-to-day basis. The symptom she developed helped her to hold herself together. Considering what happens to language in psychosis, we can even make an argument for why Anna developed the particular delusion she did: graduate students have always complained that their whole world is nothing but paper – the endless books they have to read and theses they have to write – but the claim is understood metaphorically. In addition, what held Anna together before her symptom – the admiration of her teachers – is now gone: the world she had felt safe in is dangerous, because the teachers are more distant, and she really is living in a world of paper. Here, Anna loses not only her sense of self, but also her ability to think metaphorically: she experiences her world as turning literally into paper. Might those two things, a sense of self and a capacity for metaphorical thought, be more intimately connected than meets the eye? When Aviv notes that “more and more her thoughts began to feel like ‘things’” (p.38), she is describing something that seems much more tied to subjective experience than “abnormal 4

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task-related activation in language circuits” suggests could be the case. Close attention to the subjective experience of the patient, in fact, brings a lot of the science of the DSM into question. Stijn Vanheule’s Psychiatric Diagnosis Revisited: From DSM to Clinical Case Formulation is an extremely important book because it addresses the issues raised here in a thoughtful and thorough manner. Far from dismissing the neo-Kraepelinian approach to psychiatric diagnosis that has characterized the DSM since its third edition in 1980 from a theoretical perspective, he offers a close reading of the research that led to the DSMIII, explains in clear language his concerns, and offers a detailed argument for an alternative approach to psychiatric diagnosis, the “clinical case formulation” of his subtitle. In so doing, he brings the statistical reliability of the DSM, which Aviv takes for granted in her article, radically into question. Vanheule begins his discussion of diagnosis with a detailed and comprehensive critique of the DSM as organized at least since the development of the DSM-III. As someone who trained as a psychiatrist in the 1980s, I have long taken for granted the stories of diagnostic chaos, several of which Vanheule references (pp.16-21), that made psychiatric diagnosis seem such a joke prior to the DSM-III: stories of people going to an emergency room, claiming that they heard voices, doing nothing else to suggest they suffered from mental illness of any kind, then being hospitalized for weeks at a time and discharged with a diagnosis of psychosis; stories of experts elaborating diagnoses on the thinnest threads of evidence. He devotes the first chapter, “Dynamics of Decision-Making,” to the question of diagnostic reliability. There is a decidedly interesting dynamic at play in this research. As Vanheule sees it, there were at least three forces bearing down on psychiatric diagnostic practices in the 1970s. First was the appearance, noted above, of empirical studies demonstrating the unreliability of psychiatric decision-making prior to DSM-III; second was the increasing criticism of psychiatric authority by critical scholars, most famously Michel Foucault and, from a very different perspective, Thomas Szasz; finally, as society focused more on the bureaucratization of health care administration, to emphasize quantitative measures in mental health came to seem not only unremarkable, but the only reasonable option. Thus, empiricist medical research, critical theory, and the health care bureaucracy were all aligned against the psychiatric status quo at that point. Regarding empiricism, Vanheule does a close reading of the research literature on the

BOOK REVIEWS

J. Pasila

reliability of psychiatric diagnosis; in so doing, he uncovers fascinating details. The authors who worked on that research were often the leaders of the development of the DSM-III, such as Robert Spitzer. What Vanheule shows from that literature is that the main statistical measure of significance of findings, the kappa coefficient, a measure of inter-rater reliability, became significantly less rigorous in diagnostic studies of reliability that used DSM-IIItype diagnostic criteria over time. Thus, in the early 1970s, when this literature was being started, Spitzer and Fliess (1974) argued that the inter-rater reliability of psychiatric diagnoses typically requires a kappa coefficient of “0.70 to 0.90.” Starting from this claim, they argued that reliability is high if greater than 0.90 and unacceptable if below 0.70. In a table (p.24), Vanheule shows how, by 2013 — the year the DSM-5 was published — an “unacceptable” kappa was below 0.20, while 0.60

was considered “very good.” As Vanheule notes, “over time, the standards upon which statistical evaluations were made relaxed substantially. If these changes are not taken into account, the results of different studies simply cannot be compared” (p.24). He goes on to show how differently the results of these studies could be interpreted, based on the different kappa values used. As was well known by the 1980s, the interrater reliability in Spitzer and Fliess’s original study was almost universally unacceptable; however, by the 2013 kappa values, almost all the diagnoses evaluated by Spitzer and Fliess in 1974 would have fallen into the “good” or “very good” categories. In other words, by the kappa values applied to the creation of the DSM-5, the reliability studies that led to the creation of the DSM-III were quite good, not proof of a crisis in psychiatric diagnosis. The author drives home the fact that “since the inter-rater 5

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reliability of the majority of DSM-5 categories remains untested, the idea that the DSM is a reliable instrument is simply wrong” (p.62). It does strike me, however, that the evidence that kappa values were manipulated, as telling as it is, does not make the earlier diagnostic schemas of DSM-I and -II meaningfully any better than what came after: after all, the earlier iterations of the DSM were also symptom checklists, just different ones. The criticism of Thomas Szasz, discussed below, was aimed at the diagnostic paradigm in place before the DSM-III. It is thus very much to be appreciated that Vanheule does not limit his discussion of the reliability of psychiatric diagnosis to this statistical analysis, striking as it is. He devotes several pages to a discussion of the concept of reliability, a focus one would never expect to find in academic psychiatry, where reliability is treated as self-evident. For example, in his

BOOK REVIEWS

discussion of the studies critical of psychiatric diagnostics in the 1960s and 1970s, Vanheule points out that the psychiatrists who were able to accurately diagnosis a patient as “normal” showed, in their evaluations, that they had attended closely to what the patient was actually saying (p.17). Thus, while the argument made by Spitzer et al. is that the problem with reliability was a lack of established criteria, what Vanheule shows is that it was not better criteria, but the quality of the clinician’s listening, that led to a meaningful diagnosis. Similarly, he raises the question of the “reliability” of the subject’s description of his symptoms as it relates to the clinician’s interpretation of those symptoms: “[t]he entire enterprise of evaluating reliability presupposes stability both at the side of diagnosticians’ evaluation and at the side of the patients’ account. Yet if patient accounts of distress have a different outline and character across interviews, the search for good reliability will always be disappointing unless the nature and organization of this variability are taken into account” (pp.65-66). There will always be an investment in the account on the part of all parties involved: the patient will always understand the story he tells in a way that is, at least to some extent, unique to him, while the clinician will always hear that story in terms of her own context — her training as well as her own personal investment in what is said; there will always be something transferred, so to speak. Thus, to treat the patient’s report of his symptoms, and the clinician’s registering of that report, as a material fact, as the DSM (pre-DSM-III as well as post-) inevitably does, cannot even allow for this possibility. American psychiatry in the 1960s and 1970s may have had the wind taken out of its sails by the criticism of thinkers such as R. D. Laing, Thomas Szasz, and Michel Foucault, but these authors are essentially ignored by the neo-Kraepelinian focus of the DSM. In their various ways, they were criticizing psychiatric thinking for a radically different problem from what Spitzer, Eli Robbins, et al. were focused on: ignoring the context in which symptoms arise, a context that, for all these authors, involves the larger world, a world that is not specifically medical. Szasz, for example, criticizes psychiatry for being too focused on “deeply ingrained conditions, while ‘process-thinking’, which focuses on dynamic processes, was neglected” (p.29). “Process thinking” — a term to which Vanheule will return — “is interactional in nature, and explores how problems are constructed within contexts” (p.29). For Szasz, psychopathology is not a matter of

symptom-specific diagnosis, regardless of how those symptoms are theorized, but a way of communicating and addressing problems that cannot be clearly formulated. Foucault’s approach to the problem of context was different again. In his History of Madness (1972/2006) he had shown that “whereas in the Middle Ages the so-called madman was a figure inside society, subsequent epochs defined him as an outsider. From then on, the insane person was an outcast that must be confined; a sick individual that should be studied and treated as a medical object” (p.30). Foucault’s argument is that it was only through the advent of positivistic science that the mad came to be defined as alien and in need of normalization through psychiatric intervention. In other words, the very driving force behind the development of the DSM pathologizes the insane. By presenting Szasz and Foucault in his discussion of the concept of reliability, Vanheule forces us to face the question: on what do we base the concept of reliability here? In the DSM, at least from the appearance of DSM-III, psychopathology is defined by an algorithm: does the patient have this group of symptoms? From Vanheule’s description, the focus of the researchers on the algorithm overrode what appears to have been an empirical observation, that, as noted above, clinicians who listened closely to what the patients actually said made accurate diagnoses. As Franklin Foer has noted (2017), the algorithm is a central organizing principle of our times, whereby problems are always run through a program that inevitably leads to a specific conclusion: if you have these symptoms, you have this diagnosis, therefore you need this treatment. In the research paper with which I began this review, the entire justification for treating people as “pre-schizophrenic” is a matter of fitting the patient into an algorithm. Szasz and Foucault, approaching the issue from very different perspectives, make a strong case for radically reframing the question. Vanheule writes that detailed studies of how psychiatrists actually dialogue with patients make clear that through concrete interactions, reification indeed takes shape. Close examination of ways in which diagnosticians ask questions makes clear that they often just check the diagnostic criteria of specific DSM disorders, thus framing patient experiences as if they were discrete categories (Ziółkowska, 2012). While in daily life specific experiences have a process-like character, and are embedded in broader sets of mental representations, life histories, and interactional contexts, in diagnostic contexts they are 6

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frequently treated as isolated states with an object-like character (p.33). Vanheule concludes the chapter on reliability with the observation that research into diagnostic reliability has inadvertently opened another field of inquiry: what psychiatric disorders exactly are and how mental health symptoms can be conceptualized. In discussions about diagnosis and assessment it is often argued that reliability is a necessary condition for validity. Indeed, before we can ever conclude that an instrument measures the phenomenon we want it to, we must already be convinced that the instrument yields stable results. Reliability research on the DSM sheds doubt on its scientific credibility… (p.67); and more pointedly: “…the reliability of contemporary DSM-based diagnosis is exaggerated, and not based on evidence” (ibid.). This strikes me as an explosive claim, but one that is fully supported by the evidence Vanheule presents: reliability, contrary to what academic mental health research has promoted, is a secondary concern. More significant, even after many decades of psychiatric research, is the question of what constitutes a psychiatric problem: what makes the claim that something is a psychiatric symptom scientifically valid? From here, Vanheule goes on to make his case for the validity of the clinical case formulation. He elaborates his focus on the value of the clinician listening and contextualizing the report of the patient as the most important way of proceeding clinically. In fact, from what Vanheule is describing (and what analysts should be aware of, anyway), “… separating symptoms from subjective experience and the meaning-making processes that get shaped via speech acts is unjustifiable” (p.101). Here also, the author briefly addresses the relation of the symptom to a concept of science, using a Lacanian understanding of the relation of the subject to his symptom, noting in a footnote that “Lacanian psychoanalysis does not reject the idea that psychopathology is governed by laws that can be described in scientific terms, but maintains that the reflexive relation an individual has to his own condition cannot be reduced to these laws” (p.104). While I respect the perspicacity of Lacan’s approach to this question, it does seem to this reader that a larger perspective on the non-biological view of the nature of mental disorders would be very important here. Instead, the author goes through the various arguments for treating mental disorders as neurologically based, showing how inadequate these arguments are. I would suggest that the evidence for this perspective on psychiatric disorders is so weak, proving it

BOOK REVIEWS

wrong is like shooting fish in a barrel: there is very little here that would surprise the reader who is informed by psychoanalysis. But this discussion leaves open the question: is there a place for science in our understanding of psychological problems, and if there is, what is it based on? It was Kant who argued that psychology could not be a science “due to its inamenability to mathematical treatment” (Leader & Burgoyne, 2000, p.27). This would seem to be, according to Vanheule, because of the problem of context: my psychiatric symptoms may have myriad meanings and purposes that cannot be captured simply by noting that my complaints sound a lot like the complaints of others. By contrast, if I have a fever that is higher than 102 degrees Fahrenheit, I may well have a bacterial infection, because of the causes that are associated with the likelihood of having a temperature that high, which are finite in number and not influenced by subjective context. It is this context that keeps the psychological symptom “inamenable” to mathematical constructs (cf. Kant, 2002, p.185)1. This reader found Vanheule’s critique of the DSM, and of categorical diagnosis in general, more than convincing, well-argued, and compelling. The need for a concept of “clinical case formulation,” which he develops in the second half of the book, is inescapable. What I did find problematic, however, was the question of what happened to the place of science in the subsequent discussion: did Kant have the last word? And if so, shouldn’t we be making an argument for the validity of psychology as something that is not scientific? Yet in his conclusion, Vanheule writes, “Functionoriented diagnosis requires a quality policy in which the reflexivity, reliability, and validity of the diagnostic process are established as well as possible” (p.205). If reliability and validity are still important, how do we establish them in psychiatric diagnosis, given what has been described about this problem throughout the book? On the one hand, clinical case formulation seems necessary; on the other, what does clinical case formulation mean for the development of scientific psychiatric diagnosis? From the evidence, it seems clear that, whatever is scientific about the concept of mental health, it is not a simple tabulation of symptoms. Before addressing this question, however, there is another, more immediate one 1. As Vanheule notes, DSM-5 does allow for individual context as an influence on symptoms, but only as “a minor moderating role” (p.79). He also references the technology alibi, a term coined by Berrios and Marková (2002), defined as “a rhetorical strategy used since the early nineteenth century in order to support further belief in biomedical illness assumptions” (p.108). As Vanheule points out, neurobiological assumptions remain just that: assumptions for which there is at most a very small amount of evidence. For all that, in contrast to the criticisms of Allen Frances (2013), the DSM-5 is not significantly more “medical” than previous editions of the DSM: in other words, social/personal context has always been slighted in the development of categorical diagnoses.

that Vanheule does not address: why did the diagnostic researchers discussed in the first part of the book manipulate the valuation of findings by so radically changing the kappa values for the different diagnoses over time? I do not claim to know the answer to this question, but I will note that, besides reinforcing the zeitgeist’s focus on algorithmic thinking, the DSM has been great for capitalism. The DSM reduces all diagnostic questions to a very simple algorithm — what are the symptoms of the person seeking help? — and does not allow for any possibility of getting outside that question. In this, the development of academic psychiatry exactly parallels the development of neoliberalism, as described by Adam Tooze (2018). By focusing on the question of defining symptoms, academic psychiatry never has to address the details of clinical process, as Vanheule does in this book: thus, there is endless refining of diagnostic criteria and more development of new treatments for the symptoms at the same time as the suicide rate continues to climb, despite the miracles of modern psychiatry. When we go on to note that the purpose of the developments of the DSM since at least the 1970s has been largely to legitimize psychiatry as a branch of medicine, it has worked to make the treatment of psychopathology mostly a matter of finding the correct medication; consequently, the DSM has been a great supporter of the pharmacological industry.2 The point to be made on this topic is clear: there was money to be made in keeping the focus on diagnoses based on a simple listing of symptoms, with the understanding that treatment would consist of the removal of symptoms, primarily by the use of medication, which is a very big business. Vanheule’s book is so damning of academic psychiatry, it is not too much to ask that he discuss what underlies the focus of the DSM. But we must return to the question of the science of any alternative to the DSMbased approach to diagnosis if we are to be able to say anything meaningful about the details of clinical process that are overlooked by the current state of academic psychiatry. Clearly, the DSM is not “theory-neutral,” as was claimed starting with the third edition;simply by the fact that diagnoses are based primarily on the organizing of symptoms, the research theorized that a listing of symptoms could determine diagnosis. As Vanheule notes, “[a] simple alternative to the DSM… does not exist” (p.169) – we can’t just come up with a better way of listing symptoms. 2. In the mid-90s, the psychiatrist with whom I shared a suite of offices at the university where I then worked was on the state Medicaid board that oversaw the use of medications. He told me after one meeting of the board that the best-selling medication in Missouri at that time, across all ages and diagnoses, psychiatric and otherwise, was Zyprexa, a “second-generation” antipsychotic that was argued to be harmless but was, in fact, leading to significant health problems even then, and is now much less widely used. 7

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Instead, as he further notes, a symptom can have completely different meanings, or, as he quotes Freud (p.170): “In every instance the meaning [of a symptom] can be a different one, according to the nature of the suppressed thoughts which are struggling for expression.” An anorexic girl obsessing over what she eats or how she is perceived by others is not engaged in the same activity as the Rat Man, obsessing over how to get his three crowns and 80 pence to Lieutenant A. As Vanheule rightly notes, contextualizing the function of the symptom is more important than an objective listing of symptoms can even begin to suggest. Further, if we are to take what Freud says most literally, to merely name a symptom verges on being a pointless exercise, one that does very little to help us determine what to do with it. In this setting, figuring out what constitutes the science of psychological medicine, broadly defined, remains very challenging. It is worth noting that Leader and Burgoyne (2000) have shown that even in studies of the scientific basis of psychoanalysis, there has been significant confusion on this score. From Vanheule’s description of the issues in his discussion of clinical case formulations, it appears that the science of psychological medicine has some relation to the lack of clarity of what is consciously perceived: a focus that is decidedly not algorithmic or amenable to statistical manipulation, though it undoubtedly has its own problems. If this is correct, then what Vanheule is describing here is a significantly more radical challenge to the status quo of academic psychiatry and psychology than even the critique of the DSM that is the focus of this work. z REFERENCES Aviv, R. (2010). Which way madness lies: Can psychosis be prevented? Harper’s Magazine, December 2010, 35-46. Berrios, G. E., & Marková, I. S. (2002). Conceptual issues. In H. E’haenen, J. A. den Boer, & P. Willner (Eds.), Biological Psychiatry (pp.9-39). Chichester, UK: Wiley. Corcoran, C. M., Carrillo, F., Fernández-Slezek, D., Bedi, G., Klim, C., Javitt, D. C., . . . Cecchi, G. A. (2018). Prediction of psychosis across protocols and risk cohorts using automated language analysis. World Psychiatry 17, 67-75. Foer, F. (2017). World without mind. New York, NY: Penguin Press. Foucault, M. (2006). History of madness (Jonathan Murphy and Jean Khalfa, Trans.). Abingdon, UK: Routledge. (Original work published 1972) Freud, S. (2002). The Schreber case (Andrew Webber, Trans.). London, UK: Penguin Press. (Original work published 1911) Kant, I. (2002). Theoretical philosophy after 1781. Cambridge, UK: Cambridge University Press. Lacan, J. (1993). The psychoses: The seminar of Jacques Lacan, vol. III. New York, NY: Norton. Leader, D., & Burgoyne, B. (2000). Freud’s scientific background. In D. Leader, Freud’s footnotes (pp.11-48). London, UK: Faber & Faber. Spitzer, R. L., & Fliess, J. L. (1974). A re-analysis of the reliability of psychiatric diagnosis. British Journal of Psychiatry, 125, 341-347. Tooze, A. (2018). Review: Globalists: The end of empire and the birth of neoliberalism by Quinn Slobodian. Dissent, Summer 2018, 132-136. Vanheule, S. (2017). Psychiatric diagnosis revisited: From DSM to clinical case formulation. London, UK: Palgrave Macmillan. Ziółkowska, J. (2012). The objectifying discourse of doctors’ questions. Qualitative analysis of psychiatric interviews. Social Theory and Health, 10, 292-307.

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Poetry and Psychoanalysis: A Generative Couple/t “It was at that age that poetry came in search of me.” Pablo Neruda Climate of Opinion: Sigmund Freud in Poetry Edited and with an Introduction by Irene Willis International Psychoanalytic Books, NY Paperback, 2017 224pp., $19.95 In Climate of Opinion, poet and poetry editor for International Psychoanalysis Irene Willis offers a finely curated perspective on Freud and psychoanalysis from the viewpoints of poets, past and present. The book’s title, a quote from one of the best-known poems about Freud, invites one into dozens of worthy entries, many the poems of academics and psychoanalysts and patients whose names are well known, but equally many by writers who will be new to most readers. There is no apparent science to what Willis includes, only her poet’s fine-tuned sensibility. She does not insist that her choices reference Freud or even psychoanalysis directly. Rather, through her selections, she allows us to see these poets’ Freud and, via the collection as a whole, her own. This free ranging quality and the enjoyment in her curatorial process evident in her “Introduction” serve the reader well. I was particularly pleased to be introduced to the work of many contemporary poets. Including their voices in this chorus ensures that the reader traverses a vast range of content, tone, and perspective and, in that way, of opinion. From the powerful role of a listening presence to the evocation of a unique transferential/countertransferential dyad, from affect through self-reflection and insight, from anxiety through gratitude and reparation, Willis effectively includes poems that shift our focus, as though she is rotating a kaleidoscope, offering myriad images of Freud and his legacy as it is reflected in poetry. Thus, her choices evidence not only the ubiquity of Freud’s theories in contemporary culture, but also and simultaneously, unique perspectives on them. I can well imagine the embarrassment of riches Willis faced as she culled what she refers to as the “harvest” of hundreds of poems submitted for entry in this volume. I face a similar quandary in reviewing this beautifully edited collection of dozens of her choices. In the hope that my review will whet your appetite for what is a reader’s equivalent of “a good feed,” I will highlight a small subset of the dozens of poems gathered here. Following the “Introduction,” in which she describes the development of the book

project, Irene Willis begins with W. H. Auden’s “For Sigmund Freud,” the source of the book’s title. In response to Freud’s death, Auden highlighted that Freud’s insights were both of human scale All he did was to remember Like the old and be honest like children. He wasn’t clever at all; he merely told The unhappy Present to recite the Past. and, paradoxically, yielded in understandings beyond the proportion of any one man. (“One step for man, one giant leap for mankind.”) They quickly so permeated the way we understand ourselves that Freud is now with us always, what we inhale and exhale with neither intention nor attention, what sustains us in our peculiarly human self-reflective state. As Auden asserted: To us he is no more a person Now, but a whole climate of opinion Under whom we conduct our different lives This poem is most often referred to by the title “In Memory of Sigmund Freud,” but Willis uses an alternate title — “For Sigmund Freud” — one that suggests, subtly but cogently, that the poem be read as a thank you rather than a memorial. Hilda Doolittle’s “The Master” is the second poem in this collection and the first of many that reflect the patient’s experience of a fruitful psychoanalytic process: each word was separate yet each word led to another word, and the whole made a rhythm in the air, till now unguessed at, unknown. Two poems by Anna Freud are also included, testimonies to a daughter’s burden and to a daughter’s fealty. Perhaps other poems that will be familiar to the reader are those by Louise Gluck. For me, Gluck’s particular gift is her highly refined capacity to capture moments of meaning in simple images of intimate human interaction. For example, Freud, entering Gluck’s poem “Humidifier: After Robert Pinsky,” asks, Why are you always sick, Louise? I can see him standing, cigar smoke commingling with mist, both dreamy representative of the question and pointed harbinger of an answer. 8

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Gemma MARANGONI AINSLIE

Similarly, Gluck’s seemingly plain observation in “The Sword in the Stone,” in which she compares the analyst to a mother watching a sleeping child, is a compelling rendering of the analytic paradox of ritual yielding playfulness. The last words of the poem, reminiscent of Mary Cassatt’s impressionist portrayals of mothers and their children, illustrate Gluck’s sensitivity to a particularly Winnicottian dyadic register: this silence, in which everything that remained unspoken was somehow shared. A number of poems in this collection enliven our appreciation of the trust required to engage the peculiarly frightening process of psychoanalysis. Maxine Sussman, reflecting on Freud’s background in neuroanatomy, during which he undoubtedly mastered exquisite attention to detail, portrays the risk Freud took when he ventured into thinking about the mind: …lacking means to measure further, he uncoupled himself from proof and launched into shadows. Almost in response, Laura Sheahen’s “Minotaur” suggests the parallel and equally un-mooring leap required of one entering psychoanalysis, I stretched out on the shredded couch that was when the maze began. Inevitably, many of these poems address the unbidden content encountered in a psychoanalytic process, the unavoidable and unrelenting questioning of self and truth that accompanies our patients in the most threatening moments of their self-explorations. Maroula Blades’s “Nostalgia” examines “fakers in hiding,” a poet’s descriptive insight into the inevitable drift encountered when we explore inconsistencies in who we have imagined and enacted ourselves to be. Similarly, in a reflection on the loss of certainty and balance inherent in self-examination, Alice Ostriker questions whether it is worth it, chronicling an aspect of resistance in “Misery and Frustration:” …if you give up your good drinking buddies Misery and frustration, you wonder What else might drop from the picture. …Misery and frustration Were loyal pals for years; don’t you owe them?

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Seton Smith

Much as in our consulting rooms, reflections on and reflections of relationships with parents are the raw materials of many of these poems. “Love Duck” is Peter Maruc’s amusing fantasy that his father imagined the poet and his mother were “love ducks,” enjoying Chinese dinner without him. In “Freud,” James Cummins wrestles with the complexity of a son’s relationship with his mother, and with his father, while in “Stones in Shoes on the Shoreline of Dark Lake,” William Combes encounters

and wrestles with “Eye, the internalization of a devaluing stepfather.” Similarly, childhood translations of adult communications are conveyed in several poems. Two, pivoting around guilt, of particular note are Jill Stein’s ”When I Was Six My Father Had the Power” and Jean Hollander’s “And They Shall Wear Purple…” An especially affecting piece about panic by Jed Myers, “The Best Thing For It,” portrays the paradox of anxiety compelling behavior that fuels rather than quells it, behavior that contains a 9

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recollection of a reunion with an unrelieving object, a reunion with separation. In contrast, an especially heartening aspect of this book for me was several poets’ insights into the requisite playfulness of an analytic process. In “Freudian Slip,” Fern G. Z. Carr takes us to the zoo and proves that a poet can make even a corny old joke feel new. Henry Seiden’s “From an Analyst’s Notebook” demonstrates that playing with words and images is our modus operandi, that a walnut is also an egg and an avocado

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and eventually, upon the analyst’s second or third glance, a mango. From there, we can all imagine, Seiden’s oval image will continue to rotate and wobble productively for hours, food for thought, so to speak, quelling at least momentarily the analyst’s appetite for understanding and nurturing the living organism of his productive self-examination. Moments of humor, so long eschewed as not properly “analytic,” have profound impact in the midst of our very serious work, the surprise of unintentionality as significant as the content unveiled. The clearest and most moving example in this collection is, perhaps, Richard Belin’s “Transference,” in which he renders the end of his first analytic hour when a “puzzled sensation” of immediate familiarity ushers in a moment of parapraxis, no doubt foreshadowing the arc of the process to come. Moments such as that punctuate analysts’ daily work, yet it is not always easy for us to convey them, they all too often remain in the realm of “you had to have been there”; no doubt we have much to learn from poets about “putting it into words.” As if acknowledging that assessing climate requires taking “readings” at different

yet significant locations, Willis also includes two poems in which place is a central feature. In the first, Eugene Mahon lets us join his hopeful pilgrimage to Freud’s home in “First Visit to Bergasse 19,” a poem-journey that parallels my own experience of dislocated melancholy at that same site: How ordinary the rooms… Expectation jolted, As if one Had returned to womb In search of home Only to find A used lot instead… In striking contrast to Mahon’s sad travelogue, Susan Wheatley’s “The Winter Meetings of the Freudians” returns us to the truth that in psychoanalysis any specific place is merely a stepping off point — that a hotel becomes a cake becomes a tale becomes a poem, a poem that suggests a rebuttal to the validity of free association while simultaneously instantiating it. Poetry and psychoanalysis are a rather symbiotic couple/couplet made available for our reflection and pleasure in this

Corinne Jones, July Centerfold

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volume of well-chosen and well-placed poems. Psychoanalysts and analysands and poets, seated or reclining in consulting rooms, or hunkered down at desks, have weathered storms and stood the test of time, by finding and making meaning in metaphor. In the opinion of Willis and the poets whose works she presents, the current climate regarding Freud’s work is welcoming — temperatures are warm, skies relatively sunny, the air maybe even balmy. Freud’s experience was that “Everywhere I go I find a poet has been there before me.” This collection testifies to the inverse: poets, knowingly or not, inevitably encounter and tap Freud’s legacy. As for this psychoanalyst, my copy of Climate of Opinion: Sigmund Freud in Poetry rests on the table next to my consulting room chair, already a bit dog-eared and slightly swollen with bookmarks I’ve made of poems clipped and treasured over decades. As I engage in the very peculiar conversations that embody my daily work and joy, I look forward to the companionship of poems, to reunions with many, to first encounters with others, to new and old rhymes without reason. z

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“The Terrible Fluidity of Self-Revelation”: The Widening Scope of Gender Identification In the summer of 2014, the Pulitzer Prize-winning journalist and bestselling author Susan Faludi opened an email from the father from whom she had been esIn the Darkroom By Susan Faludi New York, NY: Metropolitan Books/ Henry Holt & Company, 2016 417pp., $32.00 tranged for close to 25 years. The subject heading was “Changes,” and the message read: “Dear Susan, I’ve got some interesting news for you. I have decided that I have had enough of impersonating a macho aggressive man that I have never been inside. Love from your parent, Stefanie.” At the age of 76, the father she had known as Steven Faludi had just completed the final step of his transformation from man to woman with sex reassignment surgery in Thailand. For his daughter, the news of her father’s “change” and assumption of a new identity was both shocking and confoundingly ironic. Faludi’s early identification with feminism and its centrality as a theme of her journalistic and literary pursuits had been stimulated by the tyrannical and patriarchal authoritarianism exerted by her father throughout her childhood and adolescence. Who is the person you “were meant to be?” she asks early on in In the Darkroom, the book that evolved from her odyssey to learn about the person she had never really known or understood as a father, who was no longer identifying as such. Is who you are what you make of yourself, the self you fashion into being, or is it determined by your inheritance and all its fateful forces, genetic, familial, ethnic, religious, cultural, historical? In other words: is identity what you choose or what you can’t escape? (p.49). We live in a time in which identitarian alignments are wielded like badges — blurring further the question of whether identity is inherent or constructed, found or made. Faludi cites the sociologist Zygmunt Bauman’s observation that “if the modern ‘problem of identity’ is primarily how to construct an identity and keep it solid and stable, the postmodern ‘problem of identity‘ is primarily how to avoid fixation and keep the options open” (p.270). Faludi’s main source for the psychological underpinnings of identity is Erik Erikson, who coined the phrase “identity crisis” and defined the stages of identity formation. More than 50 years ago, Erikson had suggested that a sense of identity feels like a “subjective sense of an invigorating

Dinah M. MENDES

sameness and continuity” (Faludi, p.53). In his thinking, the consolidation of identity, whether a personal one or a group identity — national, political, religious, or cultural — is shaped both by those elements that get incorporated and synthesized and those that get disavowed and ejected. The expunging of conflictual and undesired elements from one’s personal identity leads to what Erikson termed psychic “totalism” and the creation of “an absolute boundary” (Faludi, p.55). At the level of national, political, or religious group identity, “totalism” becomes “totalitarianism,” but both states are characterized by the imposition and enforcement of conformity and an illusory homogeneity. Determined to reconstruct her father’s life story and to construct him as a person whom she can understand, Faludi reconnects with him in Hungary, where her father, who spent the first 18 years of his life there, is now repatriated. Seemingly indifferent to the persecution that he had endured as a Jew in Nazi-occupied Hungary, he is now a Hungarian chauvinist who extolls the “authentically” Hungarian at every turn. In tandem with her exploration of the roots of her father’s personal identity, Faludi also investigates intersecting but independent permutations of identity formation: the history of transsexuality; the social climate of postwar America that promoted gender conformity, role stereotypy, and consumerism; and the forging of Hungarian national identity that shifted over time from a once welcoming inclusion of its flourishingly productive Jewish population to their eventual ruthless destruction. Faludi initiates regular visits to her father’s home in Budapest, where she becomes a curious but respectful witness to the phases of his sexual transformation, even accompanying him to his appointment with the gynecologist who prescribes hormone treatment. Midway in the memoir, she shifts to the pronouns “she” and “her” in referring to her father, whom she quotes verbatim, incorporating the Hungarianelongated vowels of his speech: Waaal… Susaaan…that was before I became a laaady.” She doesn’t conceal the irritation and frustration evoked by the frequent reminders of his self-centeredness and despotic stubbornness, even as she zealously pursues the uncovering of her father’s background. The only child of self-absorbed and philandering parents, who used him to promote their own interests, he was caught cross-dressing as a young boy — the likely cause of his temporary expulsion from home. Despite all the information that 11

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she amasses, however, Faludi ultimately rejects a psychodynamic perspective on her father’s identity revisions — including his gender metamorphosis and sex change — in favor of one that draws primarily on social psychology determinants. She attributes her father’s successive incarnations (after the war, he was a film producer in Scandinavia, an adventurer in the Amazon outback, and in America, a successful commercial photographer) to the radical loss of his once privileged life as a member of a wealthy Jewish family and his persecution as a Jew. She compares her father in his various role tryouts and self-transfigurations to a fellow Jewish Hungarian — Houdini, born Erik Weisz — who was famous for making himself disappear and reappear in a new guise. Faludi links both her father’s original macho persona and his eventual decision to become a woman to the effects of virulent anti-Semitism — specifically, the Nazi derogation of Jewish masculinity and the danger of exposure as a Jewish male — and later, in postwar America, to the rigid gender stereotypy that prevailed then. When Faludi arrives at the hospital after her father’s death, a nurse hands her an envelope containing her pearl earrings. It is evident that a quiet transformation has taken place in the course of her coming to know her father; her curiosity about her complex, even fragmented, parent and her deepening affection and protectiveness have grown apace. She has had the courage and tenacity to witness “the terrible fluidity of self-revelation,” as Henry James described it (1909/2007, p.15), acknowledged by her father near the end of his life with the simple words, “You are the one who listens to me.” Faludi never discloses the personal implications for her of her father’s gender fluidity and sex change. The subject of transsexuality is a daunting subject in its own right, while the challenges posed by a parent’s change of sex almost defy imagination in their crossing of familiar structures and boundaries. In the Darkroom is a spellbinding read, although it is as difficult to classify and as fluid and hybrid a creation as its overarching theme: what comprises and what is the meaning of identity? Cooperating with her role of investigative journalist, Faludi’s father offers her meticulous photographic documentation of the stages of his transformation into a woman and his experimentation with feminine fantasies and stereotypes: the ingénue, the bordello seductress, and cookie-baking Mom in her frilly apron. Faludi questions the giddy embrace of femininity and the ur-feminine identification espoused in some of the

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transsexual literature and memoirs. Does the “trans” in transsexual mean crossing over to the other side — in a seemingly pure and absolute way — or might it signify an actual transcending of gender dimorphism and category-restriction? She cites the work of Magnus Hirschfeld, who in 1919 founded the first Institute for Sexual Science in Berlin and contended that “sexualities…are as diverse as the number of sexed individuals,“ and that as human beings we are all “sexual intermediaries,” more or less bisexual and bi-gendered (Faludi, p.155). Engaging the concept of gender fluidity and the contemporary championship of the non-binary, Faludi wonders whether it is possible to function without gender categories, to live liminally, in between the lines and spaces. Among the many people she interviews, she makes the acquaintance of Mel, a male to female transsexual, who observes with some anguish, “People can’t survive without categories.” In roughly the same time period in which In the Darkroom was published for a mainstream readership, Transparent, the TV series featuring a transwoman head of family, began its debut in 2014. The inspiration of Jill Soloway (whose father had also undergone a sex change), Transparent entered American homes in the form of family comedy, and its heimish, people-likeyou-and-me setting contributed to a normalization of the outré, transgressive public aura of transsexuality. But counter-intuitive as it may seem, transsexuality — the incongruence between one’s sex and gender assignment at birth and one’s gender identity (the internal experience of the gendered self ) — may actually be the most clear cut and least ambiguous of the challenges that fall within the broad terrain of gender nonconformity or variance. In spite of their radical — seeming change of identity, by moving themselves from one pole of the gender continuum to the other, transsexual people are still operating within the terms of the familiar and conventional gender binary. There are numerous memoirs that recount the process of sex change: Jennifer Finney Boylan’s She’s Not There: A Life in Two Genders (2003) and Stuck in the Middle with You: A Memoir of Parenting in Three Genders (2013) and Through the Door of Life: A Jewish Journey Between Genders (2012) by Joy Ladin are accounts by two English professors, both married with children, who transition in midlife. In Trans: A Memoir (2015), Juliet Jacques offers a writerly chronicle of her progression to sex reassignment surgery in England. Becoming Nicole: The Transformation of an American Family (2015) by Amy Ellis Nutt is the story of a family’s growing acceptance of the transgender identity of one of their twin sons that blossoms into public and political

advocacy. With the exception of Jennifer Finney Boylan, whose buoyancy and optimism seem almost never to falter, these stories all entail considerable suffering: the often slow to emerge recognition and confirmation of difference and incongruence, followed by the daunting aloneness of embarking on a journey rarely taken and most often ridiculed and condemned. Even with the backing of family — often qualified, if not withheld — determination and endurance are necessary to undergo the many steps of physiological and physical alteration, not to mention the psychological and social adaptation. And yet, the motivation and goals are explicit and unambiguous: to transform oneself as closely as possible into the opposite sex. For psychoanalytically oriented clinicians who live and work within the widening scope of gender identification, how does psychoanalytic theory enhance our clinical understanding of the trans experience that encompasses the broader transgender spectrum of non-binary experience and expression of sexual and gender identity? The history of the intersection of psychoanalysis, feminism, and gender theory is long and fraught, going all the way back to Freud’s Studies on Hysteria (1893/1955)with its all-female cast of characters. Although Freud noted that we are all bisexual to one degree or another — with everyone exhibiting a mix of character traits, including those of the opposite sex — and conceded, as well, his ignorance about the “dark continent” of women’s sexuality — he nonetheless constructed an essentially onelegged theory of sexual/gender development based on the little boy’s experience of being male and the little girl’s reaction to discovering that she is not male. Horney and Jones were among the few but prominent contemporary dissenters to counter Freud’s position with a separate but equal line of development for girls. Although Freud made some distinction between anatomical sexual differences and what he considered mental sexual characteristics — masculine/active and feminine/passive — It was not until the work of Money that the previously merged constructs, sex and gender, were formally divided, with sex referring to natal anatomy or male/female, and gender referring to masculine and feminine identity and experience (Person & Ovesey, 1983; Young-Bruehl, 1996). Stoller further differentiated between gender identity, the inner, psychic experience of gender; gender role, the outer or public expression of that identity; and core gender identity, the sense of oneself as male or female, a developmental milestone reached at approximately 18 months of age (Elise, 1997; Young-Bruehl, 1996). In a dramatic reversal of Freud’s phallic monism, Stoller actually proposed a theory of “protofemininity” that claimed that the earliest 12

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gender identification is universally feminine because infants are imprinted with the feminine essence of the mother as part of their symbiotic bond with her. Instead of the little girl‘s discovery that she is a boy manqué, the challenge for the little boy is to “disidentify” from the maternal matrix. Despite its appealing redress of the depreciated status of women in psychoanalysis, this hypothesis was ultimately refuted (Elise, 1997; Fast, 1990, 1996; Person & Ovesey, 1983), but the junction of psychoanalysis and second wave feminism spurred heated critique of Freudian blind spots regarding the psychic lives of girls and women, while stimulating innovative psychoanalytic research and clinical studies of female development throughout the life cycle. The influence of modernism in psychoanalysis was realized as a focus on the essential unity and coherence of the healthy self (Winnicott’s “true self ”; Kohut’s cohesive self ) and was followed by the postmodern emphasis on the intrinsic disunity of the self — its multiplicity and fluidity, and, according to Lacan, its essential fragmentation (Layton, 1998). Benjamin (1996) has noted the irony of the transmutation of psychoanalysis, a discipline founded on the revelation of the fluid, indeterminate nature and operation of the Unconscious, into a rigidly prescriptive and categorizing system, while Barratt has suggested that “the liberating potential of [postmodern] psychoanalysis lies in the way free association makes us aware of our multiplicity” (Layton, 1998, p.46). Infused by the postmodern zeitgeist, by third wave feminism, queer theory, and the emergent transgender movement (Layton, 1998), the contemporary psychoanalytic literature addresses the multiplicity of sexual orientations and gender identities, and even the construct of gender itself. The phenomenon of human bisexuality adduced by Freud is revisited theoretically in the psychoanalytic literature, at the same time that it is being lived out in new forms on the human stage. In a widely cited article, Fast (1990) made the case for the “overinclusive” and bisexual nature of early psychic life; at this pre-Oedipal stage, no possibilities are ruled out, as young children imagine all options and gender roles for themselves. Aron (1996) elaborated Fast’s hypothesis with the concept of “bisexual completeness,” rooted in the pre-Oedipal child’s fantasy of and identification with “the internalized primal scene” or the “internalized parental couple.” The consensus regarding the ubiquity of pre-Oedipal bisexual identifications in early development diverges, however, when it comes to speculation about their subsequent fate. Fast (1990) theorizes a gradual renunciation of bisexual identifications as part of normal, and specifically Oedipal stage, development — a surrender of key aspects of opposite sex

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and gender identifications. In “Melancholy Gender: Refused Identifications” (1995), Butler views the process of renunciation from a different angle: not as developmental requisite but as developmental loss, raising in her words, “the question of ungrieved and ungrievable loss in the formation of… the gendered character of the ego” (p.2). In line with Freud’s conceptualization in “Mourning and Melancholia” (1917/1957) that the ego is shaped by the “sedimentation of those objects loved and lost,” as Butler phrases it (1995, p.2), she mourns the foreclosure or exclusion of same sex identifications and their potential richness in the formation of the gendered ego or self and the “heterosexualization of desire.” Retention and integration of the psychic bounty contained in pre-Oedipal gender multiplicity, discontinuity, and disunity of identifications is advocated by Aron

(1996), Benjamin (1991), and Sweetnam (1996), who liken these phenomena to the features of the Kleinian paranoid-schizoid position that continuously oscillates and alternates with the depressive position, with its distinctive impetus to integration and unification. Aron (1996) suggests that a core gender identity confers necessary boundaries, while a multigendered self “preserves the fluidity of multifarious identifications”. Benjamin (1991) argues that optimally Fast’s “overinclusive” identifications are not renounced, but are integrated in a postconventional Oedipal resolution with the prevailing binary system of gender complementarity that reflects and resonates with the achievements of the Oedipal phase and the demands of cultural conformity. While the debate over the psychic destiny of bisexual identifications unfolds within the psychoanalytic literature between

Emma Wilcox, Eminent Domain No 3

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Oedipal stage foreclosure and disavowal, on the one hand, versus their integration into an enriched and multifarious post-Oedipal gender identity, on the other, the real-life contemporary transgender scene involves people who do not just symbolize but actually live out and express a non-binary gender identity. In Unbound: Transgender Men and the Remaking of Identity (2018), Arlene Stein observes that younger, college-educated people are increasingly schooled in the idea that gender is fluid and multi-dimensional, improvisational and performative, as opposed to fixed and singular. Unlike the older cohort of trans people who felt bound by the gender binary (as reflected in the either/or of transsexuality), younger people who identify as transgender reject the enclosure of the binary and identify as genderqueer, meaning that they do not subscribe to conventional gender distinctions

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but identify with neither, both, or a combination of male and female genders: an in-between state (p.246). The term “intersectionality,” which refers to the intersection of categories and classifications (sexual orientation and gender identity; race; class; the subaltern) and their common susceptibility to manipulation and exploitation, is another reflection of the heightened cultural attunement to the potential for distortion and confinement by conventional boundaries and categories. The preoccupation with identity, self-definition, and self-experience is a First World problem and luxury, as Brooks posits in Enigmas of Identity (2011) — and an essential constituent of what Bauman refers to as the “liquid society” (Stein, 2018, p.270), in which previously accepted norms and boundaries are challenged and upended. In an environment of focused self-cultivation, the differences and tensions between our inside — the mind or psyche — and our outside — the body and external appearance — play out in various forms. The quest to make the inside and outside congruent is expressed in the obsession with physical fitness and health, and the investment in cosmetic surgery that constructs the wished for self that is perceived as obstructed by the actual physical self, including surgical reversal of the external signs of aging that clash with internal youthfulness. The increased popularity of tattoos is another cultural testament to the incentive to express the uniqueness of the self in an eternal and indelible form. The transgender, genderqueer movement exists within this milieu, in which embodiment is an important component of self-representation and self-creation. Over the course of several years, I have worked with a number of patients who identify as genderqueer. My small sample is young, college-educated, and female from birth; Layton (1998) reported that anatomical females are generally more comfortable with a non-binary identity than anatomical males (p.265). These patients have in common a high degree of intelligence, a marked capacity for abstract thinking, and interests and aptitudes that might be conventionally labeled masculine: spatial, technological, architectural, and engineering. In the second half of college, one patient gradually moved from a whimsical, feminine style to experimentation with an androgynous one; from a history of intense heterosexual relationships throughout high school and early college to a relationship with a woman; and from an initial shift in sexual orientation to a gradual reassessment of her gender identity. Another patient, with an edgy aesthetic, seemed to experiment with her appearance almost weekly, although she explained that it could also be daily, depending on the

gender identification she was accessing on a particular day. She/they regarded these stylistic fluctuations with some bemusement, and although she/they sometimes looked gamine- feminine and sometimes more androgynous, she/they would not have been mistaken for a boy. Over one summer, she/they embarked on a brief but intense relationship with a student who also identified as genderqueer. It disturbed this patient greatly that when trying to explain these gender feelings to her/their mother, the attempted communications were overridden by the mother’s insistence, “You’re my daughter.” For much of childhood, this patient was called by her gender-neutral middle name, which though it had been replaced in high school by her feminine first name, was now readopted. In looking back at their childhoods, these patients all came to recognize that they had never felt truly comfortable as girls or in activities that were conventionally feminine/female, although they had played along well enough — like good actors. What in childhood had seemed namelessly strange, uncomfortable, or even dysphoric feelings were now understood and labeled in terms of a gender identity that felt neither absolutely male nor female. Although these patients were all notably high functioning academically and professionally, I was often struck by the sense that the complexity of their psychic makeup — the impression of a nearevenly balanced bisexuality, their striking both-and rather than either-or gender assembly — was both gift and burden. Their inner lives were rich and complex but were also a great challenge to them in terms of integration and harmonious synthesis. One patient with an athletic, muscular build had excelled in all sports, including karate, in her elementary and high school years. She had difficulty choosing a college major because she was good at and interested in so many things; post-college, she worked in an almost exclusively male industry. At the same time, she seemed almost porously sensitive to the feelings of others and to her own perceptions. The boldness of her ideas was often muted by her concern lest she take up too much space or assert too much power. She struggled over the question of a transgender identity, repeatedly questioning the authenticity of her feelings versus the possibility of cultural influence and inculcation. Similar to the others, a transgender identification was not one that she readily or happily appropriated but rather one that felt thrust on her — if only she could be honest and brave enough to follow its uncertain course. “In the individual’s mind the gendered self-representation coexists with 14

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a genderless or even opposite-gendered self-representation,” writes Benjamin in The Bonds of Love (1988, p.113). Working with these patients, I felt a heightened alertness to my own gender state: at what moments did I experience myself as a female therapist with a feminine identity, and when did I feel gender-unmarked and -undefined? At moments, the self-conscious recognition of myself as a seemingly ungendered human felt liberating, as if I was afloat and untethered but aligned at the same time with the psyches of all of humanity, not bound to one half or the other. On further reflection, however, I would wonder if my self- experience at these times was truly ungendered or gender-free because how could I be certain, saturated as I am in the gender binary, that when not experiencing myself as specifically female and feminine, I wasn’t really identified with a neutral/Other that was actually colored male/masculine? There were other instances, when trying to connect empathically to a neither-nor or both-and gender identification of a patient, I would feel vertiginous, as though falling through space, trying wildly to straddle the non-binary fields without a clear gender anchor. As of now, there are few psychoanalytic road signs to point the way for clinicians working with patients who identify as genderqueer. Even the most outspoken psychoanalytic advocates of fluid and multiple gender identifications (Aron, 1996; Benjamin, 1996; Harris, 1996) seem to have psychic symbolization in mind rather than embodiment. Do the growing number of people who identify as genderqueer offer a glimpse of a brave new world of gender bending and stretching? Will this movement of embodied and expressed non-binary gender identity filter into an expansion of the range of acceptable gender expression and experience — the radical vanguard that leads to cultural shake-up, modified but perceptible? Is the genderqueer movement the latest and most radical iteration of feminism and its quest to unbind women — and men along with them? Alternatively, and perhaps challenging the grip of political correctness, how are we to know when and in which cases we might be dealing with a contemporary, gender-inflected version of identity diffusion, as case histories by R. Stein (1995) and Suchet (2011) seem to suggest? This remains an unasked and unanswered question in Susan Faludi’s account of her father’s sex and gender change. All classifications carry the risk of misuse and distortion, but might some categories turn out to be essential components of our psychological hard-wiring? In the process of gender identity formation, do we require some basic

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boundary-formation, via differentiation and separation of genders, in order to barricade ourselves against the threat of psychic dissolution? Can there be an authentic, sustained experience of self without a foundational sense of core gender identity, around which other gender identifications might also play? The genderqueer world is still very new, and we don’t have enough information about the psychological and developmental trajectory of many of the young people who currently identify as genderqueer or

gender non-conforming. Psychodynamic determinants underpin all character and behavioral manifestations (Mitchell, 2002), and the temptation to pathologize — especially when it comes to variations from the norm — is considerable. The history of homosexuality within psychoanalysis bears witness to this, and many feminists of a century ago were regarded as gender-deviant and even freaks. On the subject of gender multiplicity and non-binary identification, and in keeping with the open-minded spirit of

Mac Adams, stlllife

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psychoanalytic inquiry and exploration, it seems that at present, we have more questions than answers. z REFERENCES Aron, L. (1996). The internalized primal scene. Psychoanalytic Dialogues, 5(2), 195-237. Benjamin, J. (1988). The bonds of love: Psychoanalysis, feminism, and the problem of domination. New York, NY: Pantheon Books. Benjamin, J. (1991). Father and daughter: Identification with difference — a contribution to gender heterodoxy. Psychoanalytical Dialogues, 1(3), 277-299. Benjamin, J. (1995). Sameness and difference: Toward an “overinclusive” model of gender development. Psychoanalytic Inquiry, 15(1), 125-142. Benjamin, J. (1996). In defense of gender ambiguity. Gender and Psychoanalysis, 1(1), 27-43. Boylan, J. F. (2003). She’s not there: A life in two genders. New York, NY: Crown Press. Boylan, J. F. (2013). Stuck in the middle with you: A memoir of parenting in three genders. New York, NY: Crown Press. Brooks, P. (2011). Enigmas of identity. Princeton, NJ: Princeton University Press. Butler, J. (1995). Melancholy gender—refused identifications. Psychoanalytic Dialogues, 5(2), 165-180. Corbett, K., Dimen, M., Goldner, V., & Harris, A. (2014). Talking sex, talking gender — a roundtable. Studies in Gender and Sexuality, 15(4), 295-317. Elise, D. (1997). Primary femininity, bisexuality, and the female ego ideal: A re-examination of female developmental theory. The Psychoanalytic Quarterly, 66, 489-517. Faludi, S. (2016). In the darkroom. New York, NY: Metropolitan Books. Fast, I. (1990). Aspects of early gender development: Toward a reformulation. Psychoanalytic Psychology, 7S (Supplement), 105-117. Fast, I. (1996). Aspects of core gender identity. Psychoanalytic Dialogues, 9(5), 633-661. Freud, S. (1955). Studies on hysteria. In J. Strachey (Ed. And Trans.), Standard edition (Vol. 2, pp. 1-306). London, England: Hogarth Press. (Original work published 1893) Freud, S. (1957). Mourning and melancholia. In J. Strachey (Ed. And Trans.), Standard edition (Vol. 14, pp. 237-258). London, England: Hogarth Press (Original work published 1917) Gabbard, G. O., & Wilkinson, S. M. (1996). Nominal gender and gender fluidity in the psychoanalytic situation. Gender and Psychoanalysis, 1(4), 463-481. Goldner, V. (2011). Trans: Gender in free fall. Psychoanalytic Dialogues, 21(2), 159-171. Harris, A. (1996). Animated conversation: Embodying and gendering. Gender and Psychoanalysis, 1(3), 361-383. Jacques, J. (2015). Trans: A Memoir. London, UK and New York, NY: Verso. James, H. (2007). The Ambassadors. New York, NY: Barnes & Noble, Inc. (Original work published 1909) Ladin, J. (2012). Through the door of life: A Jewish journey between genders. Madison, WI: University of Wisconsin Press. Layton, L. (1998). Who’s that girl? Who’s that boy?: Clinical practice meets postmodern gender theory. Northvale, NJ: Jason Aronson, Inc. Mitchell, S. A. (1996). Gender and sexual orientation in the age of postmodernism: The plight of the perplexed clinician. Gender and Psychoanalysis, 1(1), 45-73. Mitchell, S. A. (2002). Psychodynamics, homosexuality, and the question of pathology. Studies in Gender and Sexuality, 3(1), 3-21. Nutt, A. E. (2015). Becoming Nicole: The transformation of an American family. New York, NY: Random House. Person, E. S., & Ovesey, L. (1983). Psychoanalytic theories of gender identity. Journal of the American Academy of Psychoanalysis, 11(2), 203-226. Saketopoulou, A. (2014). Mourning the body as bedrock: Developmental considerations in treating transsexual patients analytically. Journal of the American Psychoanalytic Association, 62(5), 773-806. Stein, A. (2018). Unbound: Transgender men and the remaking of identity. New York, NY: Pantheon Books. Stein, R. (1995). Analysis of a case of transsexualism. Psychoanalytical Dialogues, 5(2), 257-289. Sweetnam, A. (1996). The changing contexts of gender: Between fixed and fluid experience. Psychoanalytical Dialogues, 6(4), 437-459. Suchet, M. (2011). Crossing over. Psychoanalytical Dialogues, 21 (2), 172-191. Young-Bruehl, E. (1996). Gender and psychoanalysis: An introductory essay. Gender and Psychoanalysis, 1(1), 7-18. Young-Bruehl, E. (2001). Are human beings “by nature” bisexual? Studies in Gender and Sexuality, 2(3), 179-213.

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The Subject Of Torture: Psychoanalysis and Biopolitics in Television and Film Gregory NOVIE

This book offers a wide-ranging elaboration of the effects of the American military’s torture of prisoners during the Iraq war. Torture by the American military and The Subject Of Torture: Psychoanalysis and Biopolitics In Television and Film By Hilary Neroni New York, NY:, 2016 417pp., $32.00 intelligence services was practiced and documented in the context of the post-9/11 zeitgeist. Here, the practice in its psychological and cultural significance is viewed through the Lacanian lens of the desiring subject. Chapter titles illustrate the book’s far ranging field of observation: “Torture, Biopower, and the Desiring Subject;” “The Nonsensical Smile of the Torturer in Post9/11 Documentary Films;” “Torture Porn and the Desiring Subject in ‘Hostel’ and ‘Saw’”; “24, Jack Bauer, and the Torture Fantasy;” “The Biodetective Versus the Detective of the Real in ‘Zero Dark Thirty’ and ‘Homeland’”; “Alias and the Fictional Alternative to Torture.” The book begins with a brief history of torture, culminating in the Bush Administration’s classifying prisoners as existing outside the rules of the Geneva Convention, not POW’s but rather enemy combatants or detainees (essentially stateless actors). The author states: What ideological shifts occurred to change our fundamental beliefs against torture? Clearly, the shift begins with the September 11, 2001 attacks and the trauma of that event. The reaction is a seismic [emphasis added] shift. All of a sudden torture becomes a method of interrogation that promises to reveal valuable information, which the state can employ with impunity.” (pp.7-8) The basic thesis of the book is laid out in “Introduction: Confronting the Abu Ghraib Photographs.” A fundamental belief legitimizing torture is that the human subject is reducible to its body. The author contends, “Understanding the individual as a desiring subject irreducible to its body, however, would instead prompt us to view torture not only as unthinkable but also as completely ineffectual” (p.9). The former belief, that the subject is its body, considers the body as a container of truth (where else would it be in such a conception?) and torture as means to extract such truth. This brings up the author’s use of the term biopower, a term that reflects the actual body

as opposed to its signification (as a desiring subject). A crucial point in delimiting these differing conceptions is the accounting for the visible pleasure in the faces of the soldiers at Abu Ghraib who were conducting the torture. The author offers a discussion of two competing conceptions of the body, and I would even say the self. The first defines the body as biopolitical, a body whose primary and indeed only concern is its physical survival. In contrast, the body that doesn’t coexist with itself is what Lacanian psychoanalytic theory has termed the subject. The biopolitical conception of the body, preeminent today, provides the philosophical cornerstone to justify torture. As the body only wants to preserve itself, its own biological being, subjecting the body to torture is the optimal means to plumb its secrets, e.g. where is the next bomb set to explode? The author maintains: This body (the psychoanalytic version) is a body that can only exist in its connection to our psyche, and it must be understood through the complex relationship between mind and body, which is precisely where psychoanalysis places its emphasis. (p.25). At the bedrock of psychoanalytic theory is that we are divided within ourselves, that we do not know ourselves (but are capable of knowing) or control our bodies or our minds. The dominant biopolitical conception of the body, undivided in itself, has led to neuroscience as the preferred explanation of human behavior. Psychoanalysis, on the other hand, holds firm in the belief that there is a disconnect between body and mind and indeed “…subjectivity emerges through the collision of mind and body, a collision that produces desire” (p.26). There is no way possible for a co-existence of a body as machine with the subject of desire. The author sees the most striking divide in theory at present as that between biopower and biopolitics versus psychoanalysis. Various theoretical positions from authors such as Michel Foucault, Michael Hardt, Antonio Negri, and Giorgio Agamben are presented, briefly, to elucidate this divide. Challenging Foucault’s denial of subjectivity (and his promotion of the biopolitical conception) the author contends “…psychoanalysis makes clear that the subject is distinct from the human [as only a body-my italics], that the subject is the inhuman [non-corporeal, my italics] what exceeds and cannot be assimilated to humanity” 16

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(p.32). Some might call this the divine or the soul, while psychoanalysis would contend it is the desiring subject. Further, biometric identifiers, such as DNA, have come to equal the individual in the eyes of the state, and as such strengthen the “ideological resonance” (p.39) of the biopolitical/ biopower conception. “The basis of psychoanalytic theory is the subject of the signifier” (p.42). This, of course, is the basis of Lacanian psychoanalytic theory. In classical Freudian theory, the ego is the subject whereas for Lacan it is the unconscious, a structure formed through the interplay of the body and society, the latter referred to in Lacan’s system as the Symbolic Order. More specifically, the unconscious is formed through the experience of the structure of language; hence Lacan’s most famous phrase, “the unconscious is structured like a language.” As a result, the relation between the subject and its body is determined and governed by the signifier. As for desire: Desire has a structure in which we desire an object and go after that object. The pleasure is in the pursuit [emphasis added] and the idea of satisfaction that we will have once we acquire the object. Once we do reach the object, however, it doesn’t end desire all together. Instead, our desire turns to a new object. Both Freud and Lacan, point out that this is because what we are searching for is a lost object; the actual objects just stand in for this original loss. Of course there is no object that was once lost. In the end, it is loss itself that haunts us and motivates our desire toward an endless string of objects…(p.45). The experience of pleasure in the presence of pain is what Lacan referred to as jouissance. It is this experience that is displayed in the faces of the soldiers at Abu Gharib as they torture prisoners, and it is this pleasure/pain, not the non-efficacy of torture eliciting truth that sustains the torturing act. This jouissance as pleasure/pain extends to the viewer and indeed, in post9/11 culture, films and television have depicted such scenes of torture to an ever-increasing degree. In such scenes, torture is justified by the “ticking bomb” fantasy that involves an imminent attack where a great loss of life is likely and time is running out. This fantasy has its origin in a 1960 novel by Jean Lartéguy, Les Centurions, which lays the foundation for the contemporary belief that truth is a material object that can be extracted (tortured) out of the body. This

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fantasy was played out in the 1967 film The Battle of Algiers (a work of fiction), where torture revealed the location of a bomb which was then defused. This book has two main points. The first is that the trauma of 9/11 made possible the rationalization for torture, in part based on the “ticking bomb” fiction. This rationalization has been further propagated in fantasy through film and television and the power of the visual aspect of the fantasy which has covered the “gaps” in the ideological foundation of this fantasy. Second, the possibility that torture could be rationalized is embedded in the dominant conception of the body, of the self. This conception is biopolitical and regards the body as a container of truth, which can be extracted through torture. This conception is opposed by psychoanalytic theory which employs a version of the Cartesian split between body and mind. The interplay between body and mind, at times the war between them, is played out on the field of the desiring subject, the more valid, complex, and comprehensive conception of the body, of the self.

The television series 24 (2001) captured the evolution of the biopolitical in its visual fantasy and promoted a crucial element of it: the pressure of the “ticking bomb.” Indeed, the novelty of the show was that the entire season was to take place in one day and that each episode was one hour of this day. Further, throughout the show a ticking clock was displayed to emphasize that the show’s protagonist, Jack Bauer (Kiefer Sutherland), worked under the immense pressure of the ticking clock to prevent a catastrophe at the hands of terrorists. As an expert at torture Bauer used these skills to retrieve information from the bodies of terrorists, consistent with the biopolitical conception of the body and of truth. Neroni is adept at making the case that “The depiction of this fantasy… reveals the contemporary torture fantasy’s fundamental structure and the source of its widespread appeal” (p.95). Neroni argues that the Bush administration shared this same fantasy. Michael Chertoff, in Bush’s Justice Department, coauthored the Patriot Act (justifying torture), and, according to Professor of International Law Phillipe

Mónika Szilád Sziladi, PassingBy

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Sands, “…liked a tough approach and was a fan of Jack Bauer…and his fictitious counter-terrorism unit colleagues, praising them for showing the kind of character and tenacity that would help America defeat terrorism” (p.111). Neroni added “The ideas presented on 24 became part of the fantasy material that knitted together the symbolic failures of actual torture…when torture wasn’t working in real life, even members of the military turned to 24 for inspiration” (p.111). It is only the body itself that has value in the biopolitical ideology, but this value must be in danger, in imminent danger, to promote the torture fantasy and to hide its gaps and ineffectiveness in real life. The series was such a vision of contemporary post 9/11 culture that decision makers at Fox (which produced the series) immediately bought the show when it was first pitched to them, a rarity in television. Each episode taking place during one hour with a ticking clock at the start and after commercial breaks was innovative. Neroni sees the emphasis that time is constantly running out, projected visually several times in each episode, as illuminating

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a fundamental structure underlying the ideology of biopower. The clock itself functions as a signifier of impending disaster, and for biopower to be effective, we must be convinced that time is almost up and anything (torture, suspension of human rights) must be done to ensure collective survival. The constant vigilance, the colored levels of terror alerts, have become the new norm – there can be no return to a previous period of normalcy. In the biopower ideology, there is no unconscious so the torturer is frustrated in his or her attempt to know the subject and its desire. In fact, we as subjects do not ever fully know our own desire; it is a lifelong process to become aware of it and to move it to a level of discourse. In 24, Arabs and Arab Americans are not depicted as subjects with desire other than the singular desire to destroy America. Neroni adds

evidence, which through the ideology of biopower, finds no doubt that truth lies in the body, not the desiring subject. Such evidence is experienced as ironclad credibility, and its importance lies in how it defines authenticity in the structure of the ideology of biopower. In film and television, forensic evidence has a ubiquitous sidekick, surveillance, and following an individual will provide answers about them (following their actual bodies, not their thoughts or desires) and as such resonates with the ideology of biopower. As the author believes, “…biodetectives tend to fall into two camps: a forensic detective or a detective who relies on torture and surveillance” (p.118). The many variations of the CSI television series are of the former type, while Maya Lambert (Jessica Chastain) of Zero Dark Thirty reflects the latter, and indeed the author believes “Maya is an archetypal biodetective who Steel Stillmani, No. 1

The Arab and Arab American characters on 24 are only defined by their concern for survival or destruction. They are presented as defined purely by their bodies, but these bodies aren’t sexual or desiring bodies because this would imply the dimension of subjectivity, which the series wants to avoid at all costs in order to sustain the torture fantasy.” (p.109). Over the course of its several seasons the series writers seemed to have had more and more difficulty sustaining the biopower ideology. At the end of the series the needed information about an impending attack was stored on a SIM card and ingested by a terrorist. Bauer’s torture failed (for the first time), and he killed the suspect to physically remove the SIM from his body. For Neroni, this SIM represented “the ultimate conclusion of the logic of biopower. The truly informative SIM card becomes the expression of the biopolitical body par excellence…what can never be transcribed onto the SIM card remains the desiring subject” (p.114). The film Zero Dark Thirty (2012) depicts the ultimate justification of torture by leading to the death of Osama bin Laden. In this film and the television series Homeland (and others), the instrument of biopower is the detective, or as the author calls the character, the “biodetective.” She reasons, “The key to understanding contemporary detectives lies in their relationship to the facts and to their concept of how to find truth” (p.116). There exist(s) two opposing forms of a detective, the biodetective and the detective of the real, and they both “…are operative in the contemporary landscape and both act as the quilting point for how a narrative engages the contemporary torture fantasy” (p.116). The biodetective rides the wave of the viewing audience’s fascination of and belief in forensic 18

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operates with a biopolitical conception of the truth” (p.119). In the movie, the beginning audio of the trauma of 9/11 leads directly to the visual display of torture and in the author’s words “…This juxtaposition stitches together these two scenes as if torture is the logical [and only – my words] response to the trauma…” (p.120). Critics have taken the director Kathryn Bigelow to task for presenting torture as the key element in finding bin Laden but as the author contends, “…this claim has been debunked, repeatedly, by reliable sources with access to the facts” (p.122). The author adds, “Bigelow’s defense of the liberty that the film takes with the facts makes clear her investment in the torture fantasy and the figure of the biodetective at the heart of the fantasy” (p.122). The march toward the hegemony of biopolitics and the ideology of biopower since

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9/11 is disturbing for anyone who holds inviolable the Bill of Rights. What price security? Indeed, since 9/11, polls have shown that most Americans feel it is inevitable to give up some of these rights to combat terrorism. The underlying structures in this ideology have been played out in the fiction and fantasy of film and television. The acceptance of torture, the ubiquitous use of surveillance and biometrics, and the unsettling conception of the individual existing only as a body and not as a subject with desire are the results. But perhaps this assault on human rights is not yet won, as there have been films and television series that challenge this hegemony, such as the Jason Bourne films and the series Homeland and Alias. In these films, as well as others already discussed the detective plays a central role, and Neroni has observed the two types, the biodetective and the detective

of the real. The former sees authenticity and unassailed credibility as residing in biology/ biometrics (and its companion surveillance), where truth is to be found, residing in the body that will only be revealed through torture. These produce claims about knowing the body, not the subject. The biodetective is invested in the “truth” of these fantasies. Maya Lambert in Zero Dark Thirty exemplifies the biodetective. Over the course of the four Jason Bourne films (spanning the decade after 9/11), there is a complete loyalty of the ideology of biopower. In the final film, The Bourne Legacy (2012), the protagonist Aaron Cross (played by Jeremy Renner) is completely controlled by biology in the pills he must continually take to maintain control over him by the CIA and the enhanced skills he acquired during his training, a training depicted as nothing short of torture. But in the end of the film he has freed himself of this control with the help of scientist Marta Shearing (Rachel Weisz). Indeed, it is the relationship that develops between the two as desiring subjects that ensures this freedom. There are no such relationships portrayed in biodetectives such as Jack Bauer and Maya Lambert. Carrie Mathison (Claire Danes) in Homeland (2011) reveals the gaps in the structure of the ideology of biopower. She is ambivalent about acting as a biodetective or a detective of the real, eventually choosing the latter. This “choice” began as a fiction in her pretending to love the suspected terrorist Nicholas Brody (Damian Lewis), but this becomes real when she actually falls in love with him and has their child after his death. She tries to find the truth in Brody (about an impending act of terror) not through torture, surveillance, or biometrics, but through interpreting his desire. Carrie’s bipolar condition works as a useful metaphor in her movement back and forth between a biodetective and a detective of the real. In an interview in 2013 with Charlie Rose, Danes said about the show “…it captures a new kind of anxiety and self-doubt and insecurity that we as a nation are coming to terms with.” She further describes how her bipolar condition is the ticking bomb, about to explode at any time. As a detective of the real, it is the understanding of a terrorist’s desire, pursuing information in the realm of desire, looking into the subject rather than the body that averts disaster. Sydney Bristow (Jennifer Garner) in the series Alias (2001) represents another example of a detective of the real. In a unique manner, the series is written around various fictions (aliases) Sydney uses to engage and follow the desire of a subject (terrorist). Truth is located in this desire, activated within the fiction, as opposed to existing in the body itself, where the truth exists for the biodetective. These methods and beliefs about where 19

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truth lies are in direct opposition to the methods and suppositions of Jack Bauer in 24. “Key to the success of Sydney’s fictional strategy at work is that she relies on her insight into subjectivity to create a successful alias and find the necessary information” (p.141). She herself is a desiring subject and looks at others as such as well, and this engagement between two desiring subjects leads to truth. For her all truth is located in the pattern of desire, not deposited like a SIM card in the body itself. As Neroni states, “…fiction is the fantasy stage upon which the characters encounter the circuitous path of desire” (p.142). Neroni explains (and I agree) that psychoanalysis was a radical idea in that it located truth in the unconscious and the real, not the conscious mind, and truth was glimpsed in dreams, associations, jokes, slips of the tongue, etc. The contrast between a psychoanalytic approach and a biopolitical one becomes especially pointed with regard to the status of truth. Biopolitics reduces truth to the symbolic order and thus believes it to be entirely knowable. It ignores the imaginary and, more importantly, the real…a psychoanalytic approach to truth, then, means taking into consideration the manner in which the symbolic, the imaginary, and the real come together. (p.144) I found this book to be fascinating in its deconstruction of the structures underpinning the ideology of biopolitics and biopower. It seems to me, unfortunately, that the fantasy of torture depicted in these media has found its way into government policy despite the ineffectiveness of torture. The price has been high in our nation’s moral standing in the world, our commitment to human rights, and the extreme suffering (and death) of its victims. z REFERENCES Abrams, J. J. (Producer). (2001). Alias [Television series]. New York, NY: American Broadcasting Company. Agamben, G. (2005). State of Exception (Kevin Attell, Trans.). Chicago, IL: University of Chicago Press. Bigelow, K. (Producer & Director). (2012). Zero dark thirty [Motion picture]. Culver City, CA: Sony Pictures Releasing. Foucault, M. (1997). Security, nation, and population: Lectures at the College de France, 1977-1978. New York, NY: Picador. Gordon, H., & Gansa, A. (Producers). (2011). Homeland [Television series]. New York, NY: Showtime. Hardt, M., & Negri, A. (2004). Multitude: War and democracy in the age of empire. New York, NY: Penguin. Lacan, J. (1978). The four fundamental concepts of psychoanalysis (Alan Sheridan, Trans.) New York, NY: Norton. Lartéguy, J. (1960). Les centurions. Paris, France: Presses de la Cite. Marshall, F., Crowley, P., Weiner, J. M., & Smith, B. (Producers), & Gilroy, T. (Director). (2012). The Bourne legacy [Motion picture]. Universal City, CA: Universal Pictures. Neroni, H. (2015). The subject of torture: Psychoanalysis and biopolitics in television and film. New York, NY: Columbia University Press. Surnow, J., & Cochran, R. (Producers). (2001). 24 [Television series]. New York, NY: Fox Broadcasting Network. Yacef, S., & Musu, A. (Producers), & Pontecorvo, G. (Director). (1967). The battle of Algiers [Motion picture]. Italy and Algeria: Rizzoli.

REMINISCENCE

Doris Silverman

Morris N. EAGLE

I have known Doris too long and too well to write something too formal. Instead, I will simply write what comes to mind when I think of Doris. Doris claims that I graded her undergraduate psychology exam papers when I was a teaching assistant at the City College of New York. If that is so, I have known Doris for many years — which is quite remarkable insofar as given her energy, attitude, and outlook, Doris does not seem to be old enough for me to have known her for that long. Not only have I known Doris for many years, but I have known all of her children, was a close friend of her deceased husband Lloyd, and am a good friend of Doris’ long-time partner, Herb Dembitzer. In short, I think of Doris as a member of my extended family. Doris is a remarkable person in a number of ways. If the character of one’s children is, in some sense, a measure of a parent’s own character and virtues, one’s competence, decency, and values, for example, then Doris embodies these qualities. Every one of her four children is a wonderful and admirable person. As Doris’ friend, I have witnessed, and have been envious of, her amazing strength of character and capacity for equanimity in dealing with adversity. I don’t know too many people who have shown the same resilience and grace under difficult circumstances. Doris’ laugh is distinctive for its full-heartedness and its ready availability. I can recall evenings at Doris’ apartment or at Paul and Fran Lippmann’s house in Stockbridge at the end of a day of the Rappaport-Klein meetings when Dave Wolitzky, Herb Dembitzer, and I would trade jokes for hours at a time, each joke punctuated by Doris’ laughter, whether or not she had already heard the joke which, most of the time, she had. Doris was co-chair, with Paul Lippmann, of the Rapapport-Klein Study Group for 12 years between 2002 and 2014, having replaced Norbert Freedman and me. During that time, Doris (and Paul) succeeded in bringing such notables to the group as Beatrice Beebe, Phil Shaver, Karlin LyonsRuth, Miriam Steele, Irwin Hoffman, Phebe Cramer, Jeanne Vivona. Having described her unique and exemplary personal qualities, I should like, now, to speak of the many important scholarly and professional contributions she has made to our discipline. The areas in which Doris has made contributions include: neonatal bonding in female babies; the relationship between sexuality and attachment; the integration between attachment theory and

psychoanalysis; discussion of empirically-based practice; the importance of affect regulation, both mutual and self-directed; an examination of the concept of symbiosis; and the implications of the Medusa myth for understanding current issues regarding oppression of women. Doris is a former editor of the Newsletter and Newsmagazine of the International Psychoanalytic Association and was also the recipient of the Scientific Scholar Award in 2007. There are people in our field, who, although they are pretty good scholars, interested in clinical and theoretical matters as well as research in other disciplines, may not be first rate-clinicians; and there are firstrate clinicians who are not especially good scholars. Doris is one of the relatively rare

Tiana Peterson

individuals in our field who excels in both areas. When I am asked to make a referral to an analyst or therapist in New York, Doris is one of the people who immediately comes to mind. On the scholarly side, I don’t think I can recall a single interaction with Doris when she did not share her interest and excitement about a clinical-theoretical issue on which she’d been thinking or writing. Her enthusiasm and energy are contagious and have not abated during the many years I have known her. She brings not only passion, but important insights to her thinking and writing. For example, I have been working on a new book and in struggling with a chapter on the relationship between what Freud referred to as “ego instincts” and “self preservative instincts” and object relations theory, I remembered Doris’ paper entitled “Attachment Patterns and Freudian Theory: An Integrative 20

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Proposal” (1991). Predictably, she had anticipated in her paper the idea about which I was so excited, namely, that an elaboration of the concept of ego instincts, in Doris’ words, provides “an explicit object relations motivational system equal to drives.”(p.170). Her interest in attachment is but one instance of Doris’ abiding aim of integrating research findings with psychoanalytic theory and practice. Over the many years I have known Doris, there has been no waning in her omnivorous interest in new ideas. My reminiscence would not be complete without an account of my annual special treat when Doris comes to visit her daughter Mara in Los Angeles. We meet for lunch, which generally lasts for at least three or four hours, in a restaurant in Culver City near her daughter’s home. As soon as we sit down, we begin our wonderfully enjoyable sharing of gossip, family reports, summaries of what has been going on since we last met, and save a lot of time to exchange the latest exciting new developments and ideas. I eagerly look forward to our annual meeting. There are many more things I can say about Doris. I have always viewed her not only as a dear friend, but also as an intellectual soul mate. She has consistently and fervently stood for and argued for integration of different psychoanalytic “schools,” openness of psychoanalysis to relevant findings from other disciplines, and the importance of an empirical base (which includes both clinical and research evidence) for psychoanalysis. I want to end my reminiscences by trying to put into words an essence of my experience of Doris: what is foremost when I think of her, what occurs to me spontaneously, and immediately, is her vitality of mind and spirit. She has a wonderful life-affirming quality that makes any interaction with her a pleasurable and meaningful experience. I am grateful for the opportunity that this reminiscence has given me to articulate thoughts, impressions, and feelings that I might not have otherwise formulated and made explicit. I am not being hagiographic when I assert that I cannot recall a single dull or inauthentic moment in my experiences with Doris. It also occurs to me, in a somewhat fresh way, both how remarkable that is, and yet, how much I have simply taken it for granted. z REFERENCES Silverman, D. K. (1991). Attachment patterns and Freudian theory: An integrative proposal. Psychoanalytic Psychology, 8 (2), 169-193.

REMINISCENCE

KuniÃ© Sugiura, Primonition (detail) 21

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DISCUSSION ON AUTISM

Response to Dr. Sergio Benvenuto’s Commentary: Autism: A Battle Lost by Psychoanalysis Joanna LHULIER

Notes about terminology: In general, autistic adults often prefer to be described as “autistic” and do not like descriptive phrases like “a person (child or adult) on the autism spectrum” or “a person with autism” or “on the spectrum.” Autistic adults prefer to be described as autistic, because their autism is seen as a core part of their identity, and they are not ashamed of the label. Parents of children with autism often prefer that their children be described as a child/teen with autism. This type of debate will continue. I will use these terms as diplomatically as possible and apologize in advance for any perceived micro-aggressions.

and cure autism were NOT the psychoanalytic tradition’s finest hour.” Emanuel (2015) expressed concern that contemporary psychoanalytic literature has not widely embraced autism as a psychological condition to be conceptualized or treated (p.53). Merritt (2012) also worried about the lack of analytic thinking in the “psychological work on autism” (p.327). Hobson (2011) suggested that there is a problematic gap between clinicians working with autistics and psychoanalytic therapists with an interest in helping those on the spectrum. Hobson (2011, p.229) explained that

Dr. Benvenuto argues that the battle has been lost, and offers several reasons for his conclusion. The following essay will examine his rationale with current research in mind to help inform further thinking. Dr. Benvenuto begins with the idea that autistics lack theory of mind (ToM), which was originally defined as one’s ability to predict another’s behavior and/or discern another’s intentionality (Baron-Cohen, Leslie, & Firth, 1985). Dr. Benvenuto seems to misconstrue ToM when he relies on this theory to conclude that an autistic lacks an understanding of his/her own mind. There is no evidence

this rift is the result of “cross-generational transmission of prejudice on both sides … [and] a lack of mutual interest and sensitivity, [and] a lack of intellectual tolerance and generosity that militates against fruitful exchange among seemingly irreconcilable antagonists.” Despite ongoing efforts from several analytically oriented therapists to mend ruptures and/or rebuild bridges (Holloway, Rhodes, Hobson, Alvarez, etc.),

to support the assertion that an autistic does not know his or her own mind in a way that is different from non-autistics not having access to all of the ways their minds operate. More importantly, there is growing empirical evidence to suggest that the hypothesis that autistics lack theory of mind is false or at the very least subject to debate. Cohen-Rottenberg (2009) and Gerns bacher (2007) have observed several limitations

Alix Pearlstein, Security

Dr. Benvenuto’s commentary makes far-reaching assertions about autism and autistic people. I would like to respond to a few of his claims and offer an alternative perspective. It has been articulated elsewhere that early psychoanalytic thinking and practice has not been helpful to members of the autism community. Epstein (2000, p.746) asserted that the “historical efforts to explain

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DISCUSSION ON AUTISM

to Baron-Cohen et al.’s work on ToM, which include small sample size, overgeneralization, oversimplification, and a lack of validity in his measurements. Gernsbacher (2007) explains that the problem with Baron-Cohen et al.’s ToM test is that it involves complex syntactic structures in the English language, which make it difficult for children with processing deficits to understand. Steele, Joseph, and Tager-Flusberg (2003) examined ToM among 57 children with autism spectrum disorder (ASD) over time, and they found statistically significant improvement in ToM ability and confirmed that these improvements were related to the children’s developing language abilities. Furthermore, Tager-Flusberg and Sullivan (1994) have demonstrated that when autistic children are matched with non-autistic children according to language skills and then compared the difference in ToM scores disappear. Peterson (2002) found that when you implement a ToM test that does not rely on language, children with autism and children with deafness actually outperform children with normal hearing. Bowler (1992) and Ozonoff, Rogers and Pennington (1991) have shown that some autistic people can pass second order theory of mind tasks consistently, applying these skills across domains (Happe, 1993) and showing evidence of insightful social behavior in everyday life (Frith & Happe, 1994). Other studies have more directly concluded that ToM might lack any real scientific evidence (Bloom & German, 2000; Bowler, Briskman, Gurvidi, & Fornells-Ambrojo, 2005; Bjorne, 2007). In addition to empirical studies questioning the validity of ToM, several autistic scholars have expressed sincere misgivings over the widespread misunderstanding that has been perpetuated by ToM advocates. Melanie Yergeau, an autistic professor of English at the University of Michigan, wrote that there are decades of scholarly work focused on the “idea that autistic people represent a limit, a boundary, a lack” (p.9). She went on to argue that “ToM have become institutionalized constructs and mechanisms that disenfranchise autistic people” (p.100). Cohen-Rottenberg (2009), an autistic blogger and advocate, agrees with Yergeau and adds that the perpetuation of stereotypes and oversimplifications of ToM have enabled tremendous harm to be carried out against individuals with autism. Dr. Benvenuto’s commentary moves from a review of theory of mind to an autistic’s inability to empathize. He puts it like this: “the opposite of autism is the capacity for empathy.” Unfortunately, he does not provide references for his conclusion. In direct refutation, there are several studies that measured understanding the intentionality

of others and failed to distinguish autistic from nonautistic people (Aldridge, Stone, Sweeney, & Bower, 2000; Carpenter, Pennington, & Rogers, 2001; Russell & Hill, 2001; Sebanz, Knoblich, Stumpf & Prinz, 2005). According to Brewer and Murphy (2016) at Scientific American, “the notion that people with autism generally lack empathy and cannot recognize feelings is wrong.” By asserting that autistics lack theory of mind and cannot empathize (both questionable), Dr. Benvenuto concludes that autistics lack awareness of or access to subjectivity. His support for this notion is a character in a film. Again, there are no scholarly references. He then refers to Temple Grandin and her lack of sexual desire. If he is trying to argue that this provides evidence of her lack of subjectivity, I would suggest that there is no correlation. If he is saying that all autistics identify as asexual, this is simply and obviously untrue. Jerry and Mary Newport, a married couple with autism, wrote a book entitled Autism, Asperger’s and Sexuality: Puberty and Beyond. In their book, they describe how many individuals with autism have complicated romantic and sexual feelings. As he develops the thesis that autistics lack subjectivity, Dr. Benvenuto falls prey to a tautological error by suggesting that we can actually better understand subjectivity when we consider its absence in autistics. He fails to provide evidence that autistics lack subjectivity and does not account for nor respond to the scientific literature that suggests otherwise. Despite his weak foundation, Dr. Benvenuto attempts to build his case that autistics lack subjectivity by engaging in further unsubstantiated theorizing. An example of this is the idea that nonverbal autistics illustrate an absence of subjectivity, as evidenced by their inability to use language to express themselves. Verbal language is not the only form of language, nor do people only rely on spoken words to communicate. In fact, part of Dr. Benvenuto’s concept of subjectivity involves perceiving meaning from the unspoken, so it is not clear how the absence of the spoken word would convey an absence of subjectivity. If he is suggesting that nonverbal autistics do not communicate or use language to express themselves, I would recommend that he and all those interested read Naoki Higashida’s book The Reason I Jump (2007/2013). Higashida, a nonverbal autistic, wrote the following when he was 13 years old “one of the biggest misunderstandings you have about us is your belief that our feelings aren’t as subtle and complex as yours … Stuck here inside these unresponsive bodies of ours, with feelings we can’t properly express, it’s always a struggle just to survive” (p.109). 23

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Just because Dr. Benvenuto does not recognize or perceive an autistic’s subjectivity, does not mean it does not exist. Damian Milton, an autistic research psychologist, has introduced the concept of the “double empathy problem.” He defines it as a “disjuncture in reciprocity between two differently disposed social actors who hold different norms and expectations of each other, such as is common in autistic to non-autistic social interactions” (Milton, 2012, p.883). In other words, there are lapses in understanding (or empathy) that exist on both sides of an exchange. Interestingly, there is a growing body of research that suggests that neurotypical adolescents have more difficulty understanding how they are perceived by autistics, than autistic participants have in judging how they are perceived by their non-autistic counterparts (Usher, Burrows, Messinger, & Hender Son, 2018; Milton, 2012). Smukler (2005) suggests that rather than assume people with ASD cause breakdowns in communication make room for the possibility that there is a disruption between parties, as would be assumed by people interacting across cultures. It is possible that Dr. Benvenuto (as well as many of us) may have an empathy problem when considering people on the autism spectrum. Using a more psychoanalytic lens, I would argue that his countertransference to a battle lost has escaped careful exploration. Unfortunately, I cannot conclude my response yet. Dr. Benvenuto makes some offensive statements throughout his commentary that need to be highlighted and responded to: “the one thing the autistic person does not have access to is a sense of humor” “autistic subjects are indeed empty as to subjectivity” “autistic subjects do not experience feelings such as modesty, shame, or guilt” “autistic individuals are not able to deceive, nor do they try to impress others. They never manipulate, they never get involved in gossip. They have no sense of ownership, they feel no envy, and they like to give. In short, they lack all the range of affectations, perhaps even contemptible ones that make our being-with-others meaningful” “I would say that an autistic person is a house with no walls, that is a house that is not actually there”

DISCUSSION ON AUTISM

“hence they often feel like animals not in the sense that they are driven by bestial inclinations but in the sense that they do not feel fully human-they are somewhere in between animals and computers-they skip humanity.” None of these statements are accurate, and are, in my opinion, discriminatory. And while I wish I had the most eloquent retort, I admit that I cannot outperform Gernsbacher’s (2007) response to similar statements. She said, “The anonymous tract, Disputatio Nova Contra Mulieres, Qua Probatur Eas Homines Non Esse (A New

general explained his allegiance to genocide by the simple contention that “Jews are not even human.” Sixteenth-century theologians, Victorian anthropologists, and 20th century Nazis are not the only ones who have deemed various groups of humans ape-like or non-human, some current-day American psychological scientists are just as guilty of this crime. (pp.6-7). Gernsbacher (2007) was responding to several offensive statements made about autistics. But one of the statements made by Falcon & Shoop (2002) is eerily similar to Benvenuto’s idea of autistics “skipping

contains hate speech, I strongly object to many of his unsubstantiated claims and conclusions. I believe that if analytically oriented clinicians find truth in his writing, they should agree that the battle has been lost and direct their help to those outside the autism community. I wanted to conclude with Philip Reyes’ thoughts about his autism. Philip is a nonverbal autistic teenager. I want people to know autism is another way of being. I am weary of stereotypes that make us out to be less human than neurotypical people. I have listened to people talk negatively about autism since I was diagnosed and, as a result, I

Laura Larson, Large Orb

Argument Against Women, in Which it Is Demonstrated That They Are Not Human Beings), first published in 1595, was reprinted prolifically during the 17th and 18th centuries. In the 1860s, British anthropologists espoused that Blacks were an inferior species, more comparable to apes than to Caucasians, and therefore well suited for slavery. At the Nuremberg Trial, one SS

humanity.” Falcon and Shoop said, “it’s as if they [autistic people] do not understand or are missing a core aspect of what it is to be human.” Gernsbacher (2007) replied, “If that they referred to members of any other minority group, we’d call the statement hate speech” (p.28). While I am not qualified to determine whether Dr. Benvenuto’s commentary 24

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learned to hate myself and think I was a monster for causing so much hardship. I can’t let others continue living under these common misconceptions about autism. Let’s pretend you are like me. You can’t talk, but you have a well-functioning mind and can understand people. Imagine you answer everyone who says

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something to you, but only you can hear it. Others hear your voice saying things you don’t necessarily mean. They think that’s all you are capable of thinking. I peacefully make friends now. I learn normally. My school values me, and I make my own goals. I feel loved when I am accepted. I feel loved when I am seen not by my momentary deficits but by my attributes that make me a complete person z (Reyes, 2019) REFERENCES Aldridge, M. A., Stone, K. R., Sweeney, M. H., & Bower, T. G. R. (2000). Preverbal children with autism understand the intentions of others. Developmental Science, 3, 294-301. Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21(1), 37-46. Bjorne, P. (2007). A possible world: Autism from theory to practice. Lund, Sweden: Cognitive Science. Bloom, P. & German, T. P. (2000). Two reasons to abandon the false belief task as a test of theory of mind. Cognition, 77, 25-31. Bowler, D. M. (1992). “Theory of mind” in Asperger’s syndrome. Journal of Child Psychology and Psychiatry, 33, 877-893. Bowler, D. M., Briskman, J., Gurvidi, N., & Fornells-Ambrojo, M. (2005). Understanding the mind or predicting signal-dependent action? Performance of children with and without autism on analogues of the false-belief task. Journal of Cognition and Development, 6, 259-283. Brewer, R., & Murphy, J. (2016, July 13). People with autism can read emotions, feel empathy. Scientific American.

From: https://www.scientificamerican.com/article/peoplewith-autism-can-read-emotions-feel-empathy1/ Carpenter, M., Pennington, B. F., & Rogers, S. J. (2001). Understanding of others’ intentions in children with autism. Journal of Autism and Developmental Disorders, 31, 589-599. Cohen-Rottenberg (2009). A critique of the empathizing-systemizing (E-S) theory of autism [Blog post]. Retrieved from https://autismandempathyblog.wordpress. com/a-critique-of-the-empathizing-systemizing-e-s-theoryof-autism/ on February 11, 2019. Emanuel, C. (2015). An accidental Pokemon expert: Contemporary psychoanalysis on the autism spectrum. International Journal of Psychoanalytic Self Psychology, 10, 53-68. Epstein, S.F. (2000). Epilogue. Psychoanalytic Inquiry, 20, 746-747. Falcon, M., & Shoop, S. A. (2002, April 10). CANdo about defeating autism. USA Today. Retrieved from http://www.usatoday.com/news/health/spotlight/2002/04/10-autism.htm Frith, U., & Happe, F. (1994). Autism: Beyond ‘Theory of Mind.’ Cognition, 50, 115-132. Gernsbacher, M. A. (2007). On not being human. Association for Psychological Science Observer, 20, 5-32. Gernsbacher, M. A., & Frymiare, J. L. (2005). Does the autistic brain lack core modules? Journal of Developmental Learning Disorders, 9, 3-16. Happe, F. G. E. (1993). Communicative competence and theory of mind in autism: A test of relevance theory. Cognition, 48, 101-119. Higashida, N. (2013). The reason I jump (KA Yoshida and David Mitchell, Trans.). New York, NY: Random House. (Original work published 2007) Hobson, R. P. (2011). On the relations between autism and psychoanalytic thought and practice. Psychoanalytic Psychotherapy, 25, 229-244. Merritt, C. (2012). The empathizing-systemizing (E-S) model of autism and psychoanalytic theories of truth, play and symbolization. Psychoanalytic Psychology, 26, 327-337.

Milton, D. (2012) On the ontological status of autism: The ‘double empathy problem.’ Disability & Society, 27, 883-887. Newport, J., & Newport, M. (2002). Autism-Asperger’s & sexuality: Puberty and beyond. Arlington, TX: Future Horizons. Ozonoff, S., Rogers, S. J., & Pennington, B. F. (1991). Asperger’s syndrome: Evidence of an empirical distinction from high-functioning autism. Journal of Child Psychology and Psychiatry, 32, 1107-1122. Peterson, C. C. (2002). Drawing insight from pictures: The development of concepts of false drawing and false belief in children with deafness, normal hearing, and autism. Child Development, 73, 1442-1459. Reyes, P. (2018, January 3). I have nonverbal autism. Here’s what I want you to know [Blog post]. Retrieved from https://researchautism.org/i-have-nonverbal-autismheres-what-i-want-you-to-know/ on August 25, 2019. Russell, J., & Hill, E. (2001). Action-monitoring and intention reporting in children with autism. Journal of Child Psychology and Psychiatry, 42, 1105-1113. Sebanz, N., Knoblich, G., Stumpf, L., & Prinz, W. (2005). Far from action-blind: Representations of others’ actions in individuals with autism. Cognitive Neuropsychology, 22, 433-454. Smukler, D. (2005). Unauthorized minds: How theory of mind misrepresents autism. Mental Retardation, 43, 11-24. Steele, S., Joseph, R. M., & Tager-Flusberg, H. (2003). Brief report: Developmental change in theory of mind abilities in children with autism. Journal of Autism and Developmental Disorders, 33, 461-476. Tager-Flusberg, H., & Sullivan, K. (1994). A second look at second-order belief attribution in autism. Journal of Autism and other Developmental Disorders, 24, 577-586. Usher, L. V., Burrows, C. A., Messinger, D. S., & Henderson, H. A. (2018). Metaperception in adolescents with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 533-548.

Response to Benvenuto’s Autism: A Battle Lost by Psychoanalysis Michael KRASS

As someone who is deeply immersed in scholarship, research and clinical work involving people on the autism spectrum and as someone who is actively engaged in highlighting the ways that psychoanalytic theories and techniques are relevant to our current knowledge about autism, I found Sergio Benvenuto’s essay “Autism: A battle lost by psychoanalysis” (DIVISION/Review No. 19, Summer 2019) to be inaccurate and misleading in both how it portrays autism and how it describes current psychoanalytic approaches to understanding and working with people on the autism spectrum. First and foremost, the ways that Benvenuto describes people with autism do not square with the understanding of autism that has been developed and increasingly refined by what is, at this point, a massive body of research on autism spectrum phenomena (a search on Google Scholar of the word “autism” brings up 19,800 citations!) and from the clinical experience of those of us who work extensively in therapy and analysis with people on the spectrum (according to PEP Web,

40 papers on autism have been published in psychoanalytic journals in the past nine years). Of concern to those of us who have been working assiduously to integrate evolving knowledge about the features and mechanisms of autism into psychoanalytic models of the mind and of treatment, his portrait of those with autism is based on a number of assumptions that are incorrect and exaggerated because they neglect to incorporate the most current picture(s) of autism derived from both non-analytically and analytically informed data. To wit, Benvenuto makes assertions based on outdated theories. For example, he states (p.28) that autism involves deficits in mirror neurons, a hypothesis that was proposed in the 2000s but has largely been disproven (e.g., Dinstein et al., 2010; Ruysschaert, Warreyn, Wiersema, Oostra, & Roeyers, 2014). He also stated (p.29) that difficulties accessing language in autism are “not caused by cognitive deficit,” a claim that is consistently contradicted by a large body of research identifying deficiencies in specific regions of the brain that 25

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govern language processing (e.g., Groen, Zwiers, van der Gaag, & Buitelaar, 2008). In addition, Benvenuto makes assertions that counter assumptions about autism that have been largely discarded by those who study autism (e.g., that people on the autism spectrum lack empathy [p.30]), overstatements that obscure intra- and inter-individual difference (“autistic people . . . are completely absorbed in the real world which is, however, completely devoid of any metaphorical ambiguity” [p.28]), generalizations that have no grounding in clinical observation or empirical research, or in the personal accounts of those on the autism spectrum (e.g., “Autistic subjects do not experience feelings such as modesty, shame or guilt” [p.31]), and over-generalizations that do not account for the now universally accepted idea of a “spectrum” of autism (e.g., “autistic subjects are indeed empty as to subjectivity” [p.29]; “an autistic person is a ‘house with no walls’: that is, a house that is not actually there” [p.29]). An exceptionally glaring series of incorrect assumptions and inaccurate

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An-My Le

statements compares “young male [normal] children” who “love linear transportation, like trains, cars, and planes” and for whom “the centrifugal movement is erotized” to the “autistic child” who “loves centripetal movements.” He explains this observation thusly: “In circular and concentric shapes [children with autism] see a solution to an intrinsic difficulty of theirs, relating to their being-in-the-world” (p.30). Not only is it incorrect to suggest that neurotypical (he unfortunately uses the now-anachronistic word “normal”) boys are drawn more to linear experiences than are boys on the autism spectrum, it is also incorrect to overgeneralize that for neurotypical boys circular motion is sexualized and thus does not have sensory functions. Most importantly, his understanding of the role of spinning and other types of self-stimulatory behavior, while beautifully and poetically expressed, disregards sound research and observation, including that of psychoanalytic writers (e.g., Pass, 2018), indicating that atypical sensory experience — in particular a tendency to become overstimulated and overloaded (e.g., Baum, Stevenson & Wallace, 2015) — is a central feature of the neurobiological profile of those on the autism spectrum.

In addition, his descriptions of those with autism treat them as if they are a unity, as “other,” and as psychically distinct from those who are neurotypical. For example, he makes the provocative claim that “if the cognitive-behavioral theory of the human mind were universally valid, we would all be autistic.” Such a statement oversimplifies the psychology of people with autism and speaks of autism as a totality, a notion that is not supported by scientific research on autism. For example, a review of the research on the genetics of autism spectrum phenomena (Zhao, Yin, & Fan, 2015) reported that, so far, hundreds of genes have been identified as potentially contributing to an autism phenotype. In addition, Evan Eichler, the head researcher of a study (O’Roak et al., 2012) examining the genetics of over 2,500 people identified as being on the autism spectrum stated that, although the study’s researchers identified similar patterns in the subjects’ genetics, they “never saw the same gene hit twice” (in Deweerdt, 2014). Such findings support the impression that many of us who work with people on the spectrum have: that autism is heterogenous, it shows itself in many variations and, as a result, often thwarts our countertransference-driven attempts to pinpoint it. 26

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One of the more problematic statements Benvenuto makes throughout his essay is his claim that “the true specificity of autism” is “its lacking an unconscious” (p.32). He adds that “[t]he analyst cannot listen to the unconscious of an autistic person because it is missing . . .” (p.32). Not only does clinical experience not support this claim but it is not consistent with basic elements of psychoanalytic theory. The unconscious, as Freud defined the term and as most analytically-oriented clinicians use it, exists in all of us. There may be powerful and seemingly airtight defenses against the unconscious, with its fantasies, feelings, memories and impulses, or our capacities to contain it might be weak and full of holes. Some, who have been traumatized, experience their unconscious more intensely and thus may utilize depersonalization and dissociation or may act out unthinkingly to manage the impulses aroused by the trauma. To suggest that the minds of people with autism do not follow this most foundational tenet of psychoanalytic theory is to suggest that people on the autism spectrum are literally a different species from those who are neurotypical, an implication that is definitionally othering. Such comments fall short of meeting consensually agreed-upon standards of

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accuracy and respect for the nuance and variability of the subject of psychoanalytic study. Rather they reflect an attempt to subsume a multidimensional and multivariate phenomenon into a theoretical structure. As such, Benvenuto appears to be trying to elegantly fit the reality (i.e. what autism is) into the theory, rather than attempting to formulate a theory around an observed and experienced reality regardless of the mess and lack of closure that such clinical realities may create in our theories. To do so, he has oversimplified the phenomenon about which he is theorizing. Benvenuto also does not do justice to the complexity, scholarship, sensitivity and thoughtfulness of many of the psychoanalytically-oriented approaches currently employed in therapeutic work involving patients on the autism spectrum. He states, “Strangely, those who intend to support the current psychoanalytic approach to autism at all costs limit themselves to attachment theory” (p.26). In fact, the most well-known and well-regarded analytically-oriented approaches to working with patients with autism over the past several decades up to the present day reflect

a wide range of theoretical perspectives, from (describing in broad terms) Bionian (e.g., Dolan Power, Celia Fix Korbvicher) to contemporary Kleinian and Tustinian (e.g., Anne Alvarez, Maria Rhode, Didier Houzel), to Mahlerian and transference-focused (William Singletary), to ego psychological (Susan Sherkow), to relational (e.g., Stephanie Pass), to a combination of all of the above (Robin Holloway), as well as my own more Winnicottian way of engaging with patients on the autism spectrum focusing on unconscious fantasy articulated in perseverative speech and behavior, to mention just a few of the many analytic writers using one of the many combinations of many psychoanalytic theories to describe the different parts of the autism elephant that they encounter. The essay criticizes psychoanalysts writing about autism for clinging to a model where “the mother-child relationship explains everything.” In fact, most if not all serious psychoanalytic theorists writing today recognize the neurobiological bases of autism. Even Frances Tustin, writing from a Bionian and Winnicottian perspective in the 1970s and 1980s before much of what

Mikael Levin, Margins

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we now know about the neurobiology of autism had been discovered, much less substantiated, asserted that the psychological features of autism derived from the interaction of a mother with a baby who, due to being “particularly anxious” and “unduly sensation-centred” (1972, p.26), turns toward “bodily satisfactions that are ever-present” (1984, p.74). My own psychoanalytic understanding of autism spectrum phenomena is built around the scientific evidence of certain neurobiological features that profoundly impact the mind, the way it develops, and the shape that it takes. I have been particularly influenced by the vast body of experimental and observational research showing that people on the spectrum are hard-wired to have difficulties reading emotional expression conveyed in eyes (e.g., Franco et al., 2014) and faces (e.g., Chawarska, Macari, & Shic, 2013), have a tendency to have difficulty habituating to novel facial stimuli (Kleinhans et al., 2009), exhibit neurological overconnectivity that results in difficulties screening out extraneous sensations, feelings, and thoughts (e.g., Keown et al., 2013), and

DISCUSSION ON AUTISM

are prone to sensory hyperacuity (e.g., Baum, Stevenson & Wallace, 2015) and that these characteristics may be present at birth (e.g., Klin, Lin, Gorrindo, Ramsay, & Jones, 2009). These findings led me to consider the possibility that this particular array of neurobiological deficits and differences interferes with many of the relational processes, such as holding and containment, that modern psychoanalytic theory (as, for example, articulated by the Boston Process of Change Study Group [Stern, et al., 1998]) places at the cornerstone of psychological development. Such an impact would be expected to be greatest during infancy when the brain and the mind are forming at great speed, but to continue through the lifespan (Sherkow & Harrison [2013] as well as Singletary [e.g., 2015] have put forward similar theories). Thus, I have suggested (201*, 2016, 2019) this neurobiological profile has psychic consequences that are directly observable in psychoanalytically-oriented work with patients on the autism spectrum. In particular, patients on the spectrum typically describe with great vividness unconscious derivatives suggesting that they experience autistic aspects of one’s brain as persecutory, destructive, hateful and omnipotent. Findings such as these suggest that, in contrast to, for example, Benvenuto’s claim that people on the spectrum lack an unconscious, there is significant evidence of the workings of an active unconscious (an assertion that ought not to require stating). By mischaracterizing, discounting, and devaluing the efforts made in the field of psychoanalysis to understand autism spectrum phenomena, by, as the title suggests, declaring it a “battle lost,” Benvenuto does an injustice to an area of psychoanalytic exploration that is, in fact, at the forefront of the effort to integrate psychoanalytic theory and clinical data with descriptive and explanatory narratives derived from non-analytic sources — that is, the very definition of construct validity. Without a doubt, psychoanalysis has a tradition of ignoring, minimizing or misunderstanding autism spectrum phenomena and people with autism. However, it is simply false to assert that the efforts to right those wrongs and to expand the understanding (and thus the empathy) of those practicing treatment through a psychoanalytic lens with people on the autism spectrum have failed. The inaccurate ways that Benvenuto describes both autism and the psychoanalytic approach to working with patients on the autism spectrum can have serious ramifications. Such misstatements risk giving ammunition to the commonly accepted belief among the mental health and the

autism communities that a psychoanalytic approach is not relevant and may even be counter to effective treatment of people who are on the autism spectrum. Anyone who provides analytically-oriented treatment to people on the autism spectrum has undoubtedly encountered prospective patients, other health professionals, educators, popular psychology books, and newspaper articles unequivocally dismissing a psychoanalytic perspective as not useful in the treatment of people who are on the autism spectrum. It is unfortunate that Benvenuto contributes to this opinion, doing so from two different angles. From one angle, he sides with those who discount the role of psychoanalytic treatments with people on the spectrum. From another angle, he provides fodder for such a critique in the way that he, as a psychoanalyst, bases many of his assertions on incorrect information and straw men. This is an exciting time to be a psychoanalyst exploring the brain-mind intricacies posed to us in our work with those on the autism spectrum. Psychoanalytic theory and clinical experience provide an invaluable way of helping neurotypical psychoanalytic clinicians to make empathic contact with those on the autism spectrum. The field of psychoanalysis has amassed vast knowledge of early emotional and cognitive development, the creation of mind, the manifestations of unconscious fantasy, of transference, of countertransference and reverie, of the intricacies of the engagement of patient and analyst in the places that evolve between them. Thus, psychoanalytically-oriented clinicians and theorists are, in my opinion, best situated of those practicing within all mental health perspectives to engage with our patients who are on the autism spectrum, not as an “other” to be examined, but as another way in which the unconscious functions of the mind can be manifested. That is, autism presents the challenge of identifying what the psychoanalytic models of the mind that we have developed look like when they are sifted through and around a brain that is built differently than that which our psychoanalytic theories were originally developed to describe. This has been achieved to the degree it has by analytic writers such as those mentioned above by embracing the nuanced humanness of the phenomena we seek to better understand with all of its complexity and its lively unwillingness to fit neatly into our elegant theories. z REFERENCES Baum, S. H., Stevenson, R. A., & Wallace, M. T. (2015). Behavioral, perceptual, and neural alterations in sensory and multisensory function in autism spectrum disorder. Progress in Neurobiology, 134, 140-160. doi:10.1016/j. pneurobio.2015.09.007 28

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Chawarska, K., Macari, S., & Shic, F. (2013). Decreased spontaneous attention to social scenes in 6-month-old infants later diagnosed with autism spectrum disorders. Biological Psychiatry, 74(3), 195-203. doi:10.1016/j. biopsych.2012.11.022 Deweerdt, S. (2014, November 24). Genetics first: A fresh take on autism’s diversity [Web article]. Simons Foundation. Retrieved from https://eichlerlab.gs.washington.edu/ news/SFARI2014Nov.pdf Dinstein, I., Thomas, C., Humphreys, K., Minshew, N., Behrmann, M., & Heeger, D. J. (2010). Normal movement selectivity in autism. Neuron, 66(3), 461-469. doi:10.1016/j. neuron.2010.03.034 Franco, F., Itakura, S., Pomorska, K., Abramowski, A., Nikaido, K., & Dimitriou, D. (2014). Can children with autism read emotions from the eyes? The eyes test revisited. Research in Developmental Disabilities, 35(5), 1015-1026. doi:10.1016/j.ridd.2014.01.037 Groen, W. B., Zwiers, M. P., van der Gaag, R. J., & Buitelaar, J. K. (2008). The phenotype and neural correlates of language in autism: An integrative review. Neuroscience & Biobehavioral Reviews, 32(8), 1416-1425. doi:10.1016/j. neubiorev.2008.05.008 Keown, C. L., Shih, P., Nair, A., Peterson, N., Mulvey, M. E., & Müller, R. A. (2013). Local functional overconnectivity in posterior brain regions is associated with symptom severity in autism spectrum disorders. Cell Reports, 5(3), 567-572. doi:10.1016/j.celrep.2013.10.003 Kleinhans, N. M., Johnson, L. C., Richards, T., Mahurin, R., Greenson, J., Dawson, G., & Aylward, E. (2009). Reduced neural habituation in the amygdala and social impairments in autism spectrum disorders. American Journal of Psychiatry, 166(4), 467-475. doi:10.1176/appi. ajp.2008.07101681 Klin, A., Lin, D. J., Gorrindo, P., Ramsay, G., & Jones, W. (2009). Two-year-olds with autism orient to non-social contingencies rather than biological motion. Nature, 459, 257-261. doi:10.1038/nature07868 Krass, M. L. (2012, January). Winnicott and Asperger’s Syndrome: When the child cannot know that the mother is ‘good enough.’ Paper presented at the American Psychoanalytic Association National Meeting, New York, NY. Krass, M. L. (2014, July). Bullies and bad guys: The introjected autistic brain. Paper presented at the 7th International Conference of the Work of Frances Tustin, Boston, MA. Krass, M. L. (2015, July). Unconscious representations of the autistic brain: Brain, body and mind in the analytic work with adults, adolescents and children on the autism spectrum. Paper presented at the 49th Congress of the International Psychoanalytical Association, Boston, MA. Krass, M. L. (2016). Brain and mind in autism. [Review of the book Asperger’s children: Psychodynamics, aetiology, diagnosis and treatment, by R. Holloway]. DIVISION/Review, 15, 58-60. Retrieved from Psychoanalytic Electronic Publishing. Krass, M. L. (2019). Reclaiming meaning in autistic speech [Unpublished manuscript]. O’Roak, B. J., Vives, L., Girirajan, S., Karakoc, E., Krumm, N., Coe, B. P., ... & Turner, E. H. (2012). Sporadic autism exomes reveal a highly interconnected protein network of de novo mutations. Nature, 485(7397), 246-250. doi:10.1038/nature10989 Pass, S. (2018). Beginning to play: Parent-child therapy with a young autistic child. Fort Da, 24(1), 39-56. Retrieved from https://www.pep-web.org/document. php?id=fd.024.0039a Ruysschaert, L., Warreyn, P., Wiersema, J. R., Oostra, A., & Roeyers, H. (2014). Exploring the role of neural mirroring in children with autism spectrum disorder. Autism Research, 7(2), 197-206. doi:10.1002/aur.1339 Sherkow, S. P., & Harrison, A. M. (2013). Autism spectrum disorder: Perspectives from psychoanalysis and neuroscience. Lanham, MD: Rowman & Littlefield. Singletary, W. M. (2016). Response to commentaries on “An integrative model of autism spectrum disorder: ASD as a neurobiological disorder of experienced environmental deprivation, early life stress, and allostatic overload”. Neuropsychoanalysis, 18(1), 25-30. doi:10.1080/15294145.2 016.1166337 Stern, D. N., Sander, L. W., Nahum, J. P., Harrison, A. M., Lyons-Ruth, K., Morgan, A. C., ... & Tronick, E. Z. (1998). Non-interpretive mechanisms in psychoanalytic therapy: The ‘something more’ than interpretation. International Journal of Psycho-analysis, 79, 903-921. Tustin, F. (1972). Autism and child psychosis. London, England: Karnac Books. Tustin, F. (1984). Autistic shapes. International Review of Psycho-analysis, 11(3), 279-290. Zhao, H. X., Yin, S. S., & Fan, J. G. (2015). High plasma neopterin levels in Chinese children with autism spectrum disorders. International Journal of Developmental Neuroscience, 41, 92-97. doi:10.1016/j.ijdevneu.2015.02.002

DISCUSSION ON AUTISM

On Autism. Response to My Critics 1. First, I apologize for my old-fashioned style of writing. In my paper I used “normal” instead of “neurotypical,” “autism” rather than “ASD,” and I did not provide an immense bibliography, quoting just the works I considered essential to my argument (but today a large bibliography is the mark of a serious paper). Just imagine; I still use terms like “hysteria,” which the DSMs did away with long ago! And I still use the term “obsessional” rather than “obsessive-compulsive!” Here I shall make amends and try to conform to mainstream “impact factor” jargon. Secondly, before replying to my critics I shall try to situate this debate of ours on autism in a wider context. In the last 50 years in hyper-industrialized societies, autism diagnoses have increased twenty-fold (whilst those diagnosed as schizophrenic have “only” increased five-fold), leading to talk of autism epidemics. Today the common belief is that there are eight autistics out of every 10,000 children under five — whilst only a few decades ago autism was considered a rare pathology. Surveys assure that in the US there are six times more autistics than in other western countries! It’s not credible that American society has such a remarkable ability to produce autistic children (assuming that autism is a product of the family and social entourage). The reason is simply that US psychiatrists are too “keen” on autism diagnoses;1 even though the inclination to diagnose autism more and more hastily is spreading throughout the industrialized world. Greta Thunberg too was diagnosed with Asperger’s during a phase of depressive mutism. In short, autism is a fashionable pathology. Ian Hacking (2010) spoke of a booming industry of narratives about autism, just like schizophrenia was fashionable decades ago, and hysteria (from which psychoanalysis drew its popularity) in the late 19th century. We should be asking why each era has its own psychopathology and why today it’s autistics we choose to see everywhere. So, our debate too, behind the veil of scientific neutrality, reflects – unconsciously – what’s at stake in this current fascination of ours for autism. Personally, I’m fascinated by autism because it puts into play certain fundamental problems of contemporary philosophy, the difficulties of concepts such as “mind,” “subjectivity,” “other minds,” “being-in-theworld,” and so on. (I will formulate a hypothesis: our age is so interested in autism because there is 1 The same way American psychiatrists used to diagnose schizophrenia twice as often as their European counterparts, in particular the British. See Shepherd et al. (1968); Katz et al. (1969); Cooper et al. (1972); Pichot (1982).

Sergio BENVENUTO

reason to suspect that we could all be autistic in some way. The same way that at the end of the 19th century, there was reason to suspect that all women were hysterical. But what does “autism” mean for people who actually have no idea of its meaning? It probably means withdrawal from social life, being closed up in one’s own world, a sort of hikikomori life-style — and perhaps our age is tempted exactly by this. Indeed, we have the feeling social life is draining us.) The tendency to see autism more and more often in people has led to the term Autistic Spectrum, which can however be interpreted in two ways. On the one hand, as a soft form of the “dimensional” approach to autism, in the sense that we’re all more or less autistic, the same way we are all more or less short, or have better or worse eyesight. I’m prepared to accept such a vision, so I can’t be accused of wanting to isolate autistics in a conceptual ghetto, given that from this point of view autism is a continuum of differences ranging from the thoroughly autistic to those who aren’t autistic at all. The thesis I’m proposing — that autism is an agnosia of subjectivity (and neither a lack of Theory of Mind [ToM] nor of subjectivity) — can be understood in a dimensional sense: as a minor ability, always relative, of perceiving subjectivity. The concept of spectrum can also mean something else: that the forms of autism are so heterogeneous that we find it difficult to include them all in a single syndrome. Hence the saying: “If you know one autistic person, you know one autistic person.” In other words, it would be reasonable to suspect that perhaps there is no such a thing as autism. The idea of a spectrum could become the gateway to the death of the concept of autism: if every autistic person is an individual case, it will become more and more difficult to find a constant trait in all autistics. The paradox is that while the figure of the autistic becomes increasingly popular (and marketed), it seems almost as if psychiatry were about to abandon this category (this is the wish of Timini, Gardner, & McCabe, 2011). The category of hysterics has disappeared from psychiatry textbooks, together with a whole range of other categories (like Asperger’s syndrome), so there’s no reason why autism shouldn’t disappear as well. Asking why every disorder is not viewed as a spectrum is a good question: no two schizophrenics are exactly the same, nor two obsessive-compulsive individuals, nor two anorexic women… In these cases, we don’t talk of spectrums because we 29

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think we can see some basic common traits, which instead increasingly elude us with regard to autism. The spectrum certainly evokes the specter. Is not treating autism as a spectrum to admit its spectral nature? In The Communist Manifesto, Marx and Engels wrote that communism is a specter haunting Europe. We may say that today autism is a specter haunting psychiatry (Laurent, 2011-12). My attempt was therefore to find a structural trait to allow us to continue talking about autism, not only as a specter. What’s striking about my critics’ texts is that they do indeed reject my description of autism not only without proposing their own definition, but without even mentioning a structural trait to help us recognize autism beyond all the individual differences. It’s hard to understand what an autistic is for them. We will later return to the question of a “structural” approach to clinical diagnosis. Thirdly, my critics accuse me of not being up to date on the current literature on autism. Now, Krass reminds us that around 20,000 citations on the subject appear on Google Scholar. But on Scholar I see they are 1,340,0002…Who could ever read all the texts that appear on the issue? The result is that one makes a selection and usually reads the research one is “fondest of,” and only that. It’s also interesting to see that among the texts quoted by my two critics as crucial, not even one appears in both bibliographies. I’m convinced that if a third critic, from another field, had replied to me, he or she would have quoted completely different texts on autism. After all, I could also cite several studies on autism I consider rather interesting (for instance, some Lacanian contributions: Laurent 2007, 2008, 2011-12; Maleval, 2009, 2011; Tendlarz 2011; Ansermet & Giacobino 2012). In line with Critical Autism Studies, an Italian contribution: Valtellina (2016). It’s true that today scientific research is essentially published in English, but not always (for example, in a psychoanalytic perspective, Robert [2018]). 2. I think that most of the criticisms from Joanna Lhulier are due to an obvious misunderstanding of the contents of my article. A misunderstanding I’m responsible for, as English isn’t my native language. An essential misunderstanding is her confusion between ToM and perception of subjectivity, which I distinctly separate and actually counterpose. She writes: “Dr. Benvenuto 2. https://scholar.google.it/scholar?hl=en&as_ sdt=0%2C5&as_vis=1&q=%22autism%22&btnG=

DISCUSSION ON AUTISM

begins with the idea that autistics lack theory of mind (ToM). … there is growing empirical evidence to suggest that the hypothesis that autistics lack theory of mind is false or at the very least subject to debate.” Now, I said quite the opposite: that autistics are such precisely because they resort to a theory of mind, while non-autistics don’t need to. ToM is a sort of prosthesis of the agnosia I see as the source of autism. The main aim of my paper was to compare the cognitivist approach, according to which we all need to build ourselves a ToM, and the phenomenological vision (adopted by some neuroscientists) according to which we have an immediate grasp of our own subjectivity and that of others (not, therefore, of the “mind”). All the counter-examples given by Dr Lhulier do not therefore grasp the question that was essential for me. Of course, autistics know that other subjects exist, but to know is one thing, to perceive is another. A blind man knows there’s a table in front of him, because someone has told him or because he’s touched it, yet he does not see it. The hypothesis (derived from phenomenology) on which I based my considerations is that, unless we’re on the spectrum, we perceive subjectivity. Ian Hacking (2001; 2009b) supports a thesis very close to mine. The difference is that while I turn to philosophical phenomenology, he turns to Köhler (1929) and Wittgenstein (2001) — and I think he did a better job than I did, because Wittgenstein’s theory lends itself more effectively than Husserl or Merleau-Ponty to reading the peculiarity of autism. Hacking writes: “We usually see what a picture is of, and do not infer it. … Likewise, I usually just see that a man is in bad humour (Wittgenstein, 1953/2001, p.153e). I note it, and do not infer it.” He quotes Köhler, who admitted at once, in 1929, that his account “gives us neither an altogether new nor an altogether perfect key to another person’s inner life; it tries only to describe so far as it can that kind of understanding which is the common property and practice of mankind” (p.266, italics added). … Köhler pointed to a wide range of phenomena in which we see and do not infer what a person is doing. (Hacking, 2009) With Köhler’s phenomena, Hacking indicates all these acts where we see the other’s subjectivity, we don’t build hypotheses about it. And “I shall stick to the phenomena. They are familiar to most people, but are precisely what are not familiar, ‘automatic’, ‘immediate’ or ‘instinctive’ for most autistic people.” In short, autistics are such because they do not have direct access to Köhler’s phenomena — but Hacking too,

like me, explains why this hypothesis confutes the theory of a lack of ToM. Hacking basically says what I tried to say. But he has never, as far as I know, been accused of offending autistics or stigmatizing them. Perhaps because he wrote in a more philosophical language, whereas I preferred to use a style closer to common language. The only difference, in fact, between Hacking and myself is that he uses Köhler’s phenomena to indicate what I mean when I say direct perception of subjectivity. Krass stresses that the hypothesis of a lack of mirror neurons has been widely disproven. I won’t cry over that. I quoted the example of mirror neurons not because I was relying on it, but because it is how phenomenology-based neuroscience — in particular the Parma School (headed by Giacomo Rizzolatti), which discovered mirror neurons — tried to provide scientific evidence for phenomenology’s (or Wittgenstein’s) claim that our relationship with others doesn’t occur through a ToM, but through an immediate perception of subjectivity (Gallese, Rochat, & Berchio, 2013). This was the important point for me, not the hypothesis — however interesting – of a mirror neuron deficit. The true issue at stake is whether neurosciences will be able to integrate a fundamental psychoanalytical (and philosophical) concept such as subjectivity – something quite difficult, as even few psychoanalysts integrate it. 3. But what do I mean by subjectivity? Various modern philosophies have elaborated some concepts of subjectivity: that of Nietzsche, Heidegger’s Dasein, Sartre’s being-for-itself, the subject as Lacan’s barred signifier, etc. I myself am not sure how to define the subject — not to be confused with the mind. I hope that autistics will allow us to better understand what this “something” they lack is, and that we, neurotypical subjects, have, without being aware of it. Perhaps it is the fact that we attribute to an “I” – and to a “you” that is in turn an “I” — all the mental processes we have (thoughts, emotions, insights, etc.). I could represent subjectivity with a torus:

Subjectivity could be that void at the center of the torus, around which all the mental forms are organized like a toroid, 30

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which is a ring-shaped object ordered around a void. My hypothesis is that with ASD the mind is not organized like a torus. I don’t see how this hypothesis could be mistaken for “hate speech,” which is what Lhulier accuses me of. When something is lacking, often there are other skills that neurotypes lack. Susanna Tamaro (2019), a bestselling writer who was diagnosed with Asperger’s, explains this well: Every time nature takes something away, it also gives something back. Not understanding the language of humans is compensated by understanding with absolute and immediate clarity all other languages that are not human. Animals talk to us, and we talk to them. We have intense and surprising dialogues with trees and flowers. In fact, when autistics are able to describe their way of being-in-the world, one is struck and fascinated by their way of relating to things, animal and the inorganic. They reveal a perception of the world that escapes neurotypical individuals. Lhulier believes that my saying that autistics “skip humanity” is offensive. In fact, I should have written “skip ‘humanity’,” with inverted commas. I was taking for granted that skipping humanity is not what they do, but what they feel. Many autistics doubt they are truly “human” (like Tamaro above), in the sense that they have the impression neurotypical individuals are not very human, so to speak. This is the famous expression that Grandin used with Sachs to describe herself: an anthropologist on Mars. Evidently, neurotypicals are Martians to her. She was the anthropologist. (I am tempted to call the book I plan to write on autism A Martian Among the Spectra). Many autistic people use often astronomical similarities to provide a concrete image of how they are different from non-autistics. The autistic Jasmine Lee O’Neill (1998) describes her way of seeing the world as Through the Eyes of Aliens (see also: Hacking, 2009a). The autistic author Jean Kearns Miller (2003) talks about Women From Another Planet. Tamaro (2019) writes that “We have landed on a planet of which we do not know the language. The world is there, in front of us, but there is no way we can reach it.” The identification of Grandin with animals is not a psychoanalytic interpretation, it is what she herself repeatedly speaks of. When she was a child (Grandin, 1986) her school organized an exhibition of domestic animals and each child had to bring one. She brought herself and behaved like her own dog (see also: Hacking, 2007). But as a child, Grandin did not think

DISCUSSION ON AUTISM

she was the “strange” one; she thought all her schoolmates were “strange,” and only when she grew up did she realize that she was “special.” My impression is that autistic people see us a bit like we see psychotics: as people who use a language that is incomprehensible, ambiguous, inconsistent. I therefore understand that many autistics are proud of their difference, the same way minorities considered “disabled” are (an elderly friend of mine has suggested we hold a Senility Pride, and says we should call elderly people “diversely young”). I know deaf-mutes from birth who are very happy and proud of their condition; they also betray a certain contempt for those who speak and hear. Everyone has the right to their own narcissism, all the more so in the case of autistics who possess extraordinary intellectual abilities. I do not believe, however, that we are doing a favour to autistic people when we use such an edifying rhetoric, which sounds something like “we are not Martians the same way you are not Martians! We are all the same!” No, we are not all the same. And it is exactly because of this difference that “Aspie pride” makes sense. There is a contradiction at the heart of political correctness: if the sameness of neurotypicals and people with “disorders” is exaggeratedly stressed, then the pride of the “disordered” no longer makes sense. If deaf and mute people were to claim that they too can hear and speak, what would their pride rest on? And political correctness risks leading to a form of obscurantism. Scientific and intellectual research should not be intimidated and blamed when it speaks of things that the prevailing ethical and political beliefs perceive as unpleasant. Otherwise, freedom of research is threatened. What I find beautiful about autistics is precisely that they are not neurotypical, that is to say, they speak to us of another way of being human. Autism expands our narrow concept of humanity. We come into contact with the autistic world trying to understand its difference, trying to understand what problems the autistic people face. This is true also if this difference, as claimed by the “dimensional” view, is only relative, if autism is to be understood as being “more or less.” If it is true that autism consists of a specific agnosia, then it is clear that each autistic person is different from the other, given that everyone has his or her own personality. The personality differences between autistics are the same as between neurotypicals. Also, people who were born blind, for example, are very different one from another: there is no typical “blind personality.”

4. Lhulier lists a series of points showing my incorrectness, but I could defend each point with sentences reported by autistics themselves. Lhulier accuses this sentence of mine: “I would say that an autistic person is a house with no walls, that is, a house that is not actually there.” All I did here, however, was to repeat, in different words, the eloquent title of the famous book by Donna Williams (1992), who has Asperger’s: Nobody Nowhere. After all, my paradoxical image of a “house with no walls” was my way of reversing Bettelheim’s (1967) image of an “empty fortress.” Lhulier cites my sentence “autistic individuals are not able to deceive, nor do they try to impress others. They never manipulate, they never get involved in gossip. They have no sense of ownership, they feel no envy, and they like to give.” To this regard, Tamaro (2019) in the article quoted above says: When my book Follow Your Heart came out, I was accused of being shady, tricky, cunning, things I have never been able to conceive. A person with Asperger never has ulterior motives, simply because they are not part of his or her horizon. We don’t know what ambiguity is, nor do we have any shady sides, except from the phantoms of our mind. Speaking of Greta Thunberg, she says: “Greta is not cunning, she has no ulterior motives, she knows none of the techniques used to manipulate which allow [one] to be at ease in society.” On various occasions, Grandin speaks of how she became angry when confronted with ambiguous situations or things, “an autistic’s way of reasoning is black and white,” she says. I must confess that my ideas come mostly from what autistic people write about their own experience (I refer mainly to: Grandin, 1986, 1995, 2005; Williams 1992, 1994; Mukhopadhyay, 2000, 2003, 2008; Tammet, 2006; Sellin, 1996) and not so much from what scholars write about ASD. Autistics, when they know how to write well, never mitigate, and above all they emphasize, their difficulties in communicating with other humans. They prefer to “converse” with things. For example, my idea that psychoses are the opposite of autism was inspired by Williams (1992), although she describes this in her own terms. At first, as a child, she was diagnosed as psychotic, but then, growing up, reading books on schizophrenia, she soon realized that her problems 31

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were of a completely different kind. This opposition between autism and psychosis is contrary to a widespread theory in continental Europe, according to which autism is a form of psychosis, as Lacan himself (1989) also argued in a certain sense. Lhulier says that my way of describing the way of being of autistics is offensive to them, but does not tell us how she thinks the specificity of autism should be described, in a supposedly non-offensive way. My impression is that according to Lhulier, autism stems from a language disorder. And in fact, all textbooks on autism today start by saying that with autism there is a language disorder. But to speak of “language disorder” still doesn’t mean anything, because there are various dimensions of language, and therefore various relationships between language and subjectivity. Also, being deaf is a language disorder. Traditionally, there is a distinction between the semantic, syntactic, and pragmatic dimensions of language. Clinical literature clearly shows that with autism, the disorder does not really affect the syntactic function, but the semantic and pragmatic ones. What does this mean? When I say that an autistic tends (certainly, not completely) to think like a computer, or like a mathematician when doing mathematics, it is precisely because computation is a primarily syntactic activity, while the subjectivity I am considering concerns the semantic and pragmatic dimensions. As I said, citing a fundamental distinction made in linguistics, an autistic can be very good at understanding énoncés (statements) but be much worse at understanding énonciations (enunciations). It is no surprise that apparently one savant out of three, the kind that has extraordinary computational abilities, is autistic (on a savant autistic, his son: Gould, 1997). The words of an autistic savant such as Tammet (2006) are in this sense very important. For him numbers, are real objects; each has its own color, texture, beauty, or ugliness, it is funny or unpleasant — and the same goes for the words of the various languages he knows. For example, he is fascinated by the sullen beauty of prime numbers. He sees signifiers as objects, precisely because he does not perceive them in relation to subjectivity. Conversely, the Indian autistic Tito Mukhopadhyay (2000, 2008), in his beautiful testimony, tends to see objects, especially mobile or glowing objects, as real texts (“The story behind an object is far more important to me than the object”). From a very early age, his best companions have been mirrors and the shadows of objects. With mirrors, he is not interested in seeing himself (we cannot speak of a

DISCUSSION ON AUTISM

Lacanian mirror stage), but in the fact that mirrors tell stories. Shadows, on the other hand, have the power to interrupt stories. “I believed that the mirror wanted to tell me a story. And I believed that the mirror wanted to tell me a story because I wanted to tell it a story … I knew that the mirror heard everything because only when I stood in front of it could I hear the walls and the floor talk. … The mirror understood exactly what I was trying to explain. … My stories were not meant for human ears. Human ears cannot hear anything other than sounds.” (His are not “human ears”: should this be taken as hate speech against himself?) The sky and earth speak to each other. On the contrary, “shadows never told any story. Many times I waited for my shadow to begin some story. But my shadow never told me any story… I wondered why shadows don’t tell stories.” It would be a mistake to view this talking and telling world in which Tito lives as hallucinatory. In psychotic hallucinations, the signifiers invade the real, they colonize it. Here, on the other hand, the opposite occurs: the real objects rise to the status of quasi-subjects, they possess that subjectivity that Tito hardly recognizes in humans; objects are like fragmentary oases of subjectivity. Mirrors and shadows have the common trait of being the doubles of things: it’s as if Tito perceived subjectivity as a reflection of the body, as a double of the body. It is as if the autistic saw the world scattered with pieces of subjectivities, since he or she does not see these pieces coagulate as centers, of him/herself and of the other. Take autistic echolalia. To say it is a language disorder is merely to apply a label. Autistic people who talk about it say they cannot grasp the sense of the other’s words; they are meaningless sounds. The repetition of sentences is a way of saying “Look, I can enter into a relationship. I too can make noises” (Williams, 1992). That is, autistics often have problems in understanding the meaning, which is always a metaphorical sense of the signifiers; we may say they do not “subjectivize” the sounds they hear. Instead of understanding meaning silently, they are captured by the materiality of the signifier – to its being a sound – replacing subjectivation with the repetition of the signifier itself. It is like saying “April is the cruelest month means that April is the cruelest month.” The repetition of the material signifier replaces the going beyond the signifier that we call “being able to grasp the sense.”

Mirrors and shadows, in the case of Tito, echolalia in the case of other autistics, are reflections, a double of things or signifiers that replace a subjectivity which is the blind spot of their relationship with the mind. But because we have said that subjectivity is an empty organizer of the Self and of the world, we may say that autistics are blind to this emptiness. They grasp it in the form of reflection. From this perspective; it is possible to try to understand the reason for certain autistic behaviours that appear to us completely enigmatic. For example, why do they often flap their hands? Not because they are agitated; in fact it is a gesture and a sound that calm them. My hypothesis is that this gesture symbolizes the meeting-detachment of two parts of their Self, because there is no central void to organize the fragments of their soul. In this sense, we could try to understand many other autistic behaviors that are incomprehensible for us. My hypothesis of agnosia of subjectivity is an attempt to make the autistic being-inthe-world more intelligible. David Humphrey, house of the composer

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5. Krass’s answer is above all a defense of psychoanalytic theories of autism (British in particular). And therefore, he disagrees with my claim that, in a certain sense, autistics have no unconscious. He reminds us that according to Freud all human beings have an unconscious. Indeed, I used a somewhat provocative term to talk about a certain poverty of unconscious in autistics, but above all to advance the idea that the autistic life form should broaden our original concept of unconscious. Like when I said that autistics “skip humanity,” which angered Lhulier. Autism actually invites us to redefine our notions of humanity and of unconscious. It is not possible to elaborate further on this notion here, but what I can say, very briefly, is that autistics do not possess the essentially metaphorical unconscious of neurotics and psychotics, we may say they lack an “inner” unconscious, that what they have is rather an external one, one emanating from things. Krass reminds us that today, all psychoanalysts accept the neurological basis of autism. However, as I have said, my intent was not to discuss the etiology of autism.

DISCUSSION ON AUTISM

Moreover, if the neurological basis of autism is accepted, why not accept the same for almost all mental disorders, for schizophrenia, depression, hysteria, etc.? I would even be willing to discuss an etiology that essentially focuses on the mother-child relationship as the main cause of autism — although frankly I find this explanation unlikely, even though I do believe that the way parents cope with an autistic child can strongly determine the development of the child. But the point that interests me, I repeat, is not this. I criticized the focus on the mother-child relationship to the extent that it does not allow psychoanalysts to grasp what seems to me to be essential, namely the quid, the what, of autism. Many psychoanalysts believe that it is the modalities of this relationship that produce the various symptoms, or disabilities, of autism, while I believe it is firstly necessary to identify the characterizing features of autism as manifestations of a focal knot. I believe that one reason my critics reject my theses is due to the fact that, unlike them, I was educated in an intellectual and psychoanalytic environment – France and Italy in particular — where thinking is developed in structural terms. The purpose of my article was to try to clarify which essential structural traits distinguish autism from other life forms. Krass, for example, writes: people on the spectrum are hardwired to have difficulties reading emotional expression conveyed in eyes … and faces …, have a tendency to have difficulty habituating to novel facial stimuli …, exhibit neurological overconnectivity that results in difficulties screening out extraneous sensations, feelings and thoughts …, and are prone to sensory hyperacuity … and that these characteristics may be present at birth …. These are well-known traits of autism. The point is that Krass lists all these traits without searching for the structuring element, as if autism were the sum of a series of deficits, somewhat in the style of the DSM, in which each disorder is described by a list of traits with no attempt made to find a structural link between them. Now, my hypothesis (if refuted so much the better) is this: all these traits or deficits are expressions of an agnosia of subjectivity. My hypothesis may well be completely wrong, but at least, let me say this, I have tried to put forward a theory. ... This basic difference, I believe, as to what a good explanation might be, causes various misunderstandings also on the part of Krass. For example, Krass contests my thesis that “neurotypical boys’ circular motion is sexualized and thus does not have

sensory functions.” But I wrote that for neurotypical boys, the “centrifugal movement is erotized.” The centrifugal, not the circular motion. By “erotized” (and not “sexualized”) I simply meant that boys especially take pleasure from linear movements, without denying that it may also have a sensory function. I simply emphasized the different ways in which autistic and neurotypical children derive enjoyment from movement. Krass cites studies that question the non-understanding of metaphors by autistics. It is a complex issue that would require to be discussed in detail. Certainly high-functioning people with Asperger’s understand metaphors and can also produce them, but the main point is: what does a metaphor mean for them? My impression is that they take it very literally, and therefore, in a certain sense, they take it much more seriously. Wittgenstein (2001, 152e) wrote that: “The human body is the best picture of the human soul.” Hacking (2009) insists on this sentence. We could also say that the human body is an excellent metaphor for the human soul. But my impression is that for those with ASD, the human body is the human soul. The metaphor draws its own meaning into itself. A bit like the shadows of Tito, that we can take as metaphors of the objects of which they are shadows, but that prevent the objects from “telling stories,” that is, from manifesting the variety that constitutes them. For this reason, many autistic people cannot be touched by others. “If someone touches me, I no longer exist” (Williams 1992). It is worse than rape: by touching the body of an autistic, the other is stealing his or her identity, a sign that the body is not experienced as something that allows a subject to enter into relationship with the world, but as something that takes the place of the subject. There is a lot more still to be said, but I have already written too much. After all, the aim of my article was essentially to provoke psychoanalysts, like a stone thrown into a pond. For this reason, the accurate and passionate way in which my critics have reacted satisfies me, because it means the stone has created some waves. z REFERENCES Ansermet, F. & Giacobino, A. (2012). Autisme: à chacun son génome. Paris, France: Navarin. Bettelheim, B. (1967). The empty fortress: Infantile autism and the birth of the self. New York, NY: The Free Press. Cooper, J. E., Kendell, R. E., Gurland, B. J., Sharpe, L., Copeland, J. R. M., & Simon, R. (1972). Psychiatric Diagnosis in New York and London. Oxford, UK: Oxford University Press. Gallese, V., Rochat, M. J., & Berchio, C. (2013). The mirror mechanism and its potential role in autism spectrum disorder. Developmental Medicine & Child Neurology, 55, issue 1, 15-22. Gould, S. J. (1997). Five weeks. In Questioning the millenium. New York, NY: Harmony Books. 33

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Grandin, T. (1986). Emergence: Labeled autistic. Novato, CA: Arena Press. Grandin, T. (1995). Thinking in pictures: Other reports from my life with autism. New York, NY: Doubleday. Grandin, T. (2005). Emergence: Labeled autistic. A true story, with a supplement, ‘Looking back 2005’. New York, NY: Grand Central Publishing. Hacking, I. (2001). Leçon inaugurale, faite le jeudi 11 janvier 2001. Collège de France—Chaire de Philosophie et Histoire des concepts scientifiques. https://www. college -de -france.fr/site/ian-hacking/inaugurallecture-2001-01-11.htm Hacking, I. (2007). Animals in translation: Using the mysteries of autism to decode animal behavior. Common Knowledge, 13(2-3), 456-457. Hacking, I. (2009a). Humans, aliens and autism. Daedalus, 138, 44-59. Hacking, I. (2009b). Autistic autobiography. Philosophical Transactions of the Royal Society: Biological Sciences, 364(1522), 1467-1473. Hacking, I. (2010). Autism fiction: A mirror of an internet decade? University of Toronto Quarterly, 79(2), 632-655. Katz, M., Cole, J. O., & Lowery, H. A. (1969). Studies of the diagnostic process: The influence of symptom perception, past experience and ethnic background on diagnostic decisions. American Journal of Psychiatry, 125, 937-947. Köhler, W. (1929). Gestalt psychology. New York, NY: Horace Liveright. Lacan, J. (1989). Geneva lecture on the symptom (R. Grigg, Trans.). Analysis, 1, 7-26. Laurent, É. (2007) Autisme et psychose: Poursuit d’un dialogue avec Robert et Rosine Lefort. La Cause freudienne, 66, 105-118. Laurent, É. (2008). Le chiffre de l’autisme. Le nouvel Âne, 8, 16. Laurent, É. (2011-12). Les spectres de l’autisme. La Cause freudienne, 78, 56. Maleval, J-C. (2009). L’autiste, son double et ses objects. Rennes, France: Presses Universaire de Rennes. Maleval, J-C. (2011). Langue verbeuse, langue factuelle et phrases spontanéeschez l’autiste. La Cause freudienne, 78, 77-92. Miller, J. K. (2003). Women from another planet?: Our lives in the universe of autism. Bloomington, IN: Author House. Mukhopadhyay, T. R. (2000). Beyond the silence: My life, the world and autism. London, UK: National Autistic Society. Mukhopadhyay, T. R. (2003). The mind tree: An extraordinary child breaks the silence of autism. New York, NY: Arcade. Mukhopadhyay, T. R. (2008). How can I talk if my lips don’t move? Inside my autistic mind. New York, NY: Arcade. O’Neill, J. L. (1998). Through the eyes of aliens: A book about autistic people. London, UK: Jessica Kingsley Publishers. Pichot, P. (1982). The diagnosis and classification of mental disorders in French-speaking countries: Background, current views and comparison with other nomenclatures. Psychological Medicine, 12, 475-92. Robert, J-L. (2018). Ma vérité sur l’autisme. Paris, France: Dunod. Sellin, B. (1996). I don’t want to be inside me anymore: Messages from an autistic mind. New York, NY: Basic Books. Shepherd, M., Brooke, E. M., & Cooper, J. E. (1968). An experimental approach to psychiatric diagnosis. An international study. Acta Psychiatrica Scandinavica Supplementum, 201, 7-89. Tamaro, S. (2019, October 4). Greta Thunberg. Il Corriere della Sera, pp. 84-6. Tammet, D. (2006). Born on a blue day: A memoir of Asperger’s and an extraordinary mind. London, UK: Hodder and Stoughton. Tendlarz, S. E. (2011). Autistic children. Departamento de Autismo y psicosis, May 2011. Retrieved from http:// www.silviaelenatendlarz.com/index.php?file=Articulos/ Autismo/Ninos-autistas_EN.html Timini, S., Gardner, N., & McCabe, B. (2011). The myth of autism: Medicalising men’s and boys’ social and emotional competence. London, UK: Palgrave MacMillan. Valtellina, E. (2016). Tipi umani particolarmente strani. Milan, Italy: Mimesis. Williams, D. (1992). Nobody nowhere: The extraordinary autobiography of an autistic. New York, NY: Times Books. Williams, D. (1994). Somebody somewhere: Breaking free from the world of autism. New York, NY: Times Books. Wittgenstein, L. (2001). Philosophical investigations (G. E. M. Anscombe, Trans.). Oxford, UK: Blackwell. (Original work published 1953).

DISCUSSION ON AUTISM

Response to Benvenuto’s Response to Krass It is worth considering the extent to which the discourse between Benvenuto and myself parallels, or in the language of field theory, was infected by the topic at hand, that is, whether or not psychoanalysis as a field has been successful in approaching the essence of the nature of autism or, as his title bluntly states, it is a “battle lost.” The main thrust of his comments, as I read them, are that I have misunderstood a great deal of what he wrote, not on its merits, but on the fact that we do not speak the same languages: Italian vs. English, Lacanian vs. Bionian, Winnicottian, etc., psychological vs. philosophical; phenomenological vs. descriptive, American vs. Continental, “old-fashioned” vs “politically correct.” And certainly, one of the bases for my critiques of his essay was the way he used language to describe people on the autism spectrum as well as to talk about the phenomenon (or phenomena) that falls into the category that we call “autism.” This was language that I found to often be othering and overgeneralizing. In parallel, the challenge of applying psychoanalytic theories to understanding people with autism is often impeded by, to borrow Ferenczi’s (1949) phrase, a confusion of tongues. Autism is fundamentally a neurobiological phenomenon. Thus, the way that, for those with autism, mind is expressed is qualitatively different from the way mind is expressed by those whose mind has evolved by channeling through and around a typically functioning neurobiological system. The field of psychoanalysis as a theory of development, as a theory of intra- and interpersonal functioning, and as a theory of therapeutic action has, I believe it is fair to say, primarily been formulated with the typically developed and typically functioning brain as a background context. Thus the tendency to make assumptions that are incorrect because the assumptions are based upon data that follows rules developed from experience with and by people with typically functioning brains has created detours and obstacles to the field of psychoanalysis formulating theories that are applicable to people with autism. As with Benvenuto and myself where, by all appearances, many of our reference points are different, so too with the psychoanalytic clinician and the patient on the autism spectrum: the risk of making false assumptions is high and the task of finding one’s way toward a shared experience of a psychic reality difficult and precarious. In an example of the ways the same language can be understood differently, Benvenuto plays with the term “autism spectrum” to wonder if what we are really

talking about is a “specter.” He wrote, “Is not treating autism as a spectrum to admit its spectral nature?” If I understand his comment correctly (and I acknowledge that I may not), he is suggesting that I, in my response to his essay, failed to define autism and thus allowed it to function as a kind of delimited projection. However, etymologically, it strikes me that the use of the word spectrum is more useful if thought about in terms of its use as it applies to light. That is, to think of the spectrum of autism as comprised of different wavelengths, different ways that a mind vibrates outward and is thus legible to an observer. A quote from the NASA Science website on the “visibility of light” provides a metaphor that nicely articulates my own understanding of neuroatypical phenomena such as autism: All electromagnetic radiation is light, but we can see only a small portion of this radiation — the portion we call visible light. Cone-shaped cells in our eyes act as receivers tuned to the wavelengths in this narrow band of the spectrum. Other portions of the spectrum have wavelengths too large or too small and energetic for the biological limitations of our perception. (NASA Science, n.d.) In his comments on the responses to his essay, Benvenuto elaborated on his thesis that autism is an “agnosia of subjectivity,” an assertion that I take issue with. To support his idea, he refers to an evocative account of the intimate relationship Hrvoje Slovenc, tea party

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Michael KRASS

that Tito Mukhopadhyay (2008), a man with autism, has with mirrors and shadows. Benvenuto quotes Mukhopadhyay saying that he “knew the mirror heard everything” because only when he was standing in front of it could he “hear the walls and the floor talk,” adding that “the mirror understood exactly what I was trying to explain.” In contrast, he says, “my stories are not meant for human ears. Human ears cannot hear anything but sounds.” Benvenuto made thought-provoking interpretations of these comments with respect to the state of mind in autism. In particular, he suggested that the mirror played for Mukhopadhyay a role that is common in autism, serving as a double of things or signifiers that replace a subjectivity which is the blind spot of their relationship with the mind. But because we have said that subjectivity is an empty organizer of the Self and of the world, we may say that autistics are blind to this emptiness. They grasp it in the form of reflection. While I agree with Benvenuto’s interpretation, I am also inclined to hear them more at face value: that this man with autism does not expect “human ears” — that is, the neurotypical other — to hear him, to know him, to contain him, to join with him in a shared reality. He requires something that is perfectly close to his experience, where there is no room for interpretation, for misattribution, for the chasm between being known and being unknowable. And I would suggest that there is an actuality to this, that given

DISCUSSION ON AUTISM

that the autistic brain is different from the typical brain, neurotypical ears are not tuned to the wavelength of an unconscious formed around and through this differently structured nervous system. There is much that the ear of the neurotypical human often, in fact, does not hear in those with autism. And that experience can be devastating. This can be true for the patient with autism and the neurotypical therapist. It can also be true for the baby with autism and the neurotypical parent. The infant biologically inclined toward autism is likely to have difficulty recognizing when she/he is being seen, heard, and thus contained by a mothering object, when she/he is being attuned well-enough to. The autistic baby perceives the listening ear as deaf and as stupid — perhaps willfully so. One child patient on the autism spectrum had me speak for a baby doll who, in session after session, was mummified alive, had a milk bottle rammed into his mouth until he choked, was arrested and shot, or, after my patient as the baby’s big brother would get married, was forced to live in a shack and serve as the newlywed’s slave. This boy was playing out not only his current experience of being continually and perhaps purposefully misunderstood by me, but his sense of himself as having been a baby who was hated and sadistically tortured — his wrenching experience of feeling not fully known. That is, of both not perceiving when he was known by his parents as well as his parents, in all their good intentions and strenuous attempts, often not being able to fully get him. What I am continually struck by in my work with people who are on the autism spectrum is the degree to which they are often intensely and profoundly aware of their

being neurobiologically different from most other people and the extent to which this alienates them from others. Typically discussed in displacement, I consistently hear in the material of such patients references to their own brains malfunctioning, performing poorly in relation to the ways others’ brains seem to operate. One adolescent I worked with had, for much of his life, relationships with peers that were so fraught that he needed to be transferred out of several schools and had been left friendless. He spoke to me about a student to whom he was attracted because “other kids like him,” whereas, he said, “I’m just awkward, I don’t know how to interact with people. I don’t know what they’re trying to communicate to me.” When I asked about this, he said that the boy was “moist” “like a tree and the leaves are plump,” and he was “dry” like a tree whose leaves were “shriveled up.” He added that he wanted to be like the boy because “he knows something about how to not let other people tease him. I want to have that. Brain-ily, he has that.” This young man presented as entirely unaware of the subjectivities of himself and those around him, so much so that he regularly provoked hatred, cruelty, and even physical aggression from others. Yet he was acutely aware of the neurobiological deficits that made it exceedingly difficult for him to read the cues that pave the way for relatedness, to allow for the intersubjective entwining that is necessary not only to maintain relationships with others, but to facilitate psychological development. In addition, he showed that he recognized — with great pain — my neurotypicality, my ability to grease the wheels of interpersonal relatedness with my relatively stronger abilities to read others and myself.

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It is my contention that the onus is on those of us in the psychoanalytic world to expand and hone what Isakower (1963/1992) referred to as our “analytic instrument” to better detect those “wavelengths” that have not tended to be visible to us. Because our work has been developed around the unconscious as it is refracted through the prism of neurotypical brains, it can be quite difficult for us to think differently about how the unconscious can be manifested when it is organized around and through perceptual and self-regulatory systems that are fundamentally different from those with which we are familiar. Those of us who are primarily neurotypically constituted may have “limitations” detecting in those who are neurodiverse signs of empathy, awareness of one’s own or others’ subjectivity, unconscious fantasy organized around experiences of self and other. However, that does not mean that such qualities of the mind and of self do not exist or exist in smaller amounts. It only means that the way subjectivity, awareness of the other, empathy, etc. is demonstrated is difficult to see, is radiated at wavelengths that are outside of our familiar ability to perceive. In his comments on my response, Benvenuto wrote that “Autism expands our very narrow concept of humanity. We come into contact with the autistic world trying to understand its difference, trying to understand what problems the autistic people face.” Here he speaks in a language I understand and expresses an opinion with which I wholeheartedly agree. z REFERENCES Ferenczi, S. (1949). Confusion of the tongues between the adults and the child — (The language of tenderness and of passion). International Journal of Psycho-Analysis, 30, 225-230. Isakower, O. (1992). Chapter two: Preliminary thoughts on the analyzing instrument. Journal of Clinical Psychoanalysis, 1(2), 184194. (Original work published 1963) Mukhopadhyay, T. R. (2008). How can I talk if my lips don’t move? Inside my autistic mind. New York, NY: Arcade. NASA Science (n.d.). Visible light. Retrieved from https:// science.nasa.gov/ems/09_ visiblelight

COMMENTARY

“Ox Herding” and the Art of Psychoanalytic Psychotherapy Henry M. SEIDEN, Peter LIN, and William FRIED

Abstract In this paper, we consider the classical Chinese metaphor of “ox herding” as a path to Zen enlightenment. In so doing, we find a telling analogy to the path to the mature and developed practice of psychoanalytic psychotherapy. lll

In offering this meditation on an extended metaphor, we take a position which is at once in our experience universally embraced among our colleagues and at the same time — in the current clinical/professional climate — unfashionable and often all but disowned. (See, for example, recent references to the recommendation for “evidence-based psychotherapy” and the controversy it has engendered [Shedler, 2013a, 2013b, and 2017; McCay, 2017; Mazur, 2017]). Our view is that the practice of psychoanalytic psychotherapy is an art and not a science. It is, to be sure, an art supported by science, by whatever empirical regularities science may turn up.1 (We use the terms “psychotherapy” and psychoanalytic psychotherapy interchangeably. We assume practitioners of other forms of psychotherapy will have their own positions on the relationship between the art and the science of their practice.) But it is not science. Our conviction grows out of a personal immersion — as psychoanalytic practitioners continually involved in the development and the contemporary sub-culture of our shared art. Our view grows too out of ever-interesting and ever-fruitful personal collaborations and ongoing interaction among the authors (see for example Lin, and Seiden [2015a, 2015b] and Seiden and Fried [2015]). We start from the notion that working through the stages of self-mastery and self-transcendence involved in developing as a Zen adept and eventually enlightened master is also an art. The process by which this development takes place has powerful analogy with the development of any serious art (be it painting, dance, music, poetry, photography), where ultimately, in W. B. Yeats’s felicitous phrase, one cannot tell the dancer from the dance. That is, where the art and the self who practices the art become indistinguishable. We think the practice of psychoanalytic psychotherapy is such an art. 1. One becomes mindful of the important interdependence of art and science from a reading of Walter Isaacson’s recent biography of Leonardo Da Vinci (2017). Leonardo’s science, his dissections of the body, his optical studies, his engineering projects, his study of wave forms, his understanding and sketches of the dynamics of motion, his appreciation of perspectival geometry, for example, contributed in an essential way to the greatness of his art. But the greatness of that art could never be reduced to the application of scientific protocols and principles — however brilliantly observed.

The Classical Chinese Metaphor The classical Chinese “ox herding” metaphor describes the stages one must go through in Zen (or Chan, in Chinese) practice from beginning seeker to enlightenment. It is an ancient notion — an extended metaphor that first appeared in painting and poetry in Sung Dynasty (10th-12th century AD) China. Over the centuries, it has had many different and admiring expressions in both painting and poetry and in master teachers’ discourses. Traditional Chinese art typically included poetry and painting in the same scrolls. It should be noted that the animal representing enlightenment is sometimes thought of as a bull, and sometimes, in Tibetan tradition, as an elephant. The ox herding metaphor starts with an attempt to capture the first and fascinated glimmer that there is some transcendence, some Zen way of being, some profound correspondence between inner and outer life, worth making the effort to incorporate and embody. It arrives at an approximation of the achievement of enlightenment — but only ever as a close approach to the achievement. The Stages We are greatly indebted to John M. Koller (2004) for his extensive discussion of “Ox-Herding: Stages of Zen Practice” in what follows in this section. We are indebted too to Chan Master Sheng-Yen (2014), who presents and discusses the verses from Manual of Zen Buddhism by D. T. Suzuki (1934). The images found by following the link to the URL are by the 15th century Japanese Zen monk Tenshō Shūbun. Shūbun’s images are said to be copies of originals, now lost, attributed to the 12th century Chinese Chan Master Kuoan Shiyuan, author of the original verses for the Ten Ox Herding Pictures.2 lll

The overriding understanding of the extended metaphor is that the ox represents enlightenment (or the realization of the true nature of the mind in Buddhist belief ). The stages of the search for enlightenment may be outlined briefly and in thumbnail as follows (we offer these in Koller’s Western terms): 1. The search for the ox. The image and the poem show the oxherd desperately 2. See http://chancenter.org/cmc/wp-content/uploads/2014/04/BookSummer2014web.pdf Also, Alan Watts would be among the commentators likely to be familiar to Western readers. He included a description of the Ten Bulls in The Spirit of Zen (1936). For an extensive list of images, commentaries, and references, see Wikipedia: https://en.wikipedia.org/wiki/Ten_Bulls#cite_note-12 36

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looking everywhere for his lost ox. He is seeking something he experiences in some way but as having been lost. 2. Discovering the footprints. The oxherd has now caught sight of the tracks of the ox. He is excited about the possibility of finding his ox but doesn’t know yet how to find it. 3. Perceiving the ox. He has caught sight of the ox. He glimpses a hidden power (over his perplexity, his distress, his “vexations,” perhaps his curiosity, the distant possibility of mastery), but does not know how to apply it. 4. Catching the ox. The central image is that the herder has now caught hold of the ox using the bridle of discipline (and training and study) to control it. 5. Taming the ox. The fifth image shows that disciplined practice can overcome bad habits of mind of previous conditioning and bring him more into accord with the “true” nature of reality. 6. Riding the ox home. The sixth image suggests the tranquility and satisfaction that reunion with “source of existence” brings. The oxherd rides on the ox and plays his flute. He can express his own creativity, play with his own creative process. 7. The ox transcended. In the seventh image, the oxherd realizes that the ox itself can be forgotten! The path to enlightenment is now about the transcendence in the experience of everyday things. 8. Both ox and self transcended. The eighth image suggests that when the duality of self and reality has been overcome, both disappear! The experience will be of awareness of ongoing transformation and interconnectedness — probably best described as the moment of startling, even shattering, insight. 9. Reaching the source. The ninth image: Self and reality — as constructs — are left behind. Things in the world are revealed to be just what they are. The ultimate is to be found in the ordinary. 10. In the world. The enlightened oxherd does all the ordinary things, but because of his deep awareness, everything he does is at the same time extraordinary. He shares his enlightened experience with those around him, who benefit greatly from his compassionate presence.

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The Practice of Psychotherapy as an Art In what follows here, we will consider the process analogous to the ox herding metaphor by which we think psychotherapists become “enlightened” in the practice of their art. We offer this with humility, in full recognition that analogy is not algorithm. There is no single protocol to follow and, certainly, there are no career steps to follow (as once was argued for in the early institutionalized development of our art). There are a handful of recommendations, institutes with prescribed curricula, but no longer is there an unalterable learning prescription. There are no carefully defined stages to enter into and pass through. Some therapists in learning their art will move along quickly in their grasp of and integration of their learning, and will take some real joy in their studies and training (sometimes more “rigorous,” sometimes more casual). And they will take pleasure in the sense of accomplishment. The accomplishment, to say it again, is of making their art and themselves a kind of one: a way of being themselves both in the consulting room and in their lives. We recognize the arrival at the late stages is arguably a kind of unreachable and illusive perfection.

A further caveat: the classical descriptions of the ox herding stages omit mention of the mentoring relationship and relationships which over millennia made for the cultural transmission of Zen Buddhism. Zen students sat at the feet of their teachers through successive generations. These relationships have been and continue to be crucial to that learning — as we know, they are crucial to learning the art of psychotherapy. (For example, see Magid [2013], who very carefully acknowledges the transmission of his own Zen practice through successive generations of teachers dating back to the 13th century.) And more: our art, of course, is not a solitary pursuit, not that of a painter alone with canvas and brush. It is interactive. At its essence, it involves an embrace (hopefully artful) of the intricate, complex psychology of other people. And it involves an inevitable impossibility: that of knowing any other person, including our patients, in all their fullness. Ours is an art that cannot be perfected. As to the matter of perfection, that is, the possibility of perfection in our own art or in any other, it is worth noting that Leonardo himself never thought he got there in his own art — the perfect always eluded him. The evidence is that he walked away or put aside his projects dissatisfied

Allen Frame, Mississippi

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and with the conviction that they might have been better. The Ox Herding Metaphor in Becoming a Psychoanalytic Psychotherapist In reflecting, each of us, on our own developmental processes, we take the sequence of ox herding images as informing the discussion — but not as discrete steps. More, we think of the images as glimpses of awareness and clarity. In the experience of learning to be a psychotherapist, one doesn’t pass a “stage” never to go back. There’s a kind of rhythm and recurrence of sensibility: a moving forwards, then a moving back, then a moving forward more permanently. The first glimpse: a perplexing (and useful) curiosity. An intuitive sense that there is more to life (both in oneself and outside of it) than meets the eye. A sense that others too are in need of a similar contact and embrace. The sense of a motive in one’s self to move in that direction. The second awareness: a sense that making some sense of one’s own experience and of that of other people is welcome to both parties and stabilizing. A respectful

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glimpse of the unconscious, like a sight of the ox’s footprint! The third glimpse: there is a world of such heretofore hidden experience and a language (even if clumsily spoken) for engaging. A sight of the ox — in a teacher, a book, a conversation with someone who already speaks the language of larger consciousness. The fourth “accomplishment”: a grasp (by work, study, reading, one’s own analysis, clinical practicum supervision, and the like) of the language of psychodynamic psychotherapy and the conceptual basis for that language. Some developing sense of the treatment algorithm and the importance of unconscious processes. The ox is caught by the bridle! The fifth experience: the beginnings of an integration, a more comfortable grasp of what psychotherapy is and what it isn’t, the capacity to think and behave (speak) out of a sense of method that is becoming one’s own. A useful awareness of unconscious motivation. The sixth image: an increasing capacity to exercise creativity and individuality in one’s performance of one’s role, integration of a more personal style and way of working, a mindful expression of one’s own personality and experience. A deeper grasp of relevant theory. An easy integration of the awareness of unconscious motivation. Satisfaction in the work. The seventh image: a kind of disappearance in which theory recedes into the background of the work, along with a sense of responses coming from within the therapist and within the context of the relationship. Absence of a need to trace to a source or justify things being said and done. The eighth image: an immediate experience of insight and of insight shared. A sense of boundary-less wholeness, of being in the “now.” Sometimes thought of as being at once familiar and startlingly surprising. A rare and precious achievement — recurring from time to time. The ninth image and the tenth: an increasing sense of presence in which the extraordinary seems ordinary. Probably to be seen only in master therapists of advanced age. The difference between the dancer and the dance disappears. Inner and outer realities are less and less different in a way that feels freeing, useful, and compassionate. Commentary from the Authors — Our Individual Paths In regard to the commentary that follows:

One of us, Lin, is a practitioner and meditation teacher of Chan (the Chinese equivalent of Zen) Buddhism; Seiden and Fried are lifetime practitioners, teachers, and students of Western psychoanalytic psychotherapy who took different paths in getting to their current level of practice. Seiden’s Comment Once I was working with an overly exuberant eight-year-old; we were sitting on the floor of my office playing cards. He showed me a card trick. I said, “Wow, how’d you learn that?!” He said, “Aw, I was born knowing it!” Important to say: that wasn’t the way anything was for me! I know I was born knowing nothing. But I started to learn early. I can recount some landmark experiences in the course of my growing up — and growing into in my current level of practice of the art of psychotherapy. (To be clear: I make no claim of mastery, only of growing up!) These experiences correspond roughly to the stages outlined in the ox herding images — although I can’t draw exact one-toone comparisons. My first glimmer of the ox had to do with my role in my family: my parents, my younger sister, and especially with my two grandmothers, one of whom lived with us, the other just down the block in our West Bronx neighborhood. All of them — and especially my grandmothers — talked to me when they didn’t talk to each other! They shared feelings and anxieties. They expressed, usually inadvertently, their barely disguised ambivalence about each other. This with a ten-year old kid! I listened, I nodded. However much I didn’t understand, I got enough of it to know that my listening (to what was said and to what wasn’t) and my caring mattered. Of course, my own perplexities were part of it; their complicated feelings about each other upset my world; their anxiety made me anxious. Still, they loved me and I loved them. I learned early that my presence and attention made a difference — to them and to me. Can I say there was an ox somewhere? By ox, I mean a role in life as a somehow healing or salving (or possibly consoling is a better word) psychotherapist. I couldn’t have named the ox; I didn’t even know the term “psychotherapist.” That experience of making a difference, but always in a puzzled way, characterizes my entire early career. Starting with early generic social work, the street gang work I did between graduate schools, I found that saying back what I was hearing seemed to touch my interlocutors in a startling way. The street gang kids, a tough, delinquent, and largely lost bunch of young teenagers, seemed to respond to even a brief moment 38

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of understanding. And they appreciated it even when they were giving me a hard time — which I only later understood to be transferential. I was reading Carl Rogers then, his work on client-centered psychotherapy, and especially On Becoming a Person (1961). I had only a vague psychoanalytic notion of what transference might involve. I remember early feedback from patients at the hospital in Brooklyn where I interned and began to learn to be a clinical psychologist, and similar feedback later in my beginning private practice. I’d be told by a patient about something helpful I had said — and found that what I had said was a surprise to me. And that often I hadn’t paid much attention to that particular remark. I remember a woman who said, gratefully: “I’ll never forget what you said — that there was no reason I couldn’t have a family too.” Generally, I thought my job was to be as “deep,” as theoretically sound, as psychoanalytic as possible. I found that plain and real counted for far more. I was beginning to grasp the ox; not quite yet riding it, but beginning to get a grip. This was true too in my own indispensably useful personal psychoanalysis. It was the ordinary truths I needed to hear from my analyst (my competitiveness, my anger, my ambition, and at the same time my despair at the possibility of accomplishment). And to hear myself hear. Not the fancy stuff. I can say I felt myself getting better at the art of treatment, almost in proportion to the mistakes-in-life I was making. Which luckily (or it was karmic) I found a way to recover from: like achievement troubles in college and graduate school, where I was always reaching, grandiosely, for too much and then not delivering — to the annoyance and frustration of my teachers, who were often quick to punish me. I settled down after getting my PhD. I was building a practice; I was beginning to ride the ox. I was coming home tired at the end of a long productive day with patients’ checks in my pocket. Riding high! I think an important turning point in my practice was when I could begin to make better and less self-conscious use of my own experience and associations. (I was reading the relational analysts who supported a mindful sharing — one a little freer from the worry about violations of neutrality and countertransference contaminations.) I could get more creative, make better use of my own intelligence and artfulness (for want of a better word). I could refer in session to books, to poetry I’d read, to experiences I had had. Probably this corresponds to the sixth image: a creative playfulness in the work. I should add, this turn was also reflected in the poetry I was writing. While I had been writing poetry most

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of my adult life, now I found that I was writing poems that were, to my welcome surprise, actually getting published — that is, that had meaning and resonance for other people. Somewhere in this process, both in my teaching and in my practice — and in my poetry — I found myself saying things I didn’t know I knew! And when I heard them, I thought if I had been the one listening, I would have learned something! I think this is as close as I come to the seventh ox herding image: a kind of transcendence in which what is spoken is not derived but emerges — somehow, out of what feels like the ground of one’s sensibility — or shared sensibility.

walking through what is called in Chan tradition “the gateless barrier.” To start with my initial awareness: my interest in clinical psychology started early — during my years as a Taiwanese teenager growing up in Flushing, New York, where I encountered a book (written in Chinese), Comfort arrives when your mind is clear 清心與自在: 佛法的心理學分析, written by Cheng (1985), a Taiwanese psychologist who investigated the relationship between Buddhism and Western psychotherapy. That book kindled my interest in learning more about both Buddhism and Western psychology — and especially about the com-

In college, I signed up for and was trained as a peer advisor. We had weekly supervision with clinical psychologists on our work with students in the counseling office. I was fortunate to take several courses on counseling skills and had a chance to supervise the junior peer advisors by listening to their actual interview tapes and conducting role play with them. The clients we served were students who had issues with campus life such as problems with registration. However, we were trained to recognize that the initial problems are not always the real problem. I still remember very well my first case. This was a girl who had difficulty in

mon ground shared by Eastern and Western wisdom traditions. As an immigrant, I often searched for commonality between two cultures, a search that was part of my own acculturation process. This interest would reflect the first ox herding image. My interest in psychotherapy and Buddhism continued through high school to college. In high school, I was a fine arts major. Arts were viewed as an expression and path towards one’s inner world. There was an intuitive feeling that art, Buddhism, and Western psychology all have something in common.

selecting her major, but eventually we had a long conversation about her Lyme disease and how she viewed herself as a victim of the world. Thinking of herself as a victim was her problem. This initial contact with a therapy experience would reflect the second image — seeing the hoof print of the ox. Fortunately, I was able to continue my interest in graduate school. As a graduate student, I was bombarded with different styles of psychotherapy. There were always questions: “How can I be a good therapist?” and “Which is the best style of therapy?”

Peter Baker

Do I reach the level of the eighth image? Probably not. But maybe close at those rare moments when an insight seems to wipe away everything but the insight itself. I have had those — briefly. Usually about distressing and painful concerns that have been plaguing me. Do I offer the opportunity to have such insights to my patients? I certainly hope so. Lin’s Comment My view: the path of becoming a psychotherapist is a Chan path, a path of

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Who should I be? A little Freud, a little Ellis? or a little Rogers? In graduate school, I think I worked extra hard compared to my classmates; I would work at least two or even three externships at the same time. My primary recreational activity was visiting Barnes & Noble to read about psychotherapy. The books that usually drew my attention were books for beginning psychologists, such as Yalom’s The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients (2003). Part of the challenge was that I also had many different clinical supervisors and they were all very comfortable with their own clinical orientations — be it cognitive behavioral, psychodynamic, or some other approach. It was somewhat confusing

be said to be the ones who “got it.” Similarly, with respect to the current state of clinical psychology, psychotherapy researchers and practicing clinicians may have very different ideas about what healing actually entails. For example, I had a behavioral supervisor who was a good clinician. In my training, I had shadowed his therapy sessions, sitting right next to him very frequently. The surprising part was that I did not get to observe his “manualized behavioral techniques” much. Most of the time, he was creating a healing relationship and helping his patients to see their blind spots. I still remember what he told me: “the student I wish to work with (he meant me) is a person who is familiar with behavioral techniques but has a strong psychodynamic understanding of a person.”

I had one supervisor who was an expert in Interpersonal Psychotherapy. Another supervisor was a close disciple of Lazarus. In addition, I had several supervisors who were either trained by Beck or psychoanalytically trained. Furthermore, I was fortunate to attend a weekly workshop provided by Otto Kernberg and dyadic workshops led by Jeffrey Young. However, I have reconnected with my current supervisor, Henry Seiden, because I could see that he “got it.” Seiden was my first clinical supervisor. When I first met him, I was not well informed enough to understand his clinical skills. Many years later, after I graduated from my doctoral program, we reconnected because I started to recognize what I needed in order to have good training.

During my graduate school years, my therapy skills were not developed, yet my motivation to be a good therapist was strong, and my career path as a clinician was established. This would reflect the third image: perceiving the ox. As I continued on my career path, I started to develop the ability to distinguish the strengths and weaknesses of each orientation. Given the exposure I had to different well-established clinicians, I also developed a better idea of what a good supervisor should be. For example, during my fellowship years,

One main developmental achievement in working with Seiden, and one that he has encouraged, has been the emphasis on the integration of my original interest in Chan with a psychodynamic approach. My need to be a “Little Freud” has been replaced with a sense of being comfortable with who I am as a therapist. The ox is caught. There is still a lot of room for improvement in terms of my clinical skills. However, I have a clear sense of what can work — for me — in creating my own style. The burden of “I have to

Tim Maul

to figure out what psychotherapy is when there were different opinions. I also noticed that some supervisors were better than others, despite their orientations. It seemed as if some “got it” and some “didn’t.” Chan (the predecessor of the Zen tradition) started as a response to scholastic Buddhism in the early 5th century. Influential clerics and elites were more interested in clarifying and classifying the teachings than in experiencing the practice (Guo Gu, 2012). Those who started the Chan approach could

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be a good therapist” is less. Personally, I am currently in this stage. My Chan practice has helped me to explore the common ground between different healing arts. As an immigrant who came to this country alone at a young age, I am familiar with what it is to be a person who has one foot in two worlds; not just one foot in two different cultures, but also one foot in multiple therapeutic traditions. In over ten years of private practice, I am grateful to have worked with clients who either had many years of analysis or many years of Chan practice before they came to me. They helped me to become more aware of the strengths and weaknesses of each tradition. These patients also helped me to be a therapist who can integrate the best from both traditions. Knowing the path is still different from walking the path. Part of my future is to continue learning and sharpening my clinical technique. This will come with time, clinical experience, and good supervision. Ideally, my Chan training will integrate with my clinical skills more seamlessly. When one has excellent clinical skills, the ox is tamed. Riding the ox home is the professional ideal. This is where one is transformed from a technician to an artist. In this stage, the clinician has developed his own personal style and is respected by professional peers. Models, for me, of practitioners who have ridden the ox home would be Irving Yalom or Stephen Mitchell. Although I am not there yet, I do have a sense that my personal style will be the style of Chan psychoanalysis. It is rare to have an analyst who is trained in both psychoanalysis and in Chan. Riding the ox home for me would be to be a therapist who is respected in both Buddhist and psychodynamic communities. Becoming a great artist is an achievement that most of us may not reach in this lifetime. However, there is still room to grow and transcend. If the therapist can reflect and realize that this career path is also a spiritual path, it will be taking one step further. At this stage, the therapist is no longer concerned about “being a great therapist.” Being a therapist has become a tool for personal and spiritual exploration. In other words, the ox can be transcended. Personally, at times I feel that practicing as a therapist has helped me to explore different aspects of my self, which also strengthens my personal Chan practice. This is where self-actualization begins — as Jung described. The hallmark of this process is where the difference between “the dancer and the dance” dissolves. Dancer and the dance become one. The career path and spiritual path become one. The eighth ox herding image represents enlightenment in the Chan tradition. Often,

enlightenment happens in daily life when the mind is unified, where the unification or transcendence experience in the previous stage has been shattered. I think of the folk tale of the ugly duckling as an example. In stage 7, the dancing ugly duckling has become one with her dance. In enlightenment, the ugly duckling has a powerful insight in realizing that she is not the ugly duckling. This is an experience that is beyond words and description. In Chan, this is the realization that our usual self-referential way (or dualistic way) of seeing the world can be dropped. In therapy sessions, the concepts and boundaries of therapist, client, and psychotherapy are all dissolved. This may be difficult to understand for readers. However, it is precisely the difficulty of understanding this state of mind that makes the awakening experience indescribable. Important to note, in the Chan tradition, the initial enlightenment experience becomes the second or third experience again. You see the “hoof print” or the ox (again) for the very first time. The sequence of ten images is a reminder that the quest for enlightenment never ends.3 There is a common saying in Chan: “[A]t first, we see the mountains as mountains, then the mountains are not seen as mountains. Finally, we see mountains as mountains.” Returning to the source describes this process. The world and reality are still the same, but we do not interact with them from a self-referential perspective. As one master said, “after the ecstasy, there is still laundry” (Kornfield, 2001). Finally, in Chan perspective, a major purpose of the spiritual path is to benefit others around you. The function of insight is empathy and kindness towards oneself and others. What’s the use of enlightenment if it only benefits oneself? The final picture, Entering the City with Bliss-Bestowing Hands, represents the ideal of my spirituality. My Chan teacher, Master Sheng-Yen (2001), warns that the correct way of using the ox-herding pictures is not to wait until stage 10 to help others. That would be a selfish path. We use these images as an ideal that guides our behaviors and actions. Even though I am not enlightened, I still can move towards and adopt this ideal in my life. In other words, I can strive to be a good psychotherapist not just with my couch, but as a person who can help others outside of my office. As an example, I regularly participate in disaster relief as a photojournalist, which I regard as an art. The eighth ox herding image represents enlightenment or awakening [satori, in Japanese] in the Zen tradition. Zen 3. The Zen tradition may have–and seems — sometimes to lean towards the formulation and presentation of discrete stages. This is likely in part heuristic: a way of teaching students, of helping them then pass the learning along (see Lin and Seiden, 2015a, 2015b). 41

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practitioners have expressed this experience in a variety of art forms. Often, enlightenment is said to happen in daily life when the mind is unified, where the unification or transcendence experience in the previous stage has been shattered. In the state of unification, the mind is vast, clear and receptive. At this moment, anything can potentially serve as medium for awakening, such as the sound of the bell, the hand gesture of the master, or a shooting star in the sky (as in Siddhartha’s case). Basho, the well-known haiku poet and Zen adept, is thought to have expressed his awakening through his poems. His famous frog haiku not only represented the highest art form, but also described an experience of awakening. The old pond! A frog jumps in, The sound of the water! The 17th century Zen monk Sengai expressed his version of the frog haiku (Bobrow, 2010) The old pond! Basho jumps in, The sound of the water! (p.15) As a volunteer, I have witnessed many sufferings in many places in this world. I have found that one helpful thing for the survivors is demonstrating your understanding. I remember one time I had a conversation with a woman who worried about her daughter’s behavior after an earthquake in Ecuador. Originally, her main worry was that she did not have help with calming and soothing her child. Eventually we both learned that she had been spoiling her daughter — and that the source of her anxiety was her own abusive childhood. As a therapist, we can bring the “ah-ha” moment to people in or outside of our office. There is no need to see one’s self only as a “therapist.” There is only simply the act of helping, as the right hand naturally helps the left hand. Fried’s Comment Unlike Henry Seiden and Peter Lin, my path to any mastery or enlightenment has been through immersion in what one might call “the destructive element.” My self-involvement took me to some places a psychoanalyst should not find himself, and almost left me there. Some better angel of my nature eventually reached me with a rescuing hand. Today, I feel I am helpful to almost every person I see, in every session. It took me a long time and much travail to be able to do that. When I was younger, I wanted to be a bullfighter! Quite literally. I spent some

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serious time in my late adolescence training to be a torero on a ranch in Mexico, pursuing an adolescent dream. To say the least, I was not successful. To return to the metaphor: my ox gored me repeatedly because I was trying to kill him. About a year ago, a patient I’d been seeing told me, at the start of a session, that it would be his last. I was not surprised: he’d been negotiating a steep gradient of withdrawal for several weeks. He asked me what one does in a final session. I replied that there is no formula, that he might do whatever he wished. He said, “I think I’ll lie on the couch and see what comes to mind.” After a few supine seconds, he began to ask me personal questions. I asked what the answers might do for him. “I think they would help me to remember you better,” he said. As the end of the session approached, he asked whether he might tell me a midrash (in the Jewish tradition, a tale with a moral). I encouraged him to tell it. He proceeded. “A rabbi and his wife had just finished having a very satisfying intercourse on a Friday night, and were enjoying their post-coital languor, when suddenly they heard a noise that seemed to be coming from under the bed. The rabbi stooped to investigate and was astonished to see his student, Moishe, concealed there. ‘Moishe!’ he exclaimed, ‘What are you doing here?’ ‘Rabbi, I hope you will forgive me, but I know nothing about sex and, since you are my teacher, I assumed I could learn from you.’” Here, the patient paused. The time was almost up. I said, “There are two salient aspects of the midrash that I’d like merely to mention before we stop. First, I think that Moishe probably felt more comfortable under the rabbi’s bed than under his parents’. Second, I regard it as very significant that the student’s name was Moishe, the namesake of Moses who led the Israelites to the Exodus, because the Lord did not vouchsafe that Moses to enter the Promised Land, but only to view it from a distance.” Thereupon, the patient rose from the couch, smiled ruefully, shook my hand, and left without another word. Approximately a year later, I received a call from him. He asked whether we might meet for one session so that he could bring me up-to-date on his life. I agreed. We were pleased to see each other on the appointed day. He shared as much as he could within the limits of a single session. Again, he asked me a number of personal questions. Among them, the most relevant in the current context was “What have you found to be indispensable to helping people grow, in your practice as a therapist/analyst?” With scarcely any hesitation, I replied, “The experience of being understood.”

The account of this session is a link to the divergence of my development as a practitioner from those of Henry Seiden and Peter Lin. I think it took me much longer to divest myself of myself than it took them, partly because they became far more serious about their calling a lot earlier than I did, a calling which, like the first image of the ox herding sequence, I knew was there but hadn’t really yet seen. My fallacious assumption was that a psychological healer must be charismatic. By that, I mean that he or she must be so persuasive, verbally, in demeanor, movement, gesture, and style, as to override all resistance to change. Such a belief results in the reduction of patients to the status of minor characters in the illustrious narrative of the practitioner’s career. For many years, I struggled against the conviction that what I had to say was so smart, so beautifully phrased, so much ap-

in psychoanalysis. The only explanation I have for this is that the conjunction of my glibness and their eagerness for my success blinded them to what I was doing in the consulting room. Perhaps this corresponds to the fourth image: catching the ox, looking like a psychoanalyst, but not having any true appreciation of the art. What I was doing bore a greater resemblance to bullfighting than to ox herding! The descriptors of the charisma to which I aspired: “persuasive in demeanor, movement, gesture, style,” are appropriate to a man in a suit of lights, controlling the charge of a wild animal by means of a cloth that he brandishes with consummate grace, as a prelude to killing it with a sword thrust. I could imagine each patient’s id as the beast, a locus of violent, powerful impulses that my charisma would control, and my rapier-like interpretations, dispatch.

Bill Beckley, The Savior

ropos, and so profound, that to withhold it from the patient would have been a shame. Gradually, and almost imperceptibly, some element of my mind became free to discern how fraught these inclinations were with the need to be admired. Each session conflated my needs and those of the patient. Had I allowed it, I’d have thought, “If I had to prevent myself from acting this way, I’d be nullifying my primary reason for becoming a therapist.” This was a glimpse of the second and perhaps of the third image: the footprint, the tail; no grasping of the ox yet. Most remarkable is that many patients tolerated and even accepted my performance. Even more astonishing was that I almost always received praise and approval from my supervisors, both at the graduate level and in the institute where I was trained 42

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My first attempts to control the ravening beast within me that would accept nothing less than total capitulation to its will, were mechanical. I should say I did see some slight virtue in paying attention to my patients, if only as a concession to commonplaces of our profession. It was useful to listen long enough and closely enough to acquire material for my interpretations. Here, again, is an analogy with bullfighting. Before stepping into the ring himself, the matador spends a few seconds observing how the bull behaves when pursuing one of his assistants. In this tiny interval, the most expert bullfighter can learn everything he needs to know to create a virtuosic performance with the bull. And my goal, it must be said, was nothing less than a virtuosic performance.

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The gorings I suffered by conducting myself in this way consisted of patients’ terminating their treatment with me. But this didn’t happen frequently enough, or with sufficient shock, to stir much more than myriad ingenious rationalizations of my failures. The great majority of my patients remained with me for years and sometimes decades before deciding to end their therapy in a manner that most often appeared to me inconclusive, though they might, if asked, have thought otherwise. Perhaps the dissonance between the time and effort they’d expended and an indifferent outcome led them to ascribe greater value to their experience with me than it deserved. But, in saying this, we enter the labyrinthine space of reciprocal perception, projection, and introjection that renders all such judgments as I am here attempting at least problematic, and at most, impossible. It suffices that I am able to estimate the degree to which my ability to listen, to attend closely and for uninterrupted intervals to what my patients were conveying, was probably not sufficient to contribute to their growth with any consistency. An activity that proved useful to my gradual transition from bullfighter to ox herder was taking notes at the end of each session. Doing so, I began to see with increasing clarity the parts of the session where my attention had become diverted from the patient’s communication to my own inner promptings. To remember something, you must first perceive it. Variable perception contributes to unreliable remembering. Trying to reproduce a recent experience in as much detail and as faithfully as possible may, if one is conscientious enough, reveal how much one has missed. I was often appalled at the gaps in my recall. I think I was beginning to “tame” the ox — as in the fifth image. Taking these notes inevitably led me to think about the experiences I’d had with supervisors in graduate school, the institute where I trained as an analyst, and my years in a study group with a Kleinian analyst. In effect, I was comparing my self-supervision with that which I’d gotten institutionally and semi-institutionally. I asked myself how I’d managed to emerge from countless hours of tutelage, mentoring, mirroring, teaching, brow beating, hectoring, shaming, indoctrination, praise, admiration, indifference, and neglect relatively unscathed and uninfluenced, yet stamped with so many official and personal seals of approval. Could it be that no one cared enough to confront me with my deficiencies, or maybe that they felt it would be fruitless to try to take me beyond my inherent limits as a clinician and person? In a somewhat different context (Fried, 2010), I wrote,

when the training of an analytic candidate is over, regardless of its specific methods and contents, there will remain a residue of beliefs about the analytic enterprise that has survived, unanalyzed, unsupervised and therefore unchallenged. This residue has been held in abeyance until it can be tested or merely implemented in the privacy of the analyst’s newly-earned right to conduct his or her work unobserved. Should the operations to which the beliefs give rise, deviate sufficiently from received or traditional procedures, the practitioner may find it necessary to support them with an infrastructure of innovative theory. . . . This sequence is similar in some ways to the deliberate misreading of their literary forebears by poets struggling to assert their own originality that the critic Harold Bloom (1973, 1997) has called “the anxiety of influence”. . . . I am suggesting that theoretical and technical innovations in psychoanalysis are often impelled by unconscious ambitions, a striving for originality or some combination of the two. Such a proposition would lend weight to the argument that the practice of psychoanalysis lies closer to art than to science. Not surprisingly, I wrote papers about the effects of flagging attention in psychoanalysis, and the strategies practitioners of various persuasions use to cope with it. Generalizing from my personal experience, I became convinced that attending, failing to attend, remembering, and failing to remember, were the keys to therapeutic work. Perhaps this corresponds to moving from the fifth image, starting to get things right, and approaching the sixth: riding the ox home? These deliberations were necessary, but not sufficient. It may be that I’d rediscovered something that many of my less self-involved colleagues had known from their professional and personal beginnings (and that adherents of Zen and other strains of Buddhism have known for eons). The component that remained and remains elusive, however, was and is the one contained in my answer to the patient who returned to me for one session. I believe that the single indispensable element of therapeutic work, regardless of the practitioner’s theory or orientation, is sustained attention, and that this can only be achieved by a suspension of the operations ordinarily used to leverage the self. This condition fulfilled, the patient will have an opportunity to feel known, comprehended, understood, and, in turn, held in the mind of another, a place of acceptance and safety where growth may be possible. I think this is the highest form of our therapeutic art. As to the fusion of dancer and dance, I can only report that I feel it ever more 43

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frequently as a therapist and psychoanalyst, but almost always when I am composing photographs through the view finder of my camera. At those times, I cannot tell the camera from my eye, and I become oblivious to myself. Conclusion In this paper, we have examined an extended metaphor, now a thousand years old, but successively re-imagined and appreciated, drawn from a classical Chinese formulation and presented in images and poems and in master teachers’ discourses. This, the “ox herding” metaphor, considers and outlines the stages involved in accomplishing Zen enlightenment. We take the metaphor in a non-religious sense to outline the stages involved in the mastery of any art. In Zen, this is the art of enlightenment. (We are well aware that for Zen practitioners such enlightenment is more than an art, indeed a personal transformation, and we mean no disrespect to that point of view.) Our interest in the ox herding metaphor is that it appears to be a powerful analogy for the accomplishment of mastery in other arts. We take the practice of psychoanalytic psychotherapy to be one such art. Some things the analogy brings out with respect to the practice of the art of psychoanalytic psychotherapy: Notably, arriving at a capacity to understand their experience and communicate that understanding to our patients is the epitome of our art. We hope that the authors’ personal reports included here support and illustrate that and the following conclusions: 1. The process of arriving at mastery is a developmental struggle. 2. A dedication to continuing the struggle throughout a lifetime of practice is essential. 3. An expertise with respect to common learning is the beginning, but doesn’t map the entire experience or achievement. 4. The process is a matter of the development of personhood. It is not simply the learning of a body of common knowledge. Although learning that common knowledge (including the underlying scientific knowledge, and, for psychoanalytic psychotherapists, psychoanalytic thought beginning with Freud) is a necessary condition, it is not sufficient to describe the full accomplishment. 5. The developmental struggle involves much work, much disappointment, and moments of failure and of re-dedication.

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6. The moments of progress are largely unpredictable. Courses can be passed on time; certificates awarded; but essential progress, because it is a developmental achievement, may be uneven and may occur in surprising ways and at surprising times. 7. Often these moments follow on or are part of striking and disillusioning, even humiliating, setbacks. 8. The art of psychotherapy, like any, involves the development of a unique creativity. One artist is never just like another, even if of the same “school” — that is, sharing the same precepts and assumptions. (Anyone seriously considering making a referral knows how much thought goes into considering the individuality of the person being referred to.) 9. Talent is an inescapable element of the practice of any art. Not less so in this one. There is no such thing as a journeyman practitioner. There is no value to craft without art. 10. Finally, the mastery arrived at is located within the practitioner. This conclusion cannot be overstated. In its highest form (which, again, the authors hasten to say they aspire to — but make no claim to having

achieved), art transcends technique. Surely it borrows on technique and on a shared learning tradition (of which psychological science as well as psychoanalytic thought are components), but it is more than that. It is the personal mastery of the practitioner. In the Zen tradition, the highest artistic performance goes well beyond technique. It is seen as an expression of spirituality, enlightenment, or transcendence. Some examples: the Zen garden is an accomplished expression of awakening as well as an environment to induce awakening. In the martial arts (another Zen practice), a great teacher said, “There is no best martial art, there is only best martial artist.” z REFERENCES Bobrow, J. (2010). Zen and psychotherapy: Partners in liberation. New York, NY: W. W. Norton & Company. Bloom, H. (1973, 1997). The anxiety of influence: A theory of poetry. New York, NY: Oxford University Press. Cheng, S. Y. (1985). Comfort arrives when your mind is clear (清心與自在: 佛法的心理學分析). Taipei, Taiwan: Yuan-Liou Publishing Co. Fried, W. (2010). Transference as a device for facilitating attention. Psychoanalytic Review, 97(3), 483-493. Guo Gu. (2012). The essence of Chan: A practical guide to life and practice according to the teachings of Bodhidharma. Boulder, CO: Shambhala Publications. Isaacson, W. (2017). Leonardo Da Vinci. New York, NY: Simon & Shuster. Koller, J. M. (2004). Ox-herding: Stages of Zen practice. In Expanding East Asian Studies (ExEAS), Teaching Material and Resources, Columbia University. Retrieved from http://www.columbia.edu/cu/weai/exeas/resources/ pdf/oxherding.pdf.

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Kornfield, J. (2001). After the ecstasy, the laundry: How the heart grows wise on the spiritual path. New York, NY: Bantam. Lin, P., & Seiden, H. M. (2015a). Mindfulness and psychoanalytic psychotherapy: A clinical convergence. Psychoanalytic Psychotherapy, 32(2), 321–333. Lin, P., & Seiden, H. M. (2015b). Parallel algorithms in Zen and psychoanalytic psychotherapy. Journal of American Psychoanalytic Association, 63(4), NP5-NP10. Magid, B. (2013). Nothing is hidden: The psychology of Zen koans. Somerville, MA: Wisdom Publications. McCay, D. (2017, November 28). Clinical practice guidelines [Blog post]. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/your-fearsand-anxieties/201711/clinical-practice-guidelines Mazur, B. (2017). Brutalist medicine: A reflection on the architecture of healthcare. BMJ, 359, j5676. Rogers, C. (1961). On becoming a person. New York, NY: Houghton Mifflin. Seiden, H. M., & Fried, K. W. (2015). W. B. Yeats: “Where love has pitched his mansion….” DIVISION/ Review, 13, 50-51. Shedler, J. (2013a). Recognition of psychotherapy effectiveness. Psychotherapy, 50, 102-109. Shedler, J. (2013b, October 31). Bamboozled by bad science: The first myth about “evidence-based” therapy [Blog post]. Retrieved from http://www.psychologytoday. com/blog/psychologically-minded/201310/ bamboozled-bad-science Shedler, J. (2017, November 19). Selling bad therapy to trauma victims [Blog post]. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/ psychologically-minded/201711/selling-bad-therapytrauma-victims Sheng-Yen. (2014). Enlightenment and the ten ox herding pictures. Chan Magazine, 34(3), 4-16. Sheng-Yen & Stevenson, D. (2001). Hoofprint of the ox. New York, NY: Oxford University Press. Suzuki, D. T. (1934). Manual of Zen Buddhism. Reprinted by Amazon Digital Services, 2001. Watts, A. (1936). The spirit of Zen: A way of life, work and art in the Far East. New York, NY: E. P. Dutton. Yalom, I. (2003). The gift of therapy: An open letter to a new generation of therapists and their patients. New York, NY: Harper Perennial.

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NOTES ON CONTRIBUTORS

Sergio Benvenuto is a researcher in psychology and philosophy at the National Research Council (CNR) in Rome, Italy, and a psychoanalyst, president of ISAP (Institute for Advanced Studies in Psychoanalysis). He is a contributor to cultural journals such as Telos, Lettre Internationale (French, Spanish, Hungarian, Rumanian, German and Italian editions), Texte, RISS, Journal for Lacanian Studies, L’évolution psychiatrique. He has translated into Italian Jacques Lacan’s Séminaire XX:Encore.). J. Todd Dean is a psychiatrist and psychoanalyst in St. Louis, MO, and a founding member of the St. Louis Lacan Study Group. Morris Eagle is professor emeritus, Derner Institute of Advanced Psychological Studies, Adelphi University. He is a former president of the Division of Psychoanalysis, American Psychological Association. He is the author of Recent Developments in Psychoanalysis: A Critical Evaluation among other books and articles William Fried is a clinical psychologist and psychoanalyst in addition to a photographer. For 27 years, he served as Associate Director of Psychiatry Residency Training at Maimonides Medical Center. In 2000, he received the Teacher of the Year Award from the Association for Academic Psychiatry, the first non-physician to be so honored. He is the author of Critical Flicker Fusion. And practices psychoanalysis and psychotherapy in Manhattan.

Michael Krass is a psychoanalyst in Falls Church, VA and Washington, DC who has worked clinically with children and adolescents and their parents, as well as with adults for the past 30 years. He is also an Assistant Clinical Professor at the George Washington University. He is a training and supervising analyst at and teaches in the Contemporary Freudian Society-Psychoanalytic Training Institute and has also taught in the CFS Contemporary Trends Program, at Johns Hopkins University and the Washington School of Psychiatry. Joanna Lhulier is in private practice in Chevy Chase, Md. She is a licensed psychologist in Maryland and the District of Columbia and works with patients with a wide variety of challenges including eating disorders, mood disorders (depression and anxiety), relationship issues, parenting children with special needs, and loss. Peter Lin is a licensed Psychologist who specialized in mood and anxiety disorders, as well as relationship issues. Peter Lin has great interest in the integration of Eastern Buddhism and Western psychotherapy. He has years of training in Chan (Chinese Zen) practice and is currently a Dharma teacher-in training at Dharma Drum Mountain Chan Lineage. He is also actively involved in disaster relief and is part of Buddhist Tzu Chi Foundation

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Gemma Marangoni Ainslie is a psychologist-psychoanalyst practicing in Austin, Texas. She received her doctorate in clinical psychology from the University of Michigan in Ann Arbor and is certified in psychoanalysis by the American Board of Professional Psychology. Dr. Ainslie has presented nationally and internationally on a wide variety of subjects in psychoanalysis, including gender, dreams, and psychoanalysis and film. She is Book Review Editor at DIVISION/Review. Dinah Mendes is a psychologist and psychoanalyst in practice in New York City. She is a member of and supervisor at IPTAR and enjoys writing on general topics from a psychoanalytically informed perspective. Gregory Novie is in private practice in Phoenix, Arizona, and has written articles and book reviews on topics such as countertransference, borderline states, Lacanian concepts in clinical practice, and trauma. Dr. Novie completed his PhD at Arizona State University and his analytic training at the Southwest Center for Psychoanalytic Studies. Henry Seiden was a psychologist, psychoanalyst and poet. Author of The Motive for Metaphor: Brief Essays on Poetry and Psychoanalysis (2015), among other books and articles. He was the Poetry Editor of DIVISION/Review.