Dis/abling Psychoanalysis

Jay CROSBY

If there was a country called disabled,

Then I am one of its citizens.

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

Was encouraged by doctors to leave.

I tried to surgically remove myself from disabled country

but found myself, in the end, staying and living there.

If there was a country called disabled,

I would always have to remind myself that I came from there.

I often want to forget.

I would have to remember…to remember.

-- excerpts from “Disabled Country”

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

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

Within American psychoanalysis, there has been a spate of recent crises of borders and fault lines in some presumed battles around the scope and limits of our discipline. What is psychic? What is social? Who is included and excluded as the object of psychoanalytic study? And who is authorized to ask these questions and define this scope? There are fractures and factions that emerge in our professional associations, where conflicts take on an eerie doubling to what is happening socially and politically around us. At the center of this is the question of what constitutes the core ethical framework and direction for psychoanalytic practice and inquiry.

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

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

Despite these attempts to open the purview of psychoanalytic thought and practice to those previously marginalized or excluded, analysts have been slow to enter disability country. The majority of contemporary clinical writing in psychoanalytic journals hews closely to the normative setup of abled-bodied analyst and patient exploring the patient’s afflicted mind in the context of a private setting, with alterations in this setup ascribed to the realms of “psychodynamic therapies” or “applied psychoanalysis.”

Furthermore, while there is an established although mixed history of the psychoanalytic understanding of autism, there is hardly a robust history of psychoanalytic writing on physical disability, nor cognitive or intellectual disability, in which psychoanalysts have treated by “mostly vacillating between indifference and disdain or unthinking derogation,” (Herzog, 2019, p. 136).

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

It is important to acknowledge that disability is a broad umbrella term that refers to a range of physical, sensory, cognitive, and psychic-emotional differences or impairments. As British sociologist Tom Shakespeare writes, “It is dangerous to generalize about disabled people because impairment comes in so many forms, and because each person reacts differently to their own experience of impairment. The extent to which disability is a problem depends on the complex interplay between the individual’s impairment and their personal resources for dealing with it, and the wider context of the social and physical environment in which they live,” (Shakespeare, 2007, p. 53).

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

This legacy of inaccessibility and exclusion can, at least in part, be tied to Freud. Despite his radical reformulation of human subjectivity and his position as an expositor of human psychology amidst a period of extraordinary social and historical upheaval, Freud sometimes veered toward a conservative perspective. In one of his final papers, “Analysis Terminable and Interminable,” he states, “The ego, if we are to make a pact with it, must be a normal one. However, a normal ego of this sort is, like normality in general, an ideal fiction. The abnormal ego, which is unserviceable for our purposes, is unfortunately no fiction.” (Freud, 1937, p. 235, my emphasis added). Freud, in this essay, is speaking to the extraordinary demands that the task of analysis presents to both patient and analyst alike and presumably refers to the necessity of a “normal ego” as a bulwark against so-called difficult patients and failed analytic treatments given the precarity of his still nascent psychoanalytic movement. However it is a deeply curious and suspect notion to tie it to a social construct—despite referring to it as “an ideal fiction”—without explaining why abnormality is “unserviceable” with the psychoanalytic method.

Indeed, generations of analysts and analytic movements have adopted this position in relation to normality, downplaying the psychic impact of pressures inflicted on individuals through social and historical contingencies, and in certain cases being part of the social order involved in enforcing normality. One need only look to the areas of ego psychology that stress adaptation to social norms as an analytic goal rather than the opposite: society accommodating a range of its subjects, or more to the point, analysis accommodating to a range of analysands.

With this stated, it is also vital to note that the history of psychoanalytic innovation has repeatedly involved challenging the idea that the so-called “abnormal ego” is unserviceable. From Klein to Winnicott to Bion, from the Tavistock tradition to Chestnut Lodge and Austen Riggs, and from Karen Horney and Harry Stack Sullivan to the contemporary relational tradition, psychoanalysis has benefitted from challenging its own limitations when clinicians take risks to think and work differently. In the current context, a more sustained engagement with disability and critical disability studies can help us acknowledge neurodivergence, autism, intellectual disability, physical disability and major psychiatric conditions with the same openness that we aspire to with gender, sexuality, race and class. The idea is to highlight how we are all thrown into the world in different ways, occupying life worlds and our bodies in historically contingent, singular, and precarious ways, and to further acknowledge the manner by which social forces impact and structure psychic and relational life.

References

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

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

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

Holmes Commission on Racism in American Psychoanalysis (2023). Final Report. https:apsa.org/aboutapsa/holmes-commission/

Shakespeare, Tom (2007) Disability, normality and difference, In Psychological Challenges in Obstetrics and Gynaecology: the clinical management, edited J.Cockburn and ME Pawson, London: Springer Verlag.

Contributors

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

Ben Stephens, photographer, https://www.benstephensphotography.com