DIVISION/Review Issue 10 Summer 2014

DIVISION REVIEW DIVISION A QUARTERLY PSYCHOANALYTIC FORUM A QUARTERLY PSYCHOANALYTIC FORUM

EYE ON THE BALL

UNDERSTAND SADOMASOCHISM

SEDUCTION AND DESIRE

BUSCH | Basseches

MALKIN | Quindeau

G.M.AINSLIE | Busch

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A PSYCHOANALYTIC LIFE SCHAFER | Basseches

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WHAT IS MADNESS?

ADOLESCENCE

SANCIMINO | Toronto

STAFFORD | Leader

MALBERG | Bendicsen

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A D/R CONVERSATION WITH JONATHAN SHEDLER

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A FIELD GUIDE

WINN | NEUTRALITY, INDIFFERENZ, AND DESIRE OF THE ANALYST

DEAN | FUMBLING IN THE DARK

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SEIDEN | ANOTHER TIME AND PLACE

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TOE TO HEAD: MAGRITTE AND BATAILLE HEGARTY

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Nothing Will Come of Nothing In his review of the Theatre for a New Audience’s production of Shakespeare’s King Lear, directed by Arin Arbus, Ben Brantley (2014) suggests that in this particular reading of the play, the key event of the entire tragedy occurs in the very first scene, that the tragedy has already occurred when Lear asks his doomed question.

Brantley writes about how this rendition of King Lear, and its focus on the half-considered effects of speech, conveys fundamental truths about the fragility of familial relationships especially well. He describes the father’s tragic speech act—his request to his daughters to declare their love in the form of a competition for his lega-

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cy—to be the sort of event that often casts families into extended strife.

As Brantley put it, referring to the actor Michael Pennington, “As Mr. Pennington plays the moment, you can tell that Lear regrets what he’s said as soon as the words leave his mouth. There’s a softening plea in his glowering eyes that seems to say: ‘I didn’t mean it. Get me out of this’” (p.C1). With a kingdom at stake, that is not easily done, but as Brantley goes on to say, “I don’t know about you, but I’ve certainly experienced family quarrels in which an ostensibly small slight assumed a long and smothering life of its own. The imp of the perverse (to borrow from Poe) is nev-

er more self sabotagingly present than in arguments with loved ones, when feelings run so deep that we can’t even fathom them” (p.C1).

Many an analyst has encountered the same phenomenon, when a seemingly small remark has an impact for better or worse in the clinical setting, where feelings likewise run unfathomably deep. The tragedy of Lear in this instance is the tragedy of language that sets us up as fragile speakers to utter things whose effects we know not.

Thus, while we often trust in the spontaneity of an utterance, we can as easily be undone by it. When we invite our analysands to say whatever comes to mind, we

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

CONTENTS

EDITOR

David Lichtenstein CHAIR, PUBLICATIONS COMMITTEE

Henry M. Seiden

BOOK REVIEWS 4

Creating a Psychoanalytic Mind: A Psychoanalytic Method and Theory edited by Fred Busch

Fred Busch

Battling the Life and Death Forces of Sadomasochism: Clinical Perspectives edited by Harriet Basseches, Paula Ellman, and Nancy R. Goodman

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CONTRIBUTING EDITORS

Gemma Marangoni Ainslie

Victoria Malkin

Seduction and Desire: The Psychoanalytic Theory of Sexuality Since Freud

by Ilka Quindeau

Ricardo Ainslie, Steven David Axelrod, Christina Biedermann, Chris Bonovitz, Steven Botticelli, Ghislaine Boulanger, Muriel Dimen, William Fried [REMINISCENCE], Patricia Gherovici, Peter Goldberg, Adrienne Harris, Elliott Jurist, Jane Kupersmidt, William MacGillivray, Paola Mieli, Donald Moss, Ronald Naso, Donna Orange, Robert Prince, Allan Schore, Henry M. Seiden [ON POETRY], Robert Stolorow, Nina Thomas, Usha Tummala, Jamieson Webster, Lynne Zeavin ASSOCIATE EDITORS

Loren Dent, Kerri Chladnicek MANAGING EDITOR

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Harriet I. Basseches

Tragic Knots in Psychoanalysis: New Papers on Psychoanalysis

by Roy Schafer

Mac Walton PHOTOGRAPHY BY

J Pasila 14

Catherine Sancimino

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Mark Stafford

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Norka T. Malberg

Family Entanglement: Unravelling the Knots and Finding Joy in the Parent-Child Journey

by Ellen L. K. Toronto with Robert S. Toronto

Reconceptualizing Adolescence: The Transformational Self: Attachment and the End of the Adolescent Phase

by Harold K. Bendicsen

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Todd Dean

Fumbling in the Dark

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Martin Winn

Neutrality, Indifferenz, and Desire of the Analyst INTERVIEW

Laurence Hegarty

Henry M. Seiden

The Air of Another Time and Place: A Poem by Seamus Heaney SIDEBAR

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Jonathan Shedler

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.

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Toe to Head: Magritte and Bataille ON POETRY

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A D/R Conversation with Jonathan Shedler ART

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Tim Maul Hannah Alderfer, HHA design, NYC

What is Madness

by Darien Leader

COMMENTARY

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IMAGES EDITOR

Misconceptions and Negative Stereotypes: What Can the Division Do?

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

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Nothing Will Come of Nothing from page 1 ask them to court this risk, and we should well respect both their courage and need for safety in assuming it.

Lear, after stating he has already divided the kingdom to avoid future strife, falls prey to the “imp of the perverse” in how he asks for his daughters’ testimony. His halfbaked idea is presumably to invite a ceremonial celebration of love, but he frames it as a competition, playing with rivalrous fire.

When Cordelia balks at the game, Lear is caught in the web spun by his own speech act. Shakespeare conveys desire—written by a single utterance—and how the symbolic can thereby tip into the real.

Psychoanalysis encounters a similar

fire in the speech acts of every intervention.

The weave of transferential desire is always in play, and the analyst is well advised to be attentive lest that imp of perversion intrude. Every utterance has meanings that escape our conscious intent. But as Cordelia discovers, to remain silent is no escape.

The expressions of unintended desire may not necessarily have Lear’s tragic consequences; they may in fact trigger comic effects. Indeed, the two faces of drama are never far from any psychoanalytic session.

In analysis, the play is the thing. It is not to be avoided but to be joined. Fortunately, the theatrical effects can remain on stage and played out there.

Brantley suggests that Lear should have been more cautious with his speech:

On the Photography of J Pasila J Pasila’s photographs could resemble the documentation of a forgotten post-minimal figure with their meditative vacancies and interrogation of her work environment as if searching for clues on how to proceed.

For Pasila, the camera is an organizing device that relocates peripheries to the center and elevates the surfaces of host materials, paper specifically, to the status of subject. The studio (soon to be condensed within any hand held device) often attracts the artist’s attention during the self-imposed periods of isolation necessary to the making of art. In a recent interview, the painting conceptualist Mel Bochner mentioned the desire to learn, or take away something from his daily studio regimen, even if the time invested produces nothing to show. Pasila’s images may illustrate this restless mental space.

The organizational chores that attend any career may replicate the administrative dimension of Fluxus or Conceptual art, as manual labor is necessary to the procedures of artists who navigate lead sheets against walls. Pasila’s physical inspections of marginalia in her own body of work results in a hall of mirrors type visual recycling of discrete events. Images of touch and insertion harbor a distinct erotic pull, choosing the pleasures of the disappearing stationery store (a museum of blankness) over the lurid Warholian newsstand. Pasila’s recent piece at the Tulca Festival (Galway, Ireland 2013) spectacularizes such a single interaction. As the print world accelerates toward the paper-free screen, could J Pasila’s art signal nostalgia for not only the cluttered bibliophilic archive but for the unrequited intimacy between us and all things stacked, leaning, or affixed? z www.jpasila.com Tim Maul Image Editor 3

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The sorry events that follow here seem personally upsetting because you’re so aware that none of this would have happened if Lear had thought before he spoke.

Mr. Pennington makes it clear that Lear’s subconscious never stops slapping him in rebuke from that moment on. (p.C1) In point of fact, caution and thinking before one speaks are no guarantee, and the slaps from “the subconscious” are inevitable. The best we can hope for is to observe the distinction between playing and reality and to keep the imp of perversion from erasing that gap. z REFERENCE Brantley, B. (2014, March 27). Shakespeare Reimagined, Once Quietly, and Once Very Loud. New York Times, C1.

BOOK REVIEWS

Keeping Your Eye on the Ball Fred Busch wants to open minds, from behind the couch and from the page, to the possibilities that careful attending offers. In his new book, Creating a Psychoanalytic Mind: Creating a Psychoanalytic Mind: A Psychoanalytic Method and Theory Edited by Fred Busch East Sussex, England, and New York, NY: Routledge, 182 pp., $42.95, 2014 A Psychoanalytic Method and Theory, he resumes and extends his elucidation of the efficacy of an ego psychological perspective on our work, bearing the standard for a theory that many of late eschew. In particular, Busch demonstrates the usefulness of Paul Gray’s “close process monitoring” technique as a cornerstone of his clinical orientation and asserts its centrality in focusing on what we need to know to bring about psychoanalytic change. While his position is not an easy one to occupy at this moment in the history of psychoanalysis, he does so with clarity and equanimity, neither engaging in au courant battles nor dismissing alternative contributions, while attempting to highlight ways in which his approach is integrative. Indeed, here—as in his clinical work—he asserts that there are matters overlooked and matters to be looked at if one both sustains a commitment to process and resists the seductive pull toward deep interpretation as the end-all, be-all for a truly psychoanalytic experience.

Further, Busch does so with crediting his history as a developmentalist, psychologist, and, as I discovered, former baseball player. Regarding the last, as Busch says several times in his book, “more about that later.”

Creating a Psychoanalytic Mind is aptly subtitled: “A” Psychoanalytic Method and Theory, thus belying any misunderstanding of Busch’s intent. He does not declare that he knows how psychoanalysis ought to be practiced, a position all too often projected onto those who ask us to look at our pasts again; indeed, what Gray would have viewed as a superego resistance. Rather, in this iteration of his thinking—his third book to date on ego psychology in clinical technique—Busch avers that he is open to integrating alternative theoretical positions into his own and that his work has benefited from various currents in European schools in particular. Quoting from his own work in 2005, he repeats, “the analyst of today might best be known as the contemporary Freudian, countertransferentially aware, self-psychological, relationally interested, Kleinian-inspired, ego psychologist” (p.xvi).

Nonetheless, what is clearly in the fore here is his identity as an analyst formed in a certain time and at a certain place, with strong

Gemma Marangoni AINSLIE

roots in Piaget’s contributions to developmental psychology, in child analysis as imported to the Ann Arbor community from the Hampstead Clinic, and in projective psychological testing. Busch is certainly a developmentalist and a psychologist as well as a psychoanalyst, and, like another American analyst named Fred (Pine), proud of it.

Creating a Psychoanalytic Mind is well organized, beginning with both an introduction, outlining its intent and basic perspective, and a first chapter, “A Personal Journey,” that traces the evolution of Busch’s position. In the introduction, Busch

agreement with Gray’s reckoning that there is a “developmental lag” in psychoanalytic interventions evidenced in our continued practice from a topographical model rather than fully shifting to a structural model.

Thus, Busch posits that the “home runs” we all strive for with our patients are all too often assessed on the basis of privileging “deep” interpretations, the uncovering of unconscious contents, rather than on attending carefully to the moment to moment process in the hour and commenting in ways that might best expand the ego’s capacity to observe, consider, and choose.

emphasizes his view that psychoanalysis is a process whereby the analysand comes to think about thinking, and that the curative potential of that capacity lies in greater freedom to reflect upon rather than react blindly to the ever-bubbling well of associations that constitute our specifically human existence. His view of the analyst’s position in the process, placed in the context of “Paradigm Shifts,” the first section of the book, might fairly be characterized as much like that of a guide, pointing to sights/sites the analysand might, or even must, turn away from in an effort to maintain an established albeit unsatisfying and constricting intrapsychic equilibrium. This central perspective is predicated upon his

Busch’s position, in my view, is comprised of recommendations on two fronts: where we look for the data on which to base our interpretations and what we do with what we observe. A central guiding concept for where we focus our attention is that of “language action,” which he is firm in differentiating from Schafer’s “action language.” He seats his contribution in this layer of metacommunication through which the analysand unconsciously attempts to demonstrate something to the analyst, that is, to say something about the there and then via doing something in the here and now of the session. This perspective on the analysand’s communication is, of course, not unexamined territory in any psychoanalytic

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BOOK REVIEWS

subtheory; however, Busch stresses that trying “to understand what a patient is doing with us or to us in their words, tones, phrasing of sentences, and ideas expressed” is the work and the sine qua non of an analyst. He also underscores that our own countertransferential anxiety, rather than theoretical allegiance or even considered technique, is likely what provokes shifts to one or another decentered stance, that is, to either the silent, withholding position so often used to caricature a classical analysis, or the action- or self-disclosure-dominated stance frequently used to parody a relational analysis. From this perspective, Busch ascribes to collecting data as an observer in the field and emphasizes that observation of countertransference is an essential component of data to be collected as well as a guidepost to interventions. In addition, his clinical examples, dispersed throughout both major portions of the book, demonstrate a collegial engagement with his analysands: he asks them to join him in looking at junctures that the patient alone is not free to view.

His second central emphasis is use of and expansion upon the “in the neighborhood” analogy from Freud’s “Wild” PsychoAnalysis (1910). Busch first spoke to the concept of “in the neighborhood” in 1993, clarifying and emphasizing from a structural perspective that treatment is best served when the analyst brings to the analysand’s attention what is preconscious and therefore accessible to the analysand’s observation and less likely to stir undue anxiety. In this way, consistent with Freud’s original observation, the interpretation is more likely to be usable because it can be linked to experience and less likely to be perceived as either instruction or edict, and therefore less easily conscripted as resistance. This is also, of course, an elucidation of the muchused adage that a beneficial interpretation needs to take into account timing, tact, and dosage. Busch points out that Paniagua’s (1991) concept of the “workable surface,” “that space between the patient’s and the analyst’s thoughts that can lead to a meaningful intervention” (p.16), is a corollary to “in the neighborhood.” From a Winnicottian perspective, he is noting that an interpretation is most useful when it is neither too much nor too little and that our task is to aim for the “just right.” I would add that our patients are not only inevitably primed to react with anxiety to interpretations that neglect or override readiness, but also much inclined to accept superficial comments. Of course, while too much overwhelms them, too little leaves them understimulated and interpretation “out of the neighborhood” in either direction mitigates the potential for optimal gratification–frustration tension that builds structure.

Busch’s suggestion for use of process data discovered in this way involves the analyst noting his observation—a shift, a silence, a tone, and so forth—and asking the patient to look at it as well. The tack, rather than a “you don’t want to think about X” statement, is a “could it be that you interrupted yourself from thinking aloud about something?”

Thus, Busch sees the possibility that, in a safe and respectful two-person realm constructed over significant time and undergirded with warmth and limits, the analyst can interpret in a way that neither denies his authority and expertise nor credits the analysand with more than he or she is capable of yet.

Some might criticize this as an educational intervention, and clearly that layer exists; however, Busch’s position is that it is geared toward assessing the patient’s current capacity to observe and suggesting where those observations might most therapeutically be directed in the hour.

Part II of Creating a Psychoanalytic Mind, titled “Clinical Methods,” puts Busch’s essentially developmental perspective into play. This part, I believe, holds most promise for opening the reader’s mind to new thoughts and to the potential for a next contribution. Busch covers the topics of central clinical import in the first five of these chapters. Beginning with “Free Association” and ending with “Working Within the Countertransference,” he surveys the literature on foundational psychoanalytic concepts illustrating his understanding with clinical material. Central to these chapters is his emphasis on resistance: manifestations of which he examines in typical exchanges such as the analyst asking questions.

In a chapter titled “Why Do We Ask Questions?,” Busch devotes a portion to common queries—“How did that feel?”; “How do you understand that?”; “Can you tell me more?”—and identifies the likelihood that questions interrupt the free association process, communicate to the analysand that one type of datum warrants greater focus, or misunderstand the gaps in communication as something to be overridden rather than something to be observed. Any clinician will see himself, at least at times, engaged in such queries; they are all too often suggested early in clinical training as a means by which to understand more and better. Busch’s attention to how they in fact may work against furthering insight and toward compliance, and therefore resistance, is a well-formulated caution for clinicians at all stages of development. His technical suggestion here, as elsewhere, is most applicable to treatments of greater frequency.

In contrast to questions such as these, Busch draws upon Ferro’s concept of “unsaturated interpretations” (2002) to offer the possibility of “unsaturated questions.” These questions, which he views as fostering the 5

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formation of a “psychoanalytic mind” are ones that begin with the analyst observing something and asking the analysand to join in the observation. Such a question is “an attempt to bring new connections to the patient’s mind, without suggesting any direction the patient should take” (2014, p.82).

Busch also views such questions as underscoring the too frequently “overlooked component of the psychoanalytic method, that is, the importance of the readiness of the patient to share in the analyst’s observation before interpreting the meaning of the observation” and cautions that “(w)e have not always carefully distinguished between the phenomenon we observe, and the interpretation of the phenomenon” (2014, p.82).

Three chapters organized around the beginning, middle, and termination phases will obviously draw the clinician’s attention: we all crave “how tos” over “how comes” no matter how practiced we are. The chapter on the beginning phase offers the least by way of new insight, emphasizing that patients use “language action” to tell stories that they are not aware of telling and that our work is to further their capacity to tell and hear the fullness and complexity of their own stories.

In contrast, the chapter on termination offers a new way of understanding what has been viewed as the return of symptoms at the end phase of treatment, the infamous “last throes of the neurosis.” In his reading of this phase, Busch sees evidence that resistance to the termination is manifested in the patient’s relinquishing his newly earned capacity for self-analysis and views the analytic task as “the analysis of regressive solutions to conflicts around self-analysis that develop in this phase” (2014, p.147). This perspective is solidly predicated on the developmental understanding that the most recently acquired skills are those most vulnerable to being abandoned when the individual is stressed, whether that individual is a toddler, an adolescent, or a terminating analysand.

While there is much to recommend it, the distinction Busch draws between the more typical understanding that self-analysis is “a result of an identification with the analyst’s functioning” (2014, p.147), and his own that “by analyzing in a particular fashion we create the conditions for the patient’s relationship to his own mind that allow self-analysis to take place” (2014, p.147), lacks sufficient elaboration. It relies upon his appreciation for process over content and so implicitly posits that the analysand takes the analyst’s inevitably idiosyncratic way of analyzing with him. Interestingly, in the second chapter of the book, Busch notes that “the analytic setting” rather than insights are what we analysts remember of our analyses (2014, p.18). Nonetheless, he does not expand upon his own appreciation

BOOK REVIEWS

of the components or complexities of memories of the treatment atmosphere or of the fate of the postanalytic relationship with the analyst, nor does he engage the literature (for example, the nuanced exploration offered by Tessman [2003]).

The richest potential for future exploration, it seems to me, lies in the arena Busch ventures into in the middle phase chapter. Citing the work of Novick and Novick (1998, 2001), which defines the middle phase as one in which “(t)he patient’s mind becomes an object of inquiry, and we begin to track fluctuations in the patient’s willingness to engage in the work” (2014 p.139), Busch proceeds by outlining three observable shifts in the patient: self-observation, self-reflection, and self-inquiry. The middle phase in his view is marked by the unfolding of these three related and nested capacities, each building on the preceding and all finally working in conjunction to allow the patient more and more freedom to explore and play with his own mind. This conceptualization exemplifies the ego psychological concept of synthetic function at work as well as Busch’s specific stance. Moreover and more significant, with regard to future areas of examination, the three shifts Busch names constitute a clear and vibrant example of the evolution of a developmental line, evidence of the applicability and viability of Anna Freud’s child-centered work to the underexamined realm of adult development. I believe this line of thinking leaves opens the possibility of considering from a different vantage point the conflicts and pressures that obviate development of thinking about one’s own thoughts, especially as the capacity from a Piagetian standpoint begins in adolescence.

In addition, this three-step model has significant value as we instruct and supervise analysts in formation, both as a pattern that we can help them observe in their patients and as a way of helping students and candidates assess the development of their own psychoanalytic minds.

There is much to recommend this book. Significant portions of it will ring familiar and in that respect it serves to consolidate Busch’s decades of contributions.

However, it also clarifies and extends his position. Busch says what he does and does what he says: he observes what we do and suggests how we might think about it. Without insisting upon an encyclopedic review of the literature, he draws upon many schools of thought about analytic understanding, but he firmly recommends his own narrower view of how we might best facilitate our patients’ understanding of themselves. I believe his position might have been made more solid had he underscored that his close process attention is one of many layers he works with. His

clinical examples are evidence that unconscious content and themes are clearly brought into specific focus and that he does not lose the forest for the trees; however, criticisms that he is too narrowly focused might have been mitigated by more explicitly acknowledging other layers of observation and modes of intervention. In addition, I believe all of us have and should welcome moments of intuition or inspiration and, while that is a different matter from the one he is addressing centrally, I wish Busch had made clear that our free associations are to be welcomed, engaged, and put into play in the analytic back and forth.

In the context of good to be said about Busch’s work, Creating a Psychoanalytic Mind, and in the service of being fair to him and to the scholarly reader in particular, the editing of the text is far from perfect. As well as grammatical and syntactical errors, insufficient editorial attention was paid to clarifying how clinical material was identified: at times, the use of indentations, italics, and quotation marks was confusing and I had to reread portions to clarify what better editing would have made clear. In addition, I found inconsistencies between citations in the text and works catalogued in the references. While this would not prove problematic for most readers, it does not do justice to the writer’s scholarly contribution nor provide reliable resources to those who want to explore related writings.

Still, I believe the psychoanalytic clinician, from whatever theoretical perspective and at whatever point in his own development, will find Creating a Psychoanalytic Mind a worthwhile read. Of course, not all will agree with Busch’s theory or with his technique, nor should we. There is no one truth to be uncovered in or about psychoanalysis, there is only the ongoing rewards of knowing oneself, one’s patients, and the field from multiple vantage points.

Coda Having viewed Busch’s work in Creating a Psychoanalytic Mind as testimony to his history as a developmentalist and a psychologist, I want now to (playfully) engage his prehistory as a baseball player.

I have known Fred Busch for more than 30 years, since my days as a clinical psychology graduate student at the University of Michigan interning at the Children’s Psychiatric Hospital where he was my first child supervisor. With many years of no-contact intervening, recently I have had the opportunity to spend a few hours socializing with him at meetings. In all that time his unrealized wish to be a major league baseball player—noted in this book in the first chapter, “A Personal Journey,” (2014, p.1)—was never mentioned.

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Nonetheless, the image of him playing baseball became a recurring one for me as I read this book. It seeped into the body of this review once or twice, but it is a much fuller rendering in my mind—a picture of him at the plate analogous to the image I have of him behind the couch, although I’ve never observed him in either setting. My quandary as to what to do with this image, both static and in process, leads to this coda.

In my mind’s eye, Busch operates on as many levels when analyzing as he likely did when at bat. He has his eye on the ball and his ear to his patient’s words and his or her language actions. He is comfortable and practiced in his stance, patient and aware of his own reach, waiting for the ball to make it to the strike zone. He is aware of the pitcher’s/patient’s preferred moves, the fast balls and curve balls and maybe even “spit balls,” because he has observed the pitcher/ patient in detail. And he allows the pitcher to take center stage. He is also aware of the big picture—what inning it is, the score as he approaches the plate, the count as he strikes or lets the ball pass. In the background, as well as those calling “swing, batter, swing!” to distract him, there are coaches of various disciplines supporting Busch being steady at the plate. Baseball is not a contact sport, nor is it a fast-paced small group enterprise like basketball; rather, it is a sport with no fixed time periods, where the central issue is a dyad in interaction—both trying to bring their individual best forward, and both with an eye on the ball and very aware of home base. Yet still, at some point the pitcher takes the leap to throw the ball and the batter to strike at it, each exercising intuition as much as training in their timing.

None of us will ever discern all there is to know about psychoanalysis or about baseball, but it is great fun to exchange ideas and coach one another on how the game is played. As each hour ends, each inning closes, both participants commit to taking their respective positions and doing it all again, and hopefully better. Batter up! z REFERENCES Busch, F. (1993). “In the neighborhood”: Aspects of a good interpretation and a “developmental lag” in ego psychology. Journal of the American Psychoanalytic Association, 41, 151–177.

Ferro, A. (2002). Narrative derivatives of alpha elements: Clinical implications. International Forum of Psychoanaysis, 11, 184–187.

Freud, S. (1910). “Wild” Psycho-Analysis. In: The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XI (1910): Five Lectures on PsychoAnalysis, Leonardo da Vinci and Other Works (219–228).

Novick, J., & Novick, K. K. (2001). Two systems of self-regulation. Psychoanalytic Social Work, 8, 95–122.

Novick, K. K., & Novick, J. (1998). An application of the concept of the therapeutic alliance to sadomasochistic pathology. Journal of the American Psychoanalytic Association, 46, 813–846.

Paniagua, C. (1991). Patient’s surface, clinical surface, and workable surface. Journal of the American Psychoanalytic Association., 39, 669–685.

Tessman, L. H. (2003). The analyst’s analyst within.

Hillsdale, NJ: The Analytic Press.

BOOK REVIEWS

The Struggle to Work With & Understand Sadomasochism I once had a four-hour meal at the French Laundry in Napa Valley, California. I was reminded of this experience when reading the new book Battling the Life and Death Battling the Life and Death Forces of Sadomasochism: Clinical Perspectives Edited by Harriet Basseches, Paula Ellman, and Nancy R. Goodman London: Karnac, 320 pp., £23.89, 2013, CIPS (Confederation of Independent Psychoanalytic Societies) Boundaries of Psychoanalysis series Forces of Sadomasochism: Clinical Perspectives, edited by Harriet Basseches, Paula Ellman, and Nancy R. Goodman. After the first course at the French Laundry I felt I had arrived in culinary heaven and nothing could compare to this first savory delight, only to find that each successive course added to the pleasure of the experience. The intellectual and clinical delights in this book begin with Frederic Perlman’s preface (and how many times have you heard an appreciation for a preface?) and continue with each chapter.

Perlman, the editor of the Confederation of Independent Psychoanalytic Societies book series, sees the series as a way to “encourage and enable our members to transcend insular parochialism of psychoanalytic thought and so, over time, to (search for) [parenthesis added] a multilingual, multicultural professional community” (pp.xix–xx). Here I believe Perlman has highlighted one of the central issues for psychoanalysis at this time in our history. The book succeeds admirably in this regard, as we read multiple voices speaking about this vexing clinical syndrome.

Perlman also highlights something very important in this book: even as these patients can’t help but denigrate our efforts, “there is good reason to labor on with a measure of confidence in the psychoanalytic enterprise and the long-term promise it holds” (p.xxii).

The editors begin the book with a chapter describing how the book came about. One is immediately struck with their remarkable candor in discussing personal feelings and fears, and this openness continues throughout the book. One immediately empathizes with these three clinicians as they struggle with feelings we are all familiar with but continually fight off. This working-through process can only occur with colleagues one feels great trust with, and the three editors have shared their clinical work for more than thirty years. They bravely describe how they’ve handled their most challenging cases, the ones we typically prefer not to speak of. This led them to discover the sadomasochism at the heart of many of these cases and they searched the literature for help. Their ability to concisely integrate the literature with

Fred BUSCH

their clinical acumen shows in the literature review done by Ellman and Goodman. It is rare nowadays to have analysts in the United States refer to psychosexual development and drives as causative factors in symptoms, but the authors admirably and convincingly do so. There is nothing so convincing of the fact that we are driven as the sadomasochistic patient’s need to continually entangle those around them in this singular paradigm. They also highlight the importance of perversion and the disavowal of difference in sadomasochistic patients, while respectfully describing the analyst’s experience (e.g., losing the capacity to think) and analytic work “replete with aggression and counter-aggression” (p.22).

The focus of the book revolves around four detailed case descriptions followed by

than not destabilizing. Apparent throughout the book is the treating analyst’s struggle with intense emotions—casting off easy explanations and working incredibly hard at multiple levels to reach these patients.

A central treatment question that runs through the book is, when is a sadistic attack self-protective and when is it perverse aggression? It is, of course, very difficult to empathize with the patient’s plight when under a perverse attack. However, as many of the contributors recognize that closeness for these patients involves a terrifying fear, one wonders how useful it would be to try and approach the patient first from this perspective.

Ellman presents the first case of “Diane,” which reminded me of SchmidtHellerau’s (2009) paper on moral sadism,

three discussions from many of the leading experts who have written about sadomasochism. As I was reading the case histories the words “no mas” kept coming to mind.

(These words were spoken by the boxer Robert Duran as he did what was unheard of in boxing, that is, he gave up.) I keenly felt the tortured relationships these patients bring to analysis and was reminded of similar patients I’ve worked with, some successful, some not, but always with intense countertransference reactions that were more often

where the patient cannot help but blame the analyst and those around her for her fate (of being a woman). Ellman highlights Diane’s hatred of differences and the feeling that she was never appreciated as her brother was. In reading about the analytic sessions, I was struck by how concrete Diane’s thinking was and the technical problem of making meaning from what the patient views as “facts.” There is little room for playful musing or reverie. Ellman describes how demeaning Diane is toward her

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efforts and her awareness of the countertransference reactions of wanting to “speak to her with force, to pin her down, get her to submit to me, my interpretations” (p.44).

There is a unifying theme in the commentaries on Ellman’s case presentation, which revolves around the central conflict of the wish to destroy the object and the fear of needing the object. Each commentator explains his or her view from a different theoretical perspective, but ultimately there is a common ground. Alan Bass begins his comprehensive discussion of the case by highlighting the “life and death forces in sadomasochism” (p.45). His view sheds light on the often-neglected component in work with these patients, that is, “there is not only rage at unmet needs…, but also intense anxiety about the analytic meeting of these needs, via the integration of sexuality and self-preservation” (p.58). He also raises the important point that “sadomasochism functions in relation

universal need to defend against helplessness and potential traumatization” (p.64). The open system is “attuned to reality and characterized by joy, competence, and creativity” (p.64). The closed system “avoids reality, and is characterized by power dynamics, omnipotence and stasis” (p.64). The aim in both systems is self-regulation. In the closed system, which characterizes the sadomasochistic patient, the basis for defense is the “omnipotent belief in the power and necessity to be a perpetrator or victim to survive” (p.65).

The open system is the model for treatment based on the analyst’s “objective love” (p.65) for the patient and attention to the stages of the therapeutic alliance during treatment.

In understanding the sadomasochist’s attraction to pain, the Novicks bring up the very important concept, first mentioned by Valenstein (1973), of pain as part of an object tie. The Novicks wisely suggest that the analyst cannot empathize too fully with the pa-

to the analytic process itself ” (p.59), thus suggesting that interpretations of the way the patient attempts to destroy the process are central to helping them, while reminding us that we also need to pay attention to the patient’s attempt to integrate sexuality and preservation. In the second discussion of Ellman’s material, Jack and Kerry Novick, who have written often on the topic of sadomasochism, suggest the importance of what they call two systems of self-regulation and conflict resolution “that defend against the

tient’s pain and rage to avoid becoming part of the patient’s closed system. While going through the different stages of treatment, the Novicks emphasize the open system approach with various examples of how they might approach Ellman’s patient. Marianne Robinson discusses the case from a Kleinian point of view. She experiences the raw power of the patient’s aggression and likens the analyst’s task to facing down the tanks in Tiananmen Square. After a brief foray into the importance of unconscious fantasies in 8

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the Kleinian approach, Robinson sees the patient’s dilemma as wanting Ellman to be a self-object (my term), but this wish to incorporate the analyst comes back as a fear of being annihilated. The patient also strives for a cure that “would free her from any reminders of her human vulnerabilities” (p.81)—rejecting awareness of her longings and hate for the object that brings them to her attention.

Throughout her discussion, Robinson presents her associations to the clinical material, although it wasn’t clear how she would use these to help the patient.

Nancy Goodman describes the essence of her case of Mr. B as “who was going to hurt whom?” The treatment evolves into an ongoing anal sadistic attack from the patient, likely linked to a heightening of this erotogenic zone from receiving frequent enemas by his mother. Goodman points out how “his highly cathected representation of sadomasochistic object relations would catch each of them in imagined and enacted active and passive positions” (p.97). She goes on to describe how at times she wanted to force life into him and at other times wanted to merge with his sleepy state of forced passivity. Goodman explains how it took time to recognize his narcissistic depletion based on his softer side being treated as a “thing baby.” The detailed process material provided by Goodman shows the intricate and heroic nature of her work. I was reminded of the surprise one feels when faced with one’s wishes for sadomasochistic retaliation. Containing such feelings is one of the greatest challenges with these patients and inevitably there will be enactments.

In the limited space I have for the discussants of Goodman’s material, I cannot highlight how each of them subtly and thoroughly discusses the material, provides a rich knowledge of this area, and adds an entire literature on the subject. I could see a possible integration of the Novicks’ idea, quoted in Terrence McBride, of sadomasochism as a complete withdrawal from the object, Bass’s understanding of the patient’s anxiety of wishing to have their needs met, and James Grotstein’s view that aggression can be a way of reaching out. In this formulation, sadomasochism would be a libidinal withdrawal from the object out of fear of realizing a wish to have needs and longings met, with the sadomasochistic aggression as the only means of reaching the object in a compromised form. In Margaret Ann Hanly’s commentary, she does an excellent job of organizing and summarizing the disparate elements of Goodman’s material, as well as adding new reference points. Grotstein seems to agree with the discussants of the first case in seeing Mr. B’s sadism and manic behavior as a defense against his shameful dependency needs and fear of being the helpless victim. McBride highlights how Goodman juxtaposes Oedipal

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and pre-Oedipal features, while using both instinct and object relation models to understand Mr. B, indicating the importance of including multiple theoretical and technical approaches to appreciate the complexities of our patients’ worlds.

In Andrea Greenman’s presentation of her work with “Mariah,” we find another courageous analyst sensitively working with a sadomasochistic transference. Mariah’s childhood seemed scripted for the development of a sadomasochistic character, with beatings from her father for not eating, seemingly instigated by her mother, which robbed Mariah of her individuality by treating her as a self-object. Once again we see in Mariah the sadomasochistic triumvirate: a fear of annihilation, the wish for an object relationship, and the need to destroy any growing closeness with the analyst. Mariah’s bulimia seems to encapsulate these dynamics, that is, her extreme hunger, the fear of what this food is doing to her, and the need to get rid of it—leading back to a feeling of emptiness that needs to be fed. Greenman shows the dilemma we all face with these patients in deciphering what feels like an attack and is actually protection of the self (from annihilation), from an actual attack on the analyst (as a way of connecting or disconnecting).

Ellman’s discussion of Greenman’s patient adds important insights into working with sadomasochistic patients. For example, he suggests that, early in the treatment, it may be necessary for the analyst to receive and reflect the patient’s experiences and feelings (as Greenman did) rather than interpret in order to slightly mitigate the patient’s need to create a sadistic Other. Rapid-fire interpretations of the transference done too early often leads to the patient leaving the room. I would add that it could also lead to intellectual, affectless acceptance. This raises an interesting challenge to the Kleinian way of interpreting transference early and often. Ellman also brings up the need for what he calls “affective interpenetration” (p.184) in the analytic dyad, where the analyst allows him or herself to experience the primitive sides of the patient and communicate this to the patient. Shelley Rockwell gives a convincing discussion of the case material from a Kleinian perspective. In what seems typical of a Kleinian approach, she focuses primarily on the aggressive side of Mariah with almost no emphasis on the self-protective side. This is captured in her understanding of the “sucking candies” Mariah kept around at all times, seeing it as a way that Mariah was both victim and aggressor.

Rockwell relates this to playing with a child with a pacifier in its mouth. She describes how the adult may wish to take the pacifier out of the child’s mouth as it interferes with relating to the child, even if it is a way the child is holding itself together. Rockwell seems,

suggest that an adult’s wish for relating might outweigh the child’s need for self-soothing.

This can lead to a type of blaming the patient for bad behavior, as Rockwell seems to do when she indicates Mariah didn’t appear concerned enough about her symptoms when entering treatment. Leon Wurmser points to the centrality of depersonalization and shame in Mariah. He suggests one of the purposes of induced suffering is shame followed by increased depersonalization. He also cites numerous clinical examples that show Mariah’s archaic superego. While I find a lot of support for this view in my own work, I found Wurmser’s explanation for the cause of this a bit confusing. It is my impression that early needs become viewed by the child as sinful (because of the response from the adults around), resulting in shame and guilt. This seems to be amply described in Greenman’s description of her work with Mariah.

Richard Reichbart’s experience in working with Mr. A was different from the other clinical contributors in that Reichbart didn’t feel anger or helplessness in Mr. A’s sadomasochistic attacks. While the content of these attacks were virulent, for Reichbart, they seemed to be an enlivened version of Mr. A, in contrast to his more deadened self when he was inhibited. Reichbart’s empathy with Mr. A’s childhood experience due to elements of his own personal background is given as part of the explanation for his lack of discomfort. Furthermore, Reichbart recognized early on the anxiety in Mr. A’s attacks, which further helped him empathize.

Two technical issues employed by Reichbart seemed to be very helpful in this case. The first was serving as benign superego and the second was helping the patient avoid destructive parenting by offering advice.

Finally, there is an interesting use of sarcasm

by Reichbart that struck me. In a brief literature review of this topic, most literature references the patient’s use of sarcasm or condemnations of the analyst’s use of sarcasm.

However, it seemed that Reichbart used a type of benign sarcasm that showed acceptance of his own aggression and gently prodded Mr. A to look at an obsessional defense.

Sheldon Bach adds a number of insights to Reichbart’s description. He considers Mr. A’s lack of childhood memories a common symptom of challenging patients, suggesting that living within cumulative trauma situations precludes reliable memory and the formation of the self. Bach also sees these types of patients as having little room for transitional space, leading to the concrete thinking seen in Mr. A. Reichbart’s boredom is seen as a response to annihilation anxiety, which is seen as Mr. A’s “pre-emptive counterattack to his own terrible feelings of annihilation” (p.249). Harriet Basseches begins her discussion by raising a number of interesting 9

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questions. She wonders whether Mr. A’s isolation was as complete as presented; whether his sadomasochistic imagery developed fully formed in adolescence; and whether what happened in adolescence was a regression rather than an earlier fixation. She also raises the possibility that sibling rivalry with Mr. A’s younger sister might have played a greater role than indicated in his development. She also makes a good case for Mr. A’s castration anxiety and what she calls his “Oedipal paradox,” that is, is he the mother’s favorite or is he more like a woman? Finally, I think Basseches makes an important distinction between fantasies of sadomasochistic activity and the enactment of a sadomasochistic relationship within the transference.

The former would seem to allow the analyst some greater distance than the latter.

In a poignant reminder of what we’ve lost, the book ends with a discussion by the late Leo Rangell. In his usual blunt fashion, he points out the terms sadism and masochism are not well defined, as is the case with aggression, which is seen as the driving force behind sadomasochism. He notes that aggression is not synonymous with sadomasochism and that true sadomasochism might best be studied on “death row” in prisons rather than the psychoanalyst’s office.

Similar to Basseches, Rangell sees the patient and the analyst he elicited as “good clinical examples of a complex, multi-layered, chronic neurosis” (p.277) typical of earlier clinical practice. He goes on to make an excellent case for this idea. He felt that the dramatic expressions of sadism or masochism were side issues and that Mr. A was grateful the analyst didn’t make too much of them. He further questions theories of aggression, of which much remains to be learned.

I will end this review in praise of Rangell’s thoughtful approach to this topic and the many others he addressed in his lifetime. He explained, “my way is to first identify and describe the phenomenology in question, then to delineate the relevant background theory, trace the developmental steps in the particular case history, and to attempt any generalizations that may be possible from such a combined approach and investigation” (pp.273–274). I would say that the editors of this volume have masterly succeeded in following Rangell’s scholarly approach and we are richer for it. As we continue to struggle in working with sadomasochistic patients, this book helps us learn more so that we can continue the struggle. This is a terrific contribution to the literature. z REFERENCES Schmidt-Hellerau, C. (2009). You’ve hurt me: Clinical reflections on moral sadism. Psychoanalytic Quarterly, 78(1), 233–241.

Valenstein, A. F. (1973). On attachment to painful feelings and the negative therapeutic reaction. Psychoanalytic Study of the Child, 28, 365–392.

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Seduction and Desire: The Psychoanalytic Theory of Sexuality Since Freud Victoria MALKIN

Ilka Quindeau assigns herself no small task. In an era when niche sexualities proliferate throughout virtual chatrooms and private parties, when reproductive possibilities Seduction and Desire: The Psychoanalytic Theory of Sexuality Since Freud

By Ilka Quindeau London: Karnac 320 pp., $24.99, 2013 are no longer entirely dictated by nature, and when same-sex marriage has become a matter of rights, it is hard to know what more we can ask of sexuality or what else remains hidden.

Within the field of psychoanalysis, debates about race, class, and the Other appear to have displaced arguments over sexuality and pathology. We appear to have settled our differences and sunk into a comfortable complacency over the failures of classical psychoanalysis to deconstruct its limitations and ideological straight jackets. We have moved beyond our past and loudly reject the idea of characterizing specific sexual desires as symptomatic of underlying pathological symptoms per se and now explore the meaning and function of any given sexual pleasure, practice, or fantasy in the context of a person’s personal biography. Plurality blooms as we traffic in multiplicities, genders, sexualities, and unlimited possibilities for making meaning.

As a result, flipping through subheadings and chapter titles that highlight perversions, anal eroticism, urethral eroticism, and infantile pleasure, the first temptation is to assume this book has little to offer an enlightened audience: isn’t this debate over?

But Quindeau’s thoroughly argued and persistent insistence on a revival of attention to infantile sexuality and a reintegration of the body, which leads to a refocus on pleasure and gratification—a call to revive the central role of the sexual (not sexualities) as the original force behind a dynamic unconscious—is worthy of attention. It may pull the pendulum back from what might seem like looping discussions around relationality where primacy is given to affect regulation in self states, attunement and failures, and trauma and dissociation, all of which have important roles in any analysis but leave the unconscious poised to generically contain anything that remains unspoken, unlived, or unfelt at any particular moment. Quindeau brings the reader back to what was at stake at the beginning of psychoanalysis, and returns to the vitality of the sexual that was part of our origins (metaphorical and literal) and has been buried under subsequent development. We

might even question if this is symptomatic of our participation in a culture that desensitizes us to the sexual when “sex” is everywhere. As psychoanalysts, we resist our vulnerability to compassion fatigue, but have we been bombarded into a sexual fatigue further exacerbated by our own uneasiness regarding our patriarchal beginnings?

In her book, Quindeau confronts the hegemonic and normative narratives that permeated Freud, which would later be solidified by certain followers who were more focused on teaching patients to adapt than on restoring a connection to an elusive but enlivening inner world. Her goal is to rescue the radical, to resuscitate infant sexuality and desire by bringing it back into the center of the Freudian subject matter. To do this, she returns to Freud in his earlier years—a more open and questioning Freud, less burdened by the need to control his legacy.

Beginning with the Three Essays in which Freud outlines the remarkable steps an infant takes as gratification and pleasure suffuse being, Quindeau reminds us that drive was never meant to be an endogenous force looking for satisfaction. She dissects the current shorthand that places drive squarely in the realm of the biological, synonymous with instincts and urges—a pressure cooker in need of release. Determined to rescue the Freudian drive from this misreading, she returns it to a status of desire and wishing; a meeting of soma and psyche as the baby cycles through its experiences of having and losing. Desire cannot come into being until we experience its absence—I know what it means to have the breast because it disappeared. A curse that follows us into adulthood as desire remains elusive; we are dedicated to a pleasure that is continually lost and (re)found.

For the infant, gratification partnered with desire travel throughout the body, wandering through oral incorporative needs to anal struggles and release to genital satisfactions. Quindeau revives the psychosexual stages, showing how they compel the infant’s awakening. The self here is an embodied self discovered through bodily experience and accompanying wishes. Infancy is an ode to recovering from loss through pleasure, a continual calibration of disintegration and narcissistic disturbances to overcome. Until at last, in the genital and phallic stages, the infant comes to know his or her body, finding his or her own pleasure and assertion via masturbation. No longer just the path to separateness, but that which also enables the infant to relieve what has continually disappeared: the desire for the hand, the touch, the gaze, 10

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or physical care are continually recycled, remembered, enjoyed, and lost—ephemeral but everlasting traces of pleasure.

While bringing these early moments back to our attention, Quindeau expands infancy through a reading of Freud’s seduction theory via Laplanche to elaborate on how the experience of the drives comes into being through an Other. The baby, omnipotent or undifferentiated, really does not exist without a mother. There is no satisfaction without her physical presence; no wishes granted without an Other who feeds, rocks, strokes, caresses, and cleans the child. For Quindeau, these are actions that fall under the cover of the sexual; they contain “enigmatic signifiers” (Laplanche) from the mother that remain and structure an infant’s unconscious and psyche through a lifetime. A transmission of desire takes place between generations, from parent to child.

Unconscious desire metamorphoses from mother to infant and resides like an ember, taking shape and disappearing from view. Quindeau believes we are brought into being through intersubjectivity, but she is clear this is no symmetrical relationship between parent and child. She chides developmental psychology with its metaphors of an infant who organizes its own experience: Today, from the first moment children are considered active, curious, communicative and competent…they prompt adults to behave according to their wishes and needs.

Though all these behaviours can be observed in infants, this list can almost be taken as a job description for senior managers. (p.10) Our relational beginnings are inaugurated through a necessary seduction, but Quindeau rejects this incursion as a necessarily traumatic encounter. First, she argues the lack of ego structure in the child means there is no actual incursion or confrontation; the structure first needs to be in place for a trauma to ensue. She then questions Laplanche’s assertion that the infant’s inability to process the encounter renders it traumatic. Rejecting any rationale behind this assumption, she argues it is rather an absence of stimulation, as opposed to its presence, that would lead to trauma. A mother’s desire and her unconscious sexuality is there, neither necessarily traumatic nor overwhelming, but always Other and enigmatic. In this encounter— structured through a hierarchical relationship—we are left with the intersubjectivity of Beebe and Lachman (2005). The infant here is seduced into being, not cooed into action.

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The desire of the adult is directed at the infant, as a claim or demand that is being made. The infant responds to this demand by generating his or her own sexual desire.

The constitutive process of sexuality, and beyond this of the entire psychic structure, could be taken as a pointed modification of the famous Cartesian cogito ergo sum and reformulated as desideratus ero sum, I am desired therefore I am. (p.14) While advocating intersubjectivity, Quindeau flies her flag on the ocean of sexuality. Her goal is to reanimate Freudian thought, not to jump ship. It is a European trajectory.

She frequently highlights this distinction in her reading the American position as clinging to ego psychology and a basic biological determinism. Quindeau is writing to a German audience and combines her reading of Anglo literature with German psychoanalytic writers to remind us of our own parochialism.

Even when we object to her arguments based on our own knowledge of our literature, we

can appreciate her attempts to engage us in ways we rarely engage with literatures from beyond our language map.

While Quindeau points to desire as a precursor for subjectivity, she separates her view from that of Lacan. For Lacan, desire emerges through the moment we discover we are no longer the sole object of maternal desire, at one with (m)Other, where our lack haunts us as a wound in our structure—an absence in being. Quindeau asserts her particular view and asks us to accept her use of desire “without making (explicit) reference to Lacan, in order [for me] to continue a discussion of Freud’s original concept of Drives.

If the result is congruence with Lacan, this is more coincidental then intended” (p.18).

“The lady doth protest too much”; notwithstanding, her goal is to reclaim infant sexuality as constituted through the Other’s desire and then emerging through the partial drives, or wishes, of infancy.

Infant sexuality, whose roots are determined by the Other, weaves its way into our bodies, our fantasies, and our adult lives, emerging though the rainbow of imaginaries that is adult sexuality, where fantasies and practices animate its journey—from the wish to be receptive or penetrate, to incorporate or expel, to touch and be touched, to look and be seen. We all begin as polymorphously perverse and remain subject to our unknowable desire. Our lives are shadowed by the primacy of this Other, whose seduction is at the core of our being, lodged into our unconscious. Our autonomy is a comforting fallacy. Our relational beginnings engender the very alterity and Otherness that is our life force and our nemesis.

Quindeau continually highlights Freud’s shortcomings and foreclosures: his normative values that led to mistaking prevailing ideology as a universal descriptor of a phallic order. Nevertheless, she remains rooted in a Freudian developmental schema: from a child moving out of his or her early struggles organized around narcissistic gratifications toward self-assertion via masturbation, and then further moving into the phallic and Oedipal space. She redefines the phallic stage, which is no longer about the power associated with a penis (with having and controlling it) but about the discovery of having a sexed body (where pleasure or desire now gets located into a genital area) or not having one. It is a stage where sexuality becomes localized and concentrated on both inner and outer genital spaces—present in both boys and girls. If there is a fear of castration, it is a fear of losing a sex, not of losing an organ. Perhaps a fear that I shall no longer be able to control my pleasure. The Oedipal is no longer an incarnation of a struggle over who has or doesn’t have a penis and concurrent revenge fantasies and guilt, but is now a triangulation where the child discovers a primary love object and becomes located both sexually and temporally as she or he comes into being as a sexed body, as someone who exists in a binary (hegemonic) heterosexual order with the knowledge that there is an Other who comes before; a sense of generations and a fear of incestuous wishes for both sexes and genders. The emphasis is on the move to sexuality as coded within the social order, a body with a sex, and on what we lose in this moment and how it resurfaces throughout our different developmental stages.

Quindeau sees this encounter with sexuality as the core of analytic work, where we are discovered as subjects in formation and we aspire to integrate the Other within ourselves. An encounter with a sexuality that contains the enigmatic signifiers that cause it to be, a life that came to life through the Other’s desire and under the sway of the sucking, the pleasure of expelling and receiving, the excitations of the 11

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genital, all of which remain and are continually reinscribed as the child gets older and travels through different affective, emotional, and cognitive capacities that move meaning backward and forward through Nachtraglichkeit. Our experience recalls other moments as memory traces push forward and are continually reinscribed and made meaningful through a particular life stage and set of conflicts one is experiencing in the present.

After she establishes her premise, Quindeau’s thoroughness is beguiling. Her examination of the multiple writings and debates around gender and sexuality provide a serious context for her theory building as she engages with bodies of work over time and develops her own ideas (while generously acknowledging others). The book, organized as three long chapters, takes on many of the well-known arguments against a scripted development process. With a depth of scholarship that can unfortunately run toward the pedantic, she highlights old but still riveting debates.

Quindeau writes to address her critics.

Her travels through the dissenters and debates over the question of female sexuality lead her to previous debates where Horney, Deutsch, Jones, and others argued over the lack of female desire in the phallic model and either posited an essential female sexuality or ever-more complicated female developmental pathways. The thinking she outlines around questions of sex, menstruation, pregnancy, and motherhood is pleasing and questioning in the scope of the debate, highlighting both the variability and lack of coherence in models that give birth to specifically female and male modes of sexuality.

Quindeau ultimately rejects essentialism for sex or gender along with biological explanations that limit and foreclose our experience.

She holds onto an idea of sexuality that demands us to explain heterosexuality as much as homosexuality, masculine as much as feminine, and take the body as our starting point for our psychic lives. For her, the search to define ever-more sexualities, specific and particular, reduces possibility. In essence, our sexuality precedes and overtakes us. While our sexual life might be collected into social identities and self-coherence, this remains a fantasy of knowing; a certainty of identity that escapes ourselves and our unconscious.

Aware of the precariousness of her position in relation to a positivistic demand, Quindeau discounts empirical research that seeks to understand infant sexuality from premises laden with adult projections and translations of meaning through adult experience. For Quindeau, the meaning of infant sexuality can be understood through the Nachtraglichkeit of our symptoms, fantasies, and memories. She unabashedly defends

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the hermeneutic stance. For her, theory is “correct” to the degree that it makes sense of the world and our experience. Infantile sexuality is a meaningful and valid construct insofar as it makes sense of the myriad and complex forms of sexuality and sexual experience that are part of adult life. The idea of sexuality as an endogenous force that emerges in puberty does little to explain the power of fantasy or desire as it exists, nor the risks people take to pursue it.

Quindeau is committed to a constitutional bisexuality. The unconscious has no particular sex, no gender, and no body. She refutes the idea of a core gender identity as proposed by Robert Stoller for its inherent assumption that this could be conflict free.

Nor does she accept the asexual narratives of Irene Fast and others who characterize the move into sex and gender as a loss of omnipotence, a move from an undifferentiated state to a differentiated experience that includes limits and boundaries. While acknowledging the psychic work that differentiation takes, she challenges the idea of an asexual omnipotence that precedes sex and gender as implied by Fast. For Quindeau, the infant comes into being within an economy of gratification and pleasure, which is always sexual. We are hostage to a reality principle where the experience of infant sexuality with its polarities between states— such as receptivity, phallic power, oral incorporation and unity, anal sadistic pleasures, among others—remains as memory traces, shaped according to our particular encounter with an Other and then shocked into silence as we land into the social and its demands on us.

Quindeau is at her most challenging as she carves a singular path and delineates her differences. Through her critique, she separates herself from a developmental trajectory that posits object relations as preceding sex (I know I am a girl, even if I don’t know I have a sex) because it assumes that gender precedes sex and thus that sexuality requires object relations. Examining the work of Nancy Chodorow and Jessica Benjamin, she values how they highlight the ways in which gender is reproduced through social relationships, but takes on their thinking for the ways in which they end up reifying gender differences, obscuring what remain similar in men and women’s psychic structures. Chodorow poignantly explored how mothering has been reproduced through intimate relationships and identifications, while Benjamin elaborated Chodorow’s discussion by asking how female desire comes into being when a mother’s agency and desire remains compromised. For Benjamin, it is the father who becomes the source of separation and agency through the possibility of providing (male) recognition, while

the mother remains the provider of care and nurturance: the supplier of gratification and need. Although, just what recognition means, and on what psychic level, is unclear.

In these developmental journeys a differentiated (gendered) subject emerges prior to the Oedipal stage, at which time, sex and desire emerge through new identifications and concurrent dis-identifications; although we never learn what it would mean to “dis-identify” either as a process or in relation to psychic structure.

Quindeau challenges these thinkers to bring back the sexual and show how it has been erased from a discourse where gendered identifications precede the sexual and where recognition replaces gratification. She rejects a time where we lived unchallenged by our desires until sexuality emerged at the genital stage constituted as male or female.

She emphasizes our sameness in terms of the male and female psyche; difference is not focused on what she sees as social, but on the level of the primacy of an Other. Recognition under these circumstances is impossible when we are all structured through an Other to which we struggle to gain access. It is not that we are strangers to each other who need to meet as subject to subject, but that we need to accept that we cannot fully know the Other in or between ourselves.

Quindeau’s Freudian baby gathers the bodily experiences and wishes into her unconscious, where desires to merge, incorporate, and have all erotic parts live on in fantasy. If we are doomed to the irrevocable demands of subjecthood as we are forced to enter into “the symbolic order,” it is the demand that we live as sexed and gendered beings that haunts us, an experience captured by Judith Butler in her idea of melancholy gender, where the compromise of giving up our same sexed identification and loves leads us no alternative but to introject them, leaving them like shadow puppets with whom we sleep. We live in a state of melancholy when it comes to sex—wanting it all, but at what price? For sanity, the adolescent moving into adult sexuality might need to cling to rigid identifications to manage the cacophony of desires while he or she struggles to develop a sexual identity.

But for an integrated life, Quindeau speculates that we should strive to constantly loosen these identifications and rigidities, resymbolizing our desire, searching for more access to the spectrum of fantasy and gendered identifications and introjects we carry with us. Following the thought of Donna Bassin, she advocates the possibility of creative symbolization, of working to accept the polarities of our sexual and gendered identifications and introjects, to become less threatened by our certainties and the rigidity of the heterosexual order.

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One might come away from reading Quindeau reeling under the weight of her nearly dogmatic authority—it seems a far cry to the currency of contingency and nonknowing. Alternatively, one might be refreshed by her stance. She too cheerily dismisses the primacy given to other “drives” in psychoanalytic history, politely acknowledging the role of aggression, self-assertion, attachment, and primary love as new ideas in our canon and then, with a slight of hand, minimizing them for the primacy of the sexual. Quindeau is theory building—how this works in clinical practice remains for her next book—but underlying this is a focus on fantasy: not to uncover an actual truth, but to recover and explore an Other. It is hard to imagine our parade of patients today encompassed in her one overarching theory.

Nevertheless, if we are prepared to take her insistence as a desire and let it reside in us, it may influence our clinical work in surprising ways.

If we heed her call to the sexual and, in particular, her unapologetic commitment to it along with a constitutional bisexuality in an era where biological narratives reign supreme, we may indeed help our patients to address some of their more anxious fantasies about the alterity of their own desires. There is something refreshing in Quindeau’s refusal to entertain either a biological bedrock that determines our lives or to replace the sexual with its absence in attachment and object relations. Her commitment to reject those discourses to which we find ourselves more and more subject allows her desire to flourish. She remains true to herself and reminds us that narratives of certainty, biological or developmental, when it comes to sexuality, may be fiction more than fact, comfort more than guarantees.

Foucault showed us that power is not only repressive but generative and that it generates and pushes us to think about problems and experiences in certain ways. Our current era provokes us into being biological subjects, where questions of citizenship and rights stem from this certainty. It is up to us to ask why we need these narratives and whose interests they serve. Freud spent his life trying to escape discourses of his day to reformulate problems into a new language that escaped the currents of his time and its way of thinking. However much he was hemmed in by his own subjectivity and blindsided by his biases, he left us a project that continues. If Freud may have ultimately been consumed with his questions of prohibition and conscience, Quindeau demands that we ponder our inability to know ourselves and our desire in the shadow of the Other. z REFERENCES Beebe, B. & Lachmann, F. (2005). Infant Research and Adult Treatment: Co-constructing Interactions. New York: Routledge.

Laplanche, J. (2011) Freud and the Sexual. New York: Unconscious inTranslation.

BOOK REVIEWS

A Psychoanalytic Life Roy Schafer’s book is a meaningful read for psychoanalytic therapists for a variety of reasons. Among the most important of these is the opportunity for the reader to look into Tragic Knots in Psychoanalysis: New Papers on Psychoanalysis

By Roy Schafer New York: Karnac, 196 pp., $35.95, 2009 one man’s intellectual journey of development through his career and his continued study of psychoanalytic ideas. Whether or not you see ideas similarly to Schafer (who is very persuasive), it is a model of thoughtfulness that we all might wish to emulate. Another reason for the book’s value is Schafer’s clinical acumen: he makes the exchange between therapist and patient come to life in a deeply penetrating manner. Not the least of reasons, but especially worth mentioning, is the way he weaves his clinical insights into a complex tapestry that repeatedly demonstrates the necessity of maintaining an open mind to “this and that” and abandoning “either-or.”

I have known about Roy Schafer since I “hatched” as an adult, if I consider “hatching” to be when, while doing my undergraduate senior thesis on color/form incongruity in ink blots (Siipola, 1959), I was first introduced to the psychological testing book Schafer worked on with David Rapaport and Merton Gill (1945–1946). Following college and before graduate school, I worked as a research assistant to Dr. David Shakow, well-known for his research on schizophrenia and his leadership in clinical psychology education. He had formed the first laboratory of psychology at the National Institutes of Mental Health (NIMH). Psychoanalysis was in its heyday in the United States then, although psychologists were mostly relegated to marginal roles (in that climate) as researchers and not regulars inside the APsaA tent until years later. In and out of our office came the famous in the field and I saw the backs of the heads of many important people. Among them was David Rapaport, who was especially close to David Shakow. When I left NIMH to go to graduate school in clinical psychology, I was soon studying the Rapaport, Gill, and Schafer psychological testing book first hand. Later, as a member of a local chapter of Division 39 (the WPSP), and still later, as a candidate and then member of the New York Freudian Society (NYFS)—now called the Contemporary Freudian Society—I had occasion to meet Roy Schafer and his wife, Rita Frankiel, a member of the NYFS, and through planning scientific meetings and other activities I became familiar with his developing thinking and writings.

In the last chapter (chapter 10) of his book, Tragic Knots in Psychoanalysis, Schafer

Harriet I. BASSECHES

describes “The Author’s Odyssey” that lays out the path he followed in his psychoanalytic thinking. In the description detailing his progress, he presents his major conflict in theory development: that he admires the founding thinkers in the field (“his psychoanalytic parents”) and persistently wants to question their formulations. As he himself explains, he has “profound respect for the traditional and a strong impulse to challenge it, improve it, and if necessary, change its focus” (p. 158). He sounds to me as if he has found the metaphoric solution to his Oedipal conflicts and, in the process, developed the most wonderful way of enjoying his identifications while becoming his mature self. In commentary about another of his books, Bad Feelings (2003), Schafer was described as creating “a highly successful synthesis and integration of Freudian, ego-psychological, and neo-Kleinian theory.” While I agree with that idea, I would want to add that he provides a very personal integration that constantly brings the ideas closer to everyday discourse; he makes the ideas digestible, real, and sensible—as in, down to earth and capable of resonating with the readers’ own clinical experience. At the same time, the changes he proposes do not seem superficial. He has taken his mentors’ ideas into contemporary debates and updated those ideas to remain relevant in the current psychoanalytic world.

Schafer orients his chapters around a concept that he calls “tragic knots.” The idea is complicated, but what I think he is getting at is that life, as it can be understood and studied in psychoanalysis and literature, can be experienced through impossible or tragic choices. These are not necessarily tragic in a heroic and fixed way, rather in the sorrowful recognition that reality limits sometimes in very unhappy ways. He also suggests that such tragic knots often have elements out of one’s control and perhaps without the possibility of considering the outcome. He illustrates this with the dilemma of Cordelia in Shakespeare’s King Lear. Cordelia loves her father and is asked to compete with her sisters to express devotion to their father beyond realistic possibility, but her personal integrity foreswears her participating in such distortion, leading to tragedy for her and her father.

With that template, Schafer more directly enters into the field of the analytic setting.

Throughout the pages there are so many pearls it is difficult to settle on what to describe. I think what I found most useful was the repeated mention of the complexity of feelings and thoughts; Schafer emphasizes not only multiple determination—that is, feelings and thoughts come from multiple sources—but also how often its opposite or perhaps variants can be at odds with the main 13

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tenor of the communication—be it verbal or nonverbal—making meaning so much richer.

Furthermore, he sees that these feelings and thoughts influence and are influenced by the interaction with each other in the analytic discussion and are constantly infused with matters from external and internal realities. These are the tragic knots of the analytic situation.

For Schafer, the conflict model continues to hold a meaningful place in his sense of the analytic dialogue, which he describes as a narrative: the patient’s narrative that makes space for the analyst. To me, the conflict model comes quite close to the idea of tragic knots. At least initially, the patient’s often unconscious fantasies, wishes, efforts, and defending positions comingle and interweave with the analyst’s interpretations and unconsciously driven reactions as well as the analyst’s fantasies, wishes, efforts, and defending positions: making tragic knots that call for understanding. Schafer considers such concepts as forgiveness and whether it can ever fully occur and how frustration, if unattended, can thwart the analyst’s ability to function most effectively. Schafer emphasizes the hermeneutic focus of explanatory interpretation that establishes reasons, not causes. While I do not think I do justice to Schafer’s beautifully reasoned positions, almost any paragraph captures a meaningful peek into the theoretical but especially the clinical experience. For example, in chapter 4, “Caring and Coercive Aspects of the Psychoanalytic Situation,” Schafer points out: The analysand’s desire to collaborate in the work of analysis is often associated with a fantasy of submitting to coercion. The fantasy centers on surrendering to the analyst’s will. Following instructions and abiding by limitations is, of course, adaptive on one level, but on another it can be experienced as subjugation. Consequently, collaboration can foster mixed or alternating feelings of self-satisfaction, fright, humiliation, excitement, relief, and the bliss of utter passivity. (p. 62) That small paragraph gives you a taste of the insights Schafer offers. It is like being supervised by a wise mentor who can help the therapist to see the interaction from a whole new angle and therefore improve one’s listening capacities. The book is full of such wisdom. Do take a look! z REFERENCES Rapaport, D., Gill, M. M., & Schafer, R. (1945–1946).

Diagnostic psychological testing (Vols. 1 & 2). Chicago, IL: Yearbook Publishers.

Schafer, R. (2003). Bad feelings. New York, NY: Other Press.

Schafer, R. (2009). Tragic knots in psychoanalysis.

London, UK: Karnac Books.

Siipola, E., & Basseches, H. (1959). The relation of color form incongruity and maladjustment to reaction time.

Journal of Personality, 27, 324–345.

BOOK REVIEWS

A Field Guide

Catherine SANCIMINO

Parenting manuals and books about child rearing abound in the modern literature of how-to and self-help. New parents can find books for almost any subject related to raising Family Entanglement: Unravelling the Knots and Finding Joy in the Parent-Child Journey

By Ellen L. K. Toronto with Robert S. Toronto Create Space Independent (Kindle), 276 pp., $4.99, 2013 a child—from teaching sign language to a preverbal infant, to creating a structured behavior system for an oppositional adolescent, to scheduling time for adult activities away from the offspring. Many of these books refer to specific strategies and practices that promote functional communication and a healthy environment in which growing children can learn and thrive. Family Entanglement: Unravelling the Knots and Finding Joy in the Parent-Child Journey, written by Ellen L. K. Toronto with Robert S. Toronto, offers something new. Influenced by her training as a psychologist and psychoanalyst, Dr. Toronto writes about parenting as a memoir and philosophical guide.

She explains the psychological and developmental needs of children and their parents without psychoanalytic jargon so that her meaning and personal accounts may be understood by a nonclinical audience. As such, Dr. Toronto provides an autobiographical account of how her children changed her life and how she learned to parent along the way.

Dr. Toronto begins Family Entanglement by explaining her purpose: developing a sort of field guide to communicate an approach to parenting that allows family members to build relationships that provide continual opportunities to live with authenticity and abundance.

This is not a concrete, step-by-step manual designed to teach a specific skill or manage a particular developmental task; rather, it is a general guide to help the reader understand how our own human histories and early relationships affect who we are as parents as well as what parents can do to create an environment of mutuality and respect for the entire family. A focus on self-awareness and personal accountability remains a constant theme throughout the book, as Dr. Toronto frequently explains to the reader how her own childhood impacted her parenting. In the first chapter, Dr. Toronto identifies the “see-saw” model of parenting: a model that addresses developing reciprocity with children by respecting a child’s individuality and recognizing the parent’s role as teacher. Commitment, connection, balance, and belief are all necessary elements for the see-saw model to function efficiently and harmoniously.

Following the first chapter, Dr. Toronto elaborates on the model of see-saw parenting

and describes some fundamental aspects of healthy psychological development. She explains how parents must provide a secure base and an emotional presence for their children while recognizing and relating to the child’s emotions and attachment needs. She emphasizes that regular communication between all family members and family-oriented activities help achieve balance and structure within daily living, which provide reassurance and express love and support. The poetic language Dr. Toronto uses to explain both psychological concepts and her experiences as a mother conveys a genuine sense of awe and reverence for the journey of parenthood.

Dr. Toronto notably identifies the significance of her religious beliefs to clarify how her values influenced her parenting style.

She emphasizes a parent’s responsibility to provide opportunities for a child’s spiritual expression regardless of the parent’s religious or spiritual orientation. This leads into Dr. Toronto’s description of how a child develops sense of self and what parents must provide for their children to perceive the world as a safe and trustworthy place. She describes the original adaptive function of defense mechanisms and how they later prevent an individual from accessing his or her own “basic essence”—what she refers to as the unique true nature of a person. This basic essence can be nurtured by living abundantly but is blocked by a need to protect and defend oneself from painful and unpredictable environments. Dr. Toronto describes some aspects of psychological functioning and defense mechanisms, but does so without pathologizing the individual who exhibits neuroticism or psychological disturbance.

Additionally, she describes the strengths of an abundant family environment as well as the parental responsibility to demonstrate how to live abundantly through action, which serves to protect one from losing touch with this basic essence.

Throughout the book, Dr. Toronto uses her family history and personal anecdotes to describe experiences of parenting. She broadly utilizes her relationship experiences with her family of origin and her nuclear family as examples of how relationships with primary caregivers translate into relationships with one’s own children. Through these personal stories, she demonstrates how each individual in a family unit influences and is influenced by other individuals. When Dr. Toronto writes about adolescence in the later chapters of Family Entanglement, she includes stories 14

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written by her four sons to demonstrate how her own children perceive her parenting. Her spouse, Dr. Robert S. Toronto, also a psychologist, contributes personal anecdotes to clarify how he experienced parenthood and his role as a father. These later chapters focus on guiding children through school-related issues, sibling conflict, budding sexuality, and modern technology. The final chapter shares Dr. Toronto’s sometimes very painful experiences of watching her children become adults and leave the nest. The memories shared by her family members demonstrate some of the real-life achievements and struggles they experienced within family life.

With Family Entanglement, Dr. Toronto has created a memoir of family life complete with a detailed personal history and descriptions of human development and psychological functioning. Dr. Toronto writes in a

poetic style with language that demonstrates her wonder and devotion to being a parent who was actively engaged throughout her children’s lives. She provides stories that exemplify the challenges that arise while navigating new areas of parenthood and refers to her religious and spiritual beliefs as a source of support. While references are made to psychological blockages, Dr. Toronto does not speak in psychoanalyst-ese; she writes instead for an audience of adults open to self-reflection and intellectualism. Dr. Toronto encourages new and prospective parents to wonder, through thoughtful consideration and self-awareness, how their decisions as parents will be affected by their own childhoods and life experiences and provides examples of how she and her spouse did just that to raise four well-adjusted sons. z

BOOK REVIEWS

What Is Madness?

Mark STAFFORD

To define true madness— what is’t but to be nothing else but mad Polonius, Act II, Sc I, Hamlet Polonius is a pedant whose chatty platitudes ironize the traditional role of the father as authority and advisor to his children. Hamlet, who he addresses, feigns What Is Madness?

By Darien Leader London: Penguin Press, 264pp.,£7, 2013 madness to solve the mystery of his father’s murder only to find himself in a distinctly modern relation to madness—in thinking he controls madness, he becomes mad.

Shakespeare’s (1559) poetic reflections on madness—and practically every play contains a reference to it—are followed later in the 16th century by Pascal (1669), the greatest rationalist, who wrote in his Pensées, “not to grant a place to madness in the understanding of humanity would be madness itself.”

For the Romantic movement, this rationality risks the repression of the nature of humankind and madness becomes equated with forms of insight that contribute to works of genius in art and music. Some aspects of this romantic validation of madness reprise the role of the “daimonic” in classical civilization, as Nietzsche (1886) forcefully argued in the distinction he makes between the spirits of Apollo and Dionysus in The Birth of Tragedy.

With the exception of Pascal, most Christian theologians equated madness with possession by the devil, and while a place was made for the holy fool in medieval culture, with the Christian reformation came the attempt to defend the notion of a stable self—one that communes directly with God— and hence, madness, the de-stabilization of the self or ego, is equated with some form of satanism or punishment for sin.

Nineteenth century and some 20th century psychiatry has retained a complicity with this theological conception of madness.

The resistance to the ideological notion of a stable self has marked both postmodern thinking as well as one of the inspirations for postmodernity—the anti-psychiatry movement of the 1960s and 1970s.

The leaders of that movement, R. D. Laing (1970), Donald Cooper (1978), and their philosophical allies, Michel Foucault, Gilles Deleuze (1968), and Félix Guattari (1968) (working at the La Borde clinic), saw the institutionalization of the schizophrenic as a repression of a creative potential in order to resist the increasingly mad demands of a highly regimented society. Largely

unbeknownst to them, the Soviet psychiatric establishment was using and disseminating the practice of incarcerating under the label “mad” anyone who expressed ideological opposition to the Soviet system.

The instability of the human subject’s relation to its body, and thus the psyche, is certainly rooted in the biological prematurity of the human infant, but madness is as rooted in the ideological operations of culture as it is in biological substrata.

As effective medication for psychosis began to empty into the great holding cells of the psychiatric asylum, a new form of ideology emerged based on the possibility, rather than the precise proof, that psychosis was rooted in genetic disorder. This conviction in a biological basis for psychosis would readily dismiss Polonius’s claim that to define madness would be a sign of it. At perhaps no other time in the history of madness has the equation of madness with “abnormality” been so great—even though it is relatively easy to show this idea of “normality” is based on a theological and ideological conviction that the self is essentially stable.

What then do we make of Hamlet: a manic depressive, a victim of bipolar disorder, an abnormal self whose struggle with his guilt and inability to avenge his father hold no other human significance than being a poetic representation of the symptoms of his biologically determined abnormality?

Perhaps the answer to the enigma of the play is that Hamlet’s father or grandfather was also schizoid.

The contemporary conviction, expressed by eloquent advocates for the thoughtful treatment of the “mad,” such as K. Redfield Jamison (2000), is that only more research will relieve the suffering.

Despite the fact that in her own memoir of going mad, Jamison reveals how important the love and patience of her husband, who is also a psychiatrist, was in her most severe psychotic episodes. Can we really be so blind to the obvious that madness can be worked with if there is a desire to care for the mad rather than a phobic classification of their instability as “abnormality”?

The return of the idea, via an ideological use of genetic research, that madness is a biological inheritance ignores the phenomenological observation of all the various theories of human development; that since the human infant takes so long to acquire even a modicum of agency and is dependent on the care and treatment of the Other for such a long period of time, it is not possible to rationally argue that the response to the helplessness of the infant and 15

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its introduction into the field of symbolic activity does not have a consequence on the creation of a subjectivity equal to any biological determinants.

As Leader points out in this eloquent and intelligent study, our contemporary society has condemned itself to a confusion about madness that impedes the actions that might ensure a place of safety for those among us who endure a form of psychic pain and illness that has been found constitutional to human subjectivity since the earliest studies of human psychology. This is not a reprise of anti-psychiatric radicalism. It is a brilliant critique of the nosological mania that ignores that psychotic symptoms are quite often readable so long as we acknowledge them when the individual subject is unable to gain access to a sufficient degree of symbolic activity—a conse-

contemporary society has condemned itself to a confusion about madness that impedes the actions that might ensure a place of safety for those among us who endure a form of psychic pain and illness quence of a variety of forms of deprivation, trauma, and isolation. The subject will then have to foreclose the entry point into an engagement with the Other. This foreclosure is not biologically determined but is the consequence of the fact that to become human, a subject needs to be able to inscribe itself within signifying practices that enable it to speak and articulate its own desire.

As some of Freud’s (1911) earliest studies of the psychic apparatus revealed, we are all capable of hallucinations and our beloved ego is the seedbed of paranoia.

Freud was also one of the first to point out, in his study of Daniel Schreber, in contradiction to the supposed primacy of reason, that it is the mad who frequently give us the best guidance to their condition. As Octave Mannoni (1968) remarked, “we are all in a sense partially cured psychotics” and as clinical practice frequently reveals, many of us may experience or be overwhelmed by an agonizing alienation.

Darian Leader, an English psychoanalyst and author of an excellent study of depression, melancholia, and loss, The New Black, has nuanced some of Freud’s research into psychosis by providing an unusually clear clinical exposition of the value of Jacques Lacan’s (1966) study of psychosis. Leader has incorporated in this highly readable book a remarkable survey

BOOK REVIEWS

of the post-Freudian literature on psychoanalysts penned by a generation of analysts who are largely forgotten. As this tradition has been largely discredited and dismissed since the 1980s, Leader’s book will be of particular interest to North American clinicians who may have come to believe that the era of the psychoanalyst contributing to the well-being of the psychotic is over.

However, it should be said that a substantial portion of the book concerns itself with clinical vignettes—one of which reprises the story of Lacan’s famous patient Aimée; another of which introduces the history of Harold Shipman, an English doctor who killed a large number of his elderly patients.

This case material may feel culturally un-

of the patient should approach the kind of detail shown by the founding figures of modern psychiatry such as Bleuler (1911) or Kraepelin (1913).

Leader’s psychoanalytic approach to the clinic of psychosis reminds us that these phenomenological studies of psychosis— Bleuler, Kraepelin, Jaspers, and others—not only took the time to provide detailed life histories of the patients, but they emphasized that the timing itself of a paranoia or breakdown was crucial to understanding what form and role the madness was playing in the subjectivity of the patient.

In Leader’s view, one of the things we fail to do, trusting so heavily in diagnostic criteria that are dictated by evaluations of

familiar to some readers and to some degree detracts, as does his revisiting of the case of Sergei Pankejeff—the famous patient of Freud who became known as, and preferred to be known as, the “Wolf Man.” As a psychoanalyst rather than a psychiatrist, Leader always emphasizes the singularity of each patient’s history and the specific moment at which a psychotic episode has been triggered. No doubt there are many psychiatrists who do pay great attention to the life histories of their patients and the timing of a psychotic break, but any reader of DSM-5 or the Psychiatric Desk Reference will be unable to find any recommendation to the clinician that the degree of attention to the overall life history

current behavior, is to allow the history of the patient to provide a frame within which an evaluation can be made of a period of psychosis as possible to treat or possibly permanent and impervious to cure. In either case, such evaluation takes time and if that time is not taken, there is no possibility of recognizing that it is crucial to respect that where symptoms of paranoia, schizophrenia, or manic depression appear fixed, they are often the result of an attempt at self-cure and protection.

Leader is well versed in the history of anti-psychiatry but points out that its successes were often the result of simply taking a less authoritarian position toward the patient. He is certainly not naïve about 16

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the social treatment and conditions under which many patients were confined and treated during some of the more distinguished periods of psychiatric research.

What he underlines is the seriousness and importance of these researchers and the relative ignorance of contemporary practitioners, who trained with a positivistic and neuropsychiatric approach, predominantly searching for a genetic and generic categorization.

Leader’s re-evaluation of clinicians, such as Freida Fromm-Reichmann (1955), points out that in working without the contemporary battery of psychopharmacology, they were more attentive to the kind of work the patient might subsequently be able to undertake after a period of treatment and enable the patient to stabilize and live with what Leader has called “quiet madness.”

Case after case from this period indicates patients, if treated with attention to the singularity of their madness, could find some kind of symbolic position that could enable them to stabilize—this might consist of writing, painting, caring for another person, being the object of a scientific study, whatever it might be to enable the subject to live with their madness. The examples he gives of his own clinical practice illustrate that this way of working is still possible in the analyst’s office. Moreover, as he also points out, listening of this quality can cushion the often traumatic effect that hospital and outpatient treatment may have on psychotics whose behavior is looked at through a cognitive or behavioral frame, which makes them victims of codes and orders of social normativity.

We come across these kinds of movements out of madness less frequently if, very early in the treatment, the patient is given so much medication that it is impossible to judge what actually might be a path toward their stabilization—other than a continuing, debilitating regime of medication. Which makes it very interesting to note, a genre of literary biography has emerged in which an author describes his or her own passage out of madness—although Leader mentions none of these works.

Leader is not in any way a naïve critic of the use of medication in working with psychotic patients, but he does point out that the life expectancy of people who are diagnosed as psychotic has declined significantly in the last 50 years as more and more empirical research forces us to recognize that the secondary effects of many of the medications can cause major disruptions of the endocrine system of the patient that can lead to obesity that in turn can lead to a variety of heart problems. He is certainly not asking for a return to the naïve application of Freudian dynamics

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that became dominant in American psychiatry from the late 1940s until the de-institutionalization of patients that began in the 1960s with the introduction of lithium, among other drugs.

For Leader, the current excessive division between different categories of psychotic behavior and the ineffectiveness of empirical studies that create statistical models of subjective behavior or genetic predetermination means that many clinicians are only listening, if they are listening at all, to that part of the patient’s speech that indicates what psychiatric category they might best fit into and what form of treatment is predetermined for that category of patient.

He quotes a psychiatrist (without cita-

tion), “we don’t know what form of psychosis the patient is suffering from until we can see what medication is working.” Leader is proposing that we resist this regime of descriptive categorizing and attend to a different use of the concept of differential diagnosis that distinguishes between the experience of “going mad” and not actually “being mad.” Leader uses, in a highly effective manner, the dialectic between “being mad” and “going mad” as an anchoring point for the whole of his book.

Leader questions the overemphasis on the “noisiness” of psychosis when an individual, evidently influenced by hallucinations or other attempts to fill their encounter with a void, are led to commit an act of great

violence against themselves or others. There is no doubt that violence can be the outcome of a psychosis, but what Leader wants to draw our attention to is that it can be triggered when the patient is directed (sometimes by a well-intentioned psychiatrist or clinician) to renounce certain actions or conform to others. This directive then triggers, within the patient, an encounter with what is missing or voided in their subjectivity to which they respond violently.

Leader carefully elaborates how frequently, not only in his own clinical practice, but also in the work of a very wide range of practitioners, what is really at stake in working with psychotics is not the existence of symptoms, but the way they are

being used. He reminds us that experts in the history of psychiatric literature—late 19th-century pioneers—were actually far more “empirical” in their approach than contemporary researchers (because they recognized the singularity of each psychotic’s experience). Even in the 1940s to 1950s, despite the inhuman practices of lobotomy and leucotomy, we find numerous researchers who are very attuned to the importance of stabilizing the psychotic patient and identifying those conditions and signifiers that triggered desperate moments when the patient was entering into an experience they were unable to symbolize or signify.

For Leader, this attention to the use of what is made of the symptom is completely 17

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congruent with the practice of psychoanalysis that Freud invented and Lacan inflected with the introduction of the “name of the father.”

Leader’s view is that psychoanalytic theory teaches us what not to do with psychotic patients rather than what to do with or for them. The accuracy of Leader’s idea of “quiet madness” is that when he traces the early lives of his patients he is able to identify a moment when something in the patient’s speech or account of their own actions indicates they have attempted to create something that substitutes a signifying substation that has not occurred in the psyche of the subject.

The symptom is not functioning in the same way that the symptom of a neurotic patient functions. It is not maintaining a certain form of alienation for the subject’s proper desire, hampering their capacity to invest drive and desire in their lives and work. Instead, this kind of symptom is holding the subject together, making it possible for the individual to go and survive with a potentially terrifying absence of meaning; a meaning that is not “intellectual” but includes the meaning of having a body, accepting sexuality, or tolerating moments of nonmeaning.

In his afterword to the book, he goes beyond his initial intention to provide a clear outline of the causes, the variants, and the possible ways of stabilizing and inventing with the psychotic. Here he points out how the eugenic plan to eliminate the mad was connected with the eugenic plan to eliminate “degenerate” races. The way in which a society responds to those within it who are “mad” is no doubt a litmus test of its ethics. In this sense, Leader’s book goes beyond the question of the clinic of psychosis and is a testimony to what is at the heart of psychoanalysis—its ethics of difference and of the Other. z REFERENCES Bleuler, E. (1911) in English (1923). Demnetia praecox.

New York: Macmillan.

Cooper, D. G. (1978). The language of madness. London, RKPaul.

Deleuze, G. (1968). Anti-Oedipus. London. Viking Freud, S. (1911). From the history of an infantile neurosis (1917–1919) S. E. Vol 17.

Psychoanalytic notes on an autobiographical account of a case of paranoia (1911) S.E. Vol 12.

Fromm-Reichmann, F. (1955). Some aspects of psychoanalytic psychotherapy with schizophrenics. Chicago: International University Press.

Guattari, F. (1968). in English(1970) Anti-Oedipus.

London: Viking.

Kraepelin, E. (1913). (in English (1924). General Psychopathology New York: Macmilan.

Lacan, J. (1966). Presentation on psychic causality (1946). Paris: Seuil.

Laing, R. D. (1970). Sanity madness and the family.

London: RK Paul.

Mannoni, O. (1968). Clefs pour analyses. Paris: Seuil.

Nietzsche, F. (1886). Birth of tragedy. New York: Vintage.

Pascal, P. (1669). Pensées. New York: Penguin.

Redfield, J. K. (2000). An unquiet mind. New York: Random House.

Shakespeare, W. (1599). Hamlet. New York: Penguin.

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Reconceptualizing Adolescence: The Transformational Self: Attachment and the End of the Adolescent Phase

Norka T. MALBERG

This ambitious and extremely wellstructured book proposes an integrative conceptual model under the aegis of what the author names a “regulation theory.” In this work we find an example of the value Reconceptualizing Adolescence: The Transformational Self: Attachment and the End of the Adolescent Phase

By Harold K. Bendicsen London: Karnac Books, 260 pp., $37.95, 2013 of contemporary developmental psychoanalytic thinking, one that is flexible, integrative, and builds on both the contributions of past and current pioneers in the field. Bendicsen takes on the challenge of conceptualizing the developmental transition from adolescence to young adulthood by revisiting classical conceptualizations of adolescence and the evolving self under the light of clinical and conceptual findings in the fields of attachment, self psychology, neurobiology, and relational psychoanalysis, among others.

Departing from a rigorously built theoretical framework, the author explores the diverse developmental pathways resulting from the interactional dynamics operating in the young person’s internal and external realities.

The structure of this book makes a very strong case for the importance of building from a clear and strong theoretical framework, allowing for the elaboration of a clinical hypothesis that both guides and holds the therapeutic dyad and sheds light on the meaning of the therapeutic action. By starting with an exhaustive review of the existing literature and ending with the incorporation and application of the conceptual hypothesis to the clinical reality, this book is as much a prototype for critical thinking and understanding as it is a medium for the slow development of the case for the concept of the transformational self.

In parallel with the developmental phase that it seeks to explore, this book challenges the reader with a complex description of the conceptual basis from which this author’s theoretical explorations arise. It is not welcoming to all readers, as it requires a certain level of theoretical knowledge and sophistication. However, the book promptly turns to the task of educating and organizing the reader’s thinking by introducing and operationalizing the concept of “Transformational Self,” defined by the author as follows here: a concept developed to herald the attainment of a cluster of self-state capacities, that positions the individual to assume mature states in society…[It] is an

interdisciplinary construct formulated as regulation theory, which is located conceptually in the emerging neural self theoretical orientation,” (p.28).

The author makes an interesting effort to revisit the psychoanalytic definitions of self from a historical perspective and examine how their evolution has been informed by growing empirical findings. As a student of attachment theory, I found Bendicson’s definition of the attachment self departing from Wallin’s work (2007) quite intriguing and of great value. The author’s ideas are notably congruent with the spirit in which Anna Freud created the concept of developmental lines to move away from the stage-like and deterministic nature of the theories existing at that time. The following definition by the author conveys beautifully this theoretical and philosophical affinity with Ms. Freud’s ideas regarding the developmental lines: “the transformational self remains a theoretical hybrid with an innate quality of driveness embedded in a relational matrix” (p.63). The book would have benefited from an even fuller exploration of the author’s understanding of the lines (he refers to Kohut’s work on self-narcissism) and how he thinks they contribute to the development of a more comprehensive, flexible, and integrative notion of development.

In general, this book attempts the formidable task of theoretical reconciliation and integration all at once with moments of clear ambivalence and some might say bias, as in the case of the following statement: Of these five core issues, three have been replaced: the storm and stress hypothesis as a universal adolescent developmental phenomenon has been discredited, the recapitulation theory has been supplanted and the neurotic preoccupation with masturbation with its focus on sublimating sexuality has been surpassed by an educational emphasis on the development of the whole person. (p.41) Although I am not denying that these are common trends in contemporary psychoanalysis, it is difficult for me as a psychoanalytic practitioner to conceive of a theory of developmental transition and transformation without in-depth integration of the central role of sexuality and aggression.

That being said, I found myself in awe of the author’s overall capacity for integration of ideas. One aspect of this book that I truly valued was the author’s didactic style. He not only provides the reader with constant 18

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reminders of where to find further elaboration of the ideas he presents but provides a clear and concise summary of all chapters and extremely well-organized and informative appendices. In general, from beginning to end this book provides the reader with the experience of being guided through difficult theoretical terrain all the way to the land of clinical exploration. With his presentation of clinical material, Bendicson’s complex and compelling theories begin to come together in a way that makes sense for those of us who inhabit the consulting room. The author introduces the reader to Dawn and Mesia, two very different young women struggling with issues related to loss and lack of overall sense of safety and agency, which are impeding their progressive development. I especially appreciated Bendicson’s efforts in providing us with two rich clinical examples in which he is able to highlight some of the central issues pertinent to his thesis of the transformational self in spite of the racial and socioeconomic differences between these two young women. Mesia’s story helps us reflect on the importance of a systems approach to intervention when environmental impingements and event and relational traumas are present and persistent.

On the other hand, Dawn’s story highlights the value of a good-enough early relational environment and the influence of a secure attachment as a protective factor longitudinally. As both these young women made use of their relationship to their therapist in different ways, I found particularly valuable the author’s honest reflection regarding technical questions in the context of his theoretical thesis. For example, Dr. Bendicsen explores the question of how to respond to Dawn’s interest in knowing about him, his life, his ways of managing anger being guided by his clinical formulation of this young woman. From a mentalization-based lens, one could say that this is an excellent example of “use of self,” in which the therapist reflects about their own experience of an affect and responds to the young person’s inquisitive stance, thus promoting her reflective functioning capacity and communicating that it is safe to “imagine” what others are feeling and thinking.

In general, I found The Transformational Self to be a challenging, yet worthwhile read.

I look forward to hearing more about the concepts the author espouses in his book, particularly the clinical applications of this elegant theoretical piece of psychotherapy integration. z REFERENCES Wallin,D.J. (2007). Attachment in Psychotherapy. New York and London: Guildford Press.

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Fumbling in the Dark In the spring of 2013, Thomas Insel, medical director of the National Institutes of Mental Health (NIMH), announced that all grant funding by this, the most important and prestigious mental health research center in the country, would be limited to studies attempting to elucidate the biological basis of mental illness—NIMH was not going to fund any research having to do with the mind or the environmental context of mental activity. The announcement (Belluck & Carey, 2013) was unequivocal: Insel “said in an interview…that his goal was to reshape the direction of psychiatric research to focus on biology, genetics, and neuroscience so that scientists can define disorders by their causes, rather than their symptoms,” as they are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

This announcement was surprising because, in a very real way, the search for biological underpinnings of mental illness had been a complete and utter failure after decades of effort and billions of dollars of expense. In a recent article in the New York Times: (Carey, 2014) devoted to Dr. Insel, he says as much himself: “the previous generation of biological research in psychiatry has been largely a disappointment, both in advancing basic science and in improving lives.”

In the article, it is claimed that the “overall impact of this drug revolution on public health has been mixed,” but that could be understood as a euphemism; in fact, there are no biological markers for the overwhelming majority of mental illnesses as a result of the current biological research. No genetic explanations for any of the diseases in the DSM came out of the unraveling of the human genome in the 1990s. No linking of the etiology of a mental disorder and the clinical effects of a biological therapy have been found, such as exists for insulin and diabetes or penicillin and pneumonia.

Of course, psychopharmacology is everywhere, and it has had a positive impact on the reduction of emotional suffering for many people, but, as the journalist Robert Whitaker has pointed out, with the advent of biological psychiatry as the standard of care for the treatment of mental illness, there has also come an exponential growth in the number of people on disability because of mental illness (Whitaker, 2010).

The newer, relatively side effect–free antidepressants are so widely used now that trace amounts of Prozac have been found in the drinking water in the United Kingdom (Hurley, 2004), yet the suicide rate remains at least as high as it ever was and continues 1. This article is based on the 2013 I.H. Cohn Memorial Lecture of the St. Louis Psychoanalytic Institute.

1

Todd DEAN

to change in response to the same variables as always (such as the economy).

So, what made Insel so unequivocal, so certain about the right direction for psychiatric research? Why is it that decades of work would be put into something that was so unproductive, yet still so believed in and hoped for? Why is the research leadership in psychiatry so committed to a focus that has been so unsuccessful? We can give a cynical answer: biological psychiatry has made some people very wealthy. This might answer part of the question, but I don’t think the answer is complete. Even if the ideological discourse of biological psychiatry were less insistent, it could still be a very lucrative enterprise—drugs that make people calm down would be big business anyway. In other words, do we need a theory of the biological origins of mental illness to justify using psychotropic drugs?

This is the question that came into focus from Insel’s announcement last spring. I believe it is a question about seeking knowledge and what drives us to do that—it is a question about desire.

The myth of Cupid and Psyche is ancient and Greek, but our oldest surviving account of it is from the Metamorphoses of Apuleius, a text best known today as The Golden Ass, the only novel of classical antiquity to survive in its entirety (Apuleius lived between 125 and 180 CE) (Kenney, 2004).

According to the myth, Psyche was a human princess who was deemed the most beautiful woman in the world. In time, her beauty was praised as greater than that of Venus. This infuriated the goddess of love, who ordered her son, Cupid, to make her fall in love with someone so degraded that she would be humiliated by the match and her beauty would be forgotten.

As it happens, Psyche’s parents, trying to determine who could marry her, are advised by an oracle that she be prepared for “funeral wedlock”—“place the girl on a high mountain, king” (Montis in excelsi scopulo, rex, siste puellam).

No human son-in-law (hope not) is thine, But something cruel and fierce and serpentine, That plagues the world as, borne aloft on wings, With fire and steel it persecutes all things, That Jove himself, he whom the gods revere, That Styx’s darkling stream regards with fear.”

(Apuleius, Bk. 4, ll. 33ff.; Kenney, 2004, p.74) 20

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Assuming she was going to her death, Psyche insisted that her parents carry out the oracle’s orders. In part, she realized it was envy that was leading her to this fate, but at the same time, we learn that “for all her striking beauty, [Psyche] had no joy of it” (iv, 32; Kenney, 2004, p.73). This is because “everyone feasted their eyes on her, everyone praised her, but no one, king, prince, or even commoner, came as a suitor to ask her in marriage. Though all admired her divine loveliness, they did so merely as one admires a statue finished to perfection”(ibid.) Thus, “Psyche stayed at home an unmarried virgin mourning her abandoned and lonely state, sick in body and mind, hating this beauty of hers which had enchanted the whole world”(ibid.).

What was the most beautiful girl in the world to do about this, but to go willingly to her death? She is bitter, but accepts her fate: “Why should I shirk my meeting with him who is born for the ruin of the whole world?”(ibid.).

So it was a great surprise when, left on the hilltop and expecting to be eaten by a monster, Psyche is instead carried by gentle Zephyr to a magical palace. The first night in the palace she was frightened; she “quailed and trembled, dreading, more than any possible harm, the unknown” (Kenney, iv, p.78). In the night, she was visited by a being she could not see. As it turned out, the unknown wasn’t bad at all. Before he left her, her mysterious lover told her everything she saw was hers and she would be visited nightly by him, but there was one rule: she must never try to see him. For a long time, this arrangement worked for Psyche: by day, she had the run of the palace; at night, she slept with someone she could never see but from whose company she derived pleasure.

To make a long story short, Psyche’s curiosity, provoked by her sisters’ envy, eventually got the best of her—after all, she had been told by the oracle that her lover would be something monstrous and why wouldn’t she want to verify this was not the case? One night, while he slept, she lit a lamp and saw that he was none other than Cupid, Desire himself. When he awoke and realized Psyche had seen him, he fled, angry at her for how foolish she had been.

“Simple-minded” (Kenney, xxiv, p.89) is what he called her. Psyche was crushed.

We will finish the story later.

The myth of Cupid and Psyche is focused around a very specific problem: the nature of desire. In each part of the myth, a different facet of this problem is presented. In the beginning, there is the growing adoration

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of Psyche, which ends up being a source of heartbreak for the princess and her parents.

Then there is the oracle’s prophecy, telling Psyche’s parents that her only partner would be something inhuman—a monster who “persecutes all things” and even Jove feared. There is also the discovery of Psyche’s unhappiness— she is so beautiful, so perfect in the eyes of those around her that no one feels competent to woo her—she is no more approached than a leper would be, and she is miserable as a result. Finally, there is the mystery of the castle and Psyche’s lover, whom she can never see, but only encounter by fumbling in the dark.

The motif of fumbling in the dark, I was interested to learn, is a significant one in myth. In Hindu Vedic literature, the story of King Pururavas and the Apsara (a kind of demigod), Urvashi (Masson-Oursel & Morin, 1968). Most of the details of the story are different from the Psyche myth, but one element is similar: the female, Urvashi, was forbidden to see the king naked and when she did, the relationship was brought to a sudden end. This myth also is resolved in a way very similar to the myth of Psyche—which I will get to later. The other myth I will mention only briefly is the

It was the importance of the element of darkness and the unknown that struck me. Apuleius writes how Psyche dreaded the unknown more than any possible harm. Walking in a procession to the hilltop where she expected to be devoured by a monster, she was bitter, but not afraid. We do not see her frightened until she is in a place where she does not know what to expect, even though things are working out better than she had expected. Her desire is for knowledge—even when everything is going well for her and even though her lover insists nothing good will come of her trying to see him.

story of Jacob wrestling the angel. Jacob had, up to this moment in his story, been sneaking his way around his older brother Esau and his father Isaac, trying to get as much power and wealth as he could until, feeling guilty about all this, he tried to make peace with his brother. When night fell, Genesis tells us (Genesis, 32:22–32), Jacob, alone, finds himself fighting with something totally mysterious that he cannot identify or name, but from which he demands a blessing before he will let go.

In all three of these stories, there is a similar detail: the inability of the subject of the myth—Psyche, Urvashi, and Jacob—to 21

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see the object of his or her desire combined with a wish for knowledge. These characters are not just in the dark, they are in the dark trying to find something related to their desire. For Psyche and Urvashi, the desire is to know/see their lover; for Jacob, it is to receive a blessing from the mysterious stranger.

For the anthropologist Claude LeviStrauss, recurrent elements in myth, like Psyche and Jacob’s encounters with someone they cannot see, are central to an understanding of how myth works (Levi-Strauss, 1963). These elements “provide a logical model capable of overcoming a contradiction” (1963, p.229) in thinking about the problem the myth is addressing. These are the building blocks of myth, the elements that point to the underlying concerns that led to the construction of the myth in the first place. And it is important to note that those concerns are not entirely consistent with what we would today call science, at least, in some ways of thinking about science. The point is not to explain desire in this case, but to clarify how it is problematic. Thus, the myth of Cupid and Psyche is not some primitive attempt to explain why desire happens; rather, it is a marker of something that cannot be reduced to a simpler explanation.

And that is a description that fits desire well. As it is worked out in human life, desire often seems to make no sense. In the Psyche myth, the most desirable person in the world finds herself completely alone.

In the account of the myth we have, the oracle’s description of her lover suggests a fearsome monster. The fact that this monster turns out to be Desire himself, as he is described in the text, is ironic and unexpected but does not change the fact that he is a monster, that he is feared by the gods. In both the Greco-Roman and Hindu myths, the knowledge of the desired object is actually forbidden; in the Hebrew myth, Jacob doesn’t even know what he is doing and his unknown antagonist finally causes him an irresolvable groin injury (he will have a crooked gait the rest of his life from it).

It would not be hard to come to the conclusion that nothing is worse than desire itself. It causes no end of trouble, even though satisfying desire is what we are all trying to do, all the time. And, the myths suggest, we are always fumbling in the dark when we are doing it.

The fumbling happens because there is something missing, something we cannot see or grasp. We can never say exactly what it is that we desire. We do not know beforehand exactly what it is that we want, and even when we get something that seems to be our dream, we are still not satisfied.

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Enough; no more./ Tis not so sweet now as it was before.

O spirit of love, how quick and fresh art thou, That, not withstanding thy capacity Receiveth as the sea, naught enters there, Of what validity and pitch soe’er, But falls into abatement and low price Even in a minute.

(1.1. 7–14)

came from fairly prosperous middle-class backgrounds; there were few cultural differences to take into account; nobody was trying to get disability; and so forth. But after the first dose, while one person would declare that the antidepressant had changed his or her life, another would insist that he or she would never take that medicine again, though both of these people had presented with the same symptoms at roughly the same time. Most people were somewhere between these extremes, but no matter how similar their stories, symptoms, or treatments, no two had the same treatment response. I found it very hard to believe that

them from shedding tears. And then there was the one person who cried only when she talked about how wonderful Prozac was because before she started taking it she cried all the time.

But there was another effect of SSRIs that was truly universal and not at all dependent on the patient’s symptoms: the loss of interest in sex. Again, I had seen this side effect before, but now I was working with a population of young, physically healthy people and every one of them who took one of these medications noted the loss of libido. For some, that was a deal-breaker, they preferred feeling depressed; for others,

No desire can be satisfied—nothing can be enough. As soon as a satisfaction is touched on, it is over. Orsino ends this speech, “So full of shapes is fancy/That it alone is high fantastical” (Shakespeare, 1993). It is only the pursuit of new fancies, new desires, that moves the human subject.

How crazy is this?

Psyche, when she is still in the dark, would seem to be doing a whole lot better than she had any reason to expect before she got there, yet, like Orsino, she cannot be satisfied with the satisfaction of any desire: she must move on to the next thing.

So, if desire is so important to our psyches, what role does it play in psychological medicine? Can it be reduced to the product of certain biological processes? In the age of neuroscience, is it less problematic than in the age of Apuleius?

Throughout my years at the medical center where I trained and worked, I had always been aware of concerns about the placebo effect in antidepressants, especially the type that came on the market for the first time while I was doing my internship— the serotonin reuptake inhibitors, or SSRIs. It seemed very likely to me that, at least some of the time, the benefit of the medications was the result of something that could be called suggestion. For example, the fact that a doctor was prescribing a medication for one’s mood could, in itself, relieve some people: they felt bad because they had a disease, not because they were “bad” in whatever way they felt themselves to be so, and they knew they had a disease because a doctor had given them a pill for it.

But during the more than two years I worked at a student health center, my skepticism mushroomed. I could prescribe the same antidepressant to different people on the same day, for the same symptoms, and inevitably get radically different responses from each person. This was most striking in this context, I believe, because the population I was working with was relatively homogeneous: all were in their late teens to mid-twenties; all were ambitious; most

I was doing anything more significant than distributing snake oil.

Shortly before I left this job, I found myself wondering about this problem in a different way: was there anything that serotonin reuptake inhibitors do that could be described as consistent across patients? Was there any reason to think these were not just placebos and bromides?

To my surprise, I found that there were some things these drugs did fairly consistently. First, I noticed that anyone who said they cried when they were depressed reported that they stopped crying when they took an SSRI. What was noteworthy was how people responded to this fact: some were relieved that they weren’t crying anymore, while others stopped taking the medication because it prevented

it was just the price they had to pay.

What I believe I learned from these observations was that loss of libido and of emotional intensity were not side effects of the medication: dampening energetic investment was how the SSRIs worked.

In other words, even though the effect was a biological one—the manipulation of serotonin levels in the brain to decrease emotional intensity—this wasn’t really a disease-specific effect, as one would see with antibiotics for bacterial infections or insulin for diabetes. Instead, the effect of taking these antidepressants was to blunt the expression of libido, with the consequence that they sometimes (often) palliated symptoms. A more proper analogy for how they worked, it seemed to me, would be the predictable effects of drinking alcohol.

In the opening speech of Shakespeare’s Twelfth Night (Shakespeare, 1993), Orsino interrupts his praise of the music he is hearing, music that he associates with his love for the countess Olivia, after only 6 lines:

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The biological effect of alcohol would be to disinhibit the drinker, which might make it easier for one person to talk to strangers but might make somebody else look for a fight and somebody else take a nap.

What is of secondary importance for our discussion, but what excited me the most about all this at the time, was the way it supported Freud’s understanding of what a neurotic symptom is: a substitute for sexual satisfaction. This seemed clear to me from the way that both libido and the symptom of depression or anxiety were removed by the use of the drug. As it happens, a few years after I left the student health service, a French

not an obviously psychiatric patient population. They were unhappy for a reason, as we say—diagnosed with tuberculosis, they had been forced to leave their homes and take up residence in a treatment center with other sufferers so that they wouldn’t infect others with the disease. Nobody, at that point, would have argued that there was a biological basis for their low moods; they were just in a bad place. Similarly, the first antipsychotic medicines were just anesthetic agents, major tranquilizers, which had the effect of calming down severely agitated people. There was no necessary relation between the effects of these drugs and as-

psychiatrist and analyst, Gerard Pommier, published a book on “how neuroscience demonstrates psychoanalysis” (Pommier, 2004). The relation of SSRIs to libido was one example of that demonstration.

After all, the discovery that there was some connection between serotonin and mood was made entirely by accident and not in an obviously psychiatric context. It happened when a new drug for tuberculosis (TB) was studied at an asylum for TB patients and it was observed that the patients were less emotionally upset while taking this drug than any of the others. When the drug was analyzed for its chemical effects, it was found that this particular anti-TB drug, Iproniazid, enhanced serotonin levels in the blood (Lopez-Munoz and Alamo, p.1566).

But those who responded to the drug were

sumptions about the fundamentally biological basis of psychotic agitation. How did psychiatry get from these rudimentary observations about the effects of some drugs on some emotional states to the NIMH’s decision to only fund research into the biological origins of psychopathology?

In the first session of a teaching seminar he gave in 1967–1968 (Lacan, 1967–1968), Jacques Lacan asked the same question of a famous experiment in behavioral science— Pavlov’s work with classical conditioning.

Pavlov tested the hypothesis that one could induce physical reactions in animals by conditioned responses to artificial stimuli, as opposed to the natural responses to appropriate stimuli. Most famously, he linked the sounding of a trumpet to the presentation of food, then, after a certain number of 23

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repetitions, he sounded the trumpet without presenting the food. As is well-known, the animals responded to the sound of the trumpet at this point in the same way they would have responded to the presentation of food—by generating an increase in the secretion of gastric juices. Pavlov was able to observe this because he had surgically created a gastric fistula in the animal, allowing him to measure the secretions.

Lacan’s view of this experiment is that it involves a certain sleight of hand. As with the examples of biological psychiatry mentioned above, Pavlov’s experiments suggest that there is something “in the brain” (1967– 1968, 15 November 1967) of the animal in the experiment that leads to the outcome.

But this completely overlooks the fact that, if someone had not wanted to do the experiment, it would never have happened.

There is nothing natural about what Pavlov did here. In the words of the psychoanalyst Alan Rowan, “what is silently eliminated from this experiment is the prior act of the experimenter who…actively introduces the very sign that he or she wants, indeed obliges the animal to respond to” (Rowan, 2012). In other words, what is left out of the experiment is the fact that a subject, Pavlov, is essentially forcing an outcome in a study that could never occur in nature and for which there could be no earthly use, except for the experimenter’s desire.

The value of Lacan’s discussion of Pavlov is that he points out that there is a subject who desires to push things in a certain direction. This is equally true for the examples of psychopharmacology I mention above. There was, and is, nothing in the evidence for the drugs that increase the amount of serotonin in the bloodstream to necessitate a claim that the symptoms of depression a patient experiences are due to a chemical imbalance, even if that correlation is empirically valid. The same can be said of the relation between dopamine blockades and psychosis. It is only the desire of the researchers to put things together in this way that results in this line of research being the most used. As one recent critic of this kind of scientific assumption notes, referencing the 19th-century German philosopher Schelling, empiricism is flawed from the beginning because it fails to take seriously the fact that the things it observes require an observer (White, 2013).

Thus, I must insist, desire is alive and well, if not in the depressed patient on Prozac, certainly in the psychiatric researcher who is developing models of mental illness and health. The only problem with this is that it is, after all, another example of fumbling in the dark, but unlike Psyche, in this case, the desiring subject is often unaware of the darkness.

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Consider the case of one of the most famous descriptive psychiatrists, Emil Kraepelin. Kraepelin once told his students not to indulge in “the poetic interpretation of the patient’s mental process, [which] we call empathy. Trying to understand another human being’s emotional life is fraught with potential error….It can lead to gross self-deception in research” (Kraepelin, 1992). He practiced what he preached his entire career. As a young researcher, he decided to study the behavior of the insane in an asylum for the chronically institutionalized in Estonia. It was as a consequence of this that he developed his theory of mental illness, wherein he set out to determine the course of illness for the psychiatric disorders he studied. According to one source, he chose this country for his research because he did not speak the local language and would be less prone to poetic interpretations (Greenberg, 2013). But even if he had spoken the language, the decision to study the outcome of a disease from people who are already chronically institutionalized is surely worth commenting on. Again, as in the case of Pavlov, what is left out of these decisions is “the prior act,” in Rowan’s words, of a subject’s choice, in this case, to eliminate any consideration of empathy or even verbal meaning in studying psychopathology.

Or consider the creation of the DSMIII, as described by Christopher Lane, from his review of the written record (Lane, 2007). It was absolutely central to the psychiatrists working on this text that psychiatric diagnoses be based on a listing of symptoms, which would be both unambiguous and clearly demarcated from normalcy. Again, this speaks more to the desire of the researcher than to anything that occurs in the nature of psychiatric difficulties. It assumes that such a clear demarcation exists and that it can be found, even if that basis, decades on, remains as elusive as the holy grail.

Both these examples stand in marked contrast to another fumbler in the dark of the psyche—Freud. Unlike Kraepelin and the creators of the DSM-III, Freud made the question of desire central to his own theory of mental illness. In fact, his own desires were a major focus of his first great book, The Interpretation of Dreams, a book described by at least one scholar as the first great autobiography of modernity (Davis, 1990). I would also point out that Freud was, in at least one sense, far more attentive to empirical reality than any of the other researchers I have mentioned here and, arguably, more than many analysts after him.

He was acutely aware of the fact that he was fumbling in the dark and reminds us of this fact again and again in his work.

But whether we are talking about Kraepelin or the DSM or Freud, there is no question that there is an active desire in play, a fact, as Lacan notes in his discussion of Pavlov, “that is not…the first thing that foolish people may think about”(Lacan 1967-1968, 15 November 1967) when looking at the results of all this research.

“Foolish people” brings to mind—at least to my mind—“simple-minded” Psyche. Let’s finish the story.

Because of the oracle and her sisters’ gossip, Psyche had anticipated that her lover would be a horrible monster and so had planned to kill him. She is so surprised by what she finds when she does see him that she cuts her finger on one of Cupid’s arrows and spills oil from her lamp on his shoulder.

He wakes up and discovers her disobedience only after he feels the burn of the oil.

As Apuleius tells it, the agent of vision, the lamp that allows Psyche to see her lover, is also the agent of betrayal.

Cupid flies away immediately, but Psyche is able to hold on to him for a little while before her strength gives out. When she has fallen, he explains what has happened: after Venus told him to humiliate Psyche, he fell in love with her on sight.

Disobeying his mother, he arranged that he could have Psyche as his wife; therefore, out of his mother’s hair with nobody the wiser. This is why it was so important for Psyche to not know who he was. Saying farewell, he told her that her only punishment would be his absence.

It will be noted that, up to this point in the story, nothing Psyche does could be called wise. Nothing that happens in the rest of the story will change this state of affairs. Psyche tries to kill herself several times out of regret and longing, but her beauty saves her because everything with which she tries to kill herself is struck by her beauty. Learning that Venus is trying to find her, she actually surrenders to her mother-inlaw, who gives her impossible tasks to perform. Two more suicide attempts and help from gods, ants, water, a rock, an eagle, and a tower ensue. Finally, she performs the last of the tasks she has been given, to bring back from the underworld Prosperine’s divine beauty in a box.

Throughout these tasks, we could say that the only attribute Psyche brings to her adventures is her desire and the fact that everybody and everything that encounters her, except her mother-in-law, finds her eminently attractive. At the very end of her very last task—bringing the boxed beauty of Prosperine back to Venus, a box she has been told she must never open—she tells herself, “What a fool I am, to be carrying divine beauty and not to help myself even to a tiny bit of it, so as perhaps to please my 24

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beautiful lover. (Kenney, p.104). She opens the box, which does not reveal a goddess’ beauty to her, only a deep sleep. Even to the end, Psyche’s curiosity is her undoing.

My point is not that she should be smarter. Rather, the story conveys how the mind—the psyche—really works. It is driven to satisfy desire, not to achieve a normative state of health or a state of greater insight or understanding, whatever that may be. This is the case even as desire continues to not be capable of achieving satisfaction. This is not just how Apuleius sees things—it is how psychoanalysis came to be as well.

I have already mentioned how Freud’s desire was so important to his own research.

The analyst Colette Soler has observed that “Freud would not have invented psychoanalysis without the gracious cooperation of hysterics” (Soler, 2006). It was the efforts of hysterical patients to come to terms with desire that led Freud to psychoanalysis. The myth of Psyche is also the myth of the hysteric, who is always trying to bring desire into focus, to determine what it is that her lover desires and to bring her own desire to a state of rest. But her efforts in this direction create problem after problem. This is true to experience: the only way we can produce something really new is by fumbling, like Psyche and Anna O., in the dark.

In the story, Psyche does succeed in making something happen. After she has fallen asleep, Cupid, who never stopped pining for her, appears to wake her up from the sleep induced by Proserpine’s box. He has been convalescing at his mother’s from the burn from the lamp oil, but has resolved to disobey Venus and take back his wife. To achieve this, he does the only reasonable thing: he asks Jove to make Psyche a goddess. This is a great resolution to the problem of desire and knowledge because now Psyche is immortal and is spared the dialectical struggles of mere mortals. Jove agrees and everything ends happily; even Venus is nice. In the end, Psyche has a child by Cupid named Voluptas, Pleasure.

In the myth, Psyche’s searches do not end until she is taken out of the realm of human discourse, when she becomes a god.

Since neither psychoanalysis nor Prozac nor Haldol (or CBT or EMDR or resilience training or whatever) can raise us above the level of discourse—that is, since none of these can make us gods—it is at least arguable that enriching the discourse is a more valid goal than trying to bring it to whatever we might define as a satisfactory conclusion.

Another way to say this is, desire can never be pre-empted by data and stories are at least as important as neurotransmitters.

In fact, whatever discoveries neuroscientists make in carrying out the NIMH’s mandate in the coming years, they will certainly be

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caught up in stories in a way that stories are not caught up in scientific findings. In a very real way, it is the mind—the psyche— that creates the world and not the other way around. z REFERENCES Belluck, P., & Carey, B. (2013, May 6). Psychiatry’s guide is out of touch with science, experts say. New York Times.

Retrieved from http://www.nytimes.com/2013/05/07/ health/psychiatrys-new-guide-falls-short-experts-say. html?pagewanted=all&_r=0 Carey, B. (2014, February 3). Blazing trails in brain science. New York Times. Retrieved from http://www.nytimes. com/2014/02/04/science/blazing-trails-in-brain-science.html Davis, D. (1990). Writing Freud. Retrieved from http://internationalpsychoanalysis.net/2013/02/04/ freuds-unwritten-casethe-patient-e/

Greenberg, G. (2013). The book of woe (p.30). New York.

Blue Rider Press.

Hurley, K. (2004, August 8). Prozac seeping into water supplies. The Scotsman. Retrieved from http://www. macalester.edu/academics/psychology/whathap/ubnrp/ depression05/history.html Kenney, E. J. (2004). Apuleius: The golden ass or metamorphoses. London. Penguin Books.

Kraepelin, E. (1992). The manifestations of insanity.

History of Psychiatry, 3(12), 512.

Lacan, J. (1967–1968). The psychoanalytic act (C. Gallagher, Trans.). Retrieved from http://www.lacaninireland.com/web/wp-content/uploads/2010/06/Book-15The-Psychoanalytical-Act.pdf Lane, C. (2007). Shyness (pp.39–103). New Haven: Yale University Press.

Levi-Strauss, C. (1963). The structural study of myth, in structural anthropology (C. Jacobson & B. Grundfest Schoepf, Trans.). New York: Basic Books.

Lopez-Munoz, F., and C., Alamo: (2009). Monoamin-

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ergic neurotransmission: The history of the discovery of antidepressants from 1950s until today.

Current Pharmaceutical Design, 15, 1563-1586.

Masson-Oursel, P., & Morin, L. (1968). Indian mythology. In The new Larousse encyclopedia of mythology (pp.343– 344). England, UK: Hamlyn House.

Pommier, G. (2004). Comment les neurosciences demontrent la psychanalyse. Paris, France: Flammarion.

Rowan, A. (2012). The psychoanalytic act as act and orientation. LCExpress. Retrieved from http://lacaniancompass.files.wordpress.com/2011/05/lce-02-18-2012.pdf Shakespeare. (1993). In B. A. Mowatand & P. Werstine (EdS.), Twelfth Night, or What You Will. New York. Simon and Schuster.

Soler, C. (2006). What Lacan said about women (J. Holland, Trans.) (p.3). New York, NY: Other Press.

Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Crown.

White, C. (2013). The science delusion (p.171). Brooklyn, NY: Melville House.

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Neutrality, Indifferenz, and Desire of the Analyst The “motor” of an analysis is the strange connection that the analysand forms with their analyst: Freud called it transference or even “transference love.”

The status of this love can be quite troubling both for the analyst as well as the analysand, not to mention the general population who tends to view this love with an uneasy suspicion. Josef Breuer was horrified when he realized that Anna O. had produced a hysterical pregnancy out of her love for him. He fled, abandoning her treatment. Freud, on the other hand, persisted.

He advocated a position of “neutrality” in relation to transference love, which allowed him to discover the unconscious and to pursue his exploration of it.

This “neutrality,” in orthodox psychoanalytic circles, is taken to be an “objective” response to what is seen as a “false” or “neurotic” love. The analyst, undisturbed in his or her “objective” position, does not confuse transference with “true” love.

However, this characterization of transference is actually unsupportable from a psychoanalytic perspective, at least in Lacan’s view. Lacan showed that transference is not merely a product of the analysand, but that it is a structure that always includes the analyst (Lacan, 2001). Transference is fundamental to the structure of all human

relations, which is why it is so powerful. If this is the case, how then can the analyst have a position of “neutrality”? Or should the analyst even strive for such a position?

Yet, Lacan argued that Freud, in adhering to a position Freud called “neutral,” was able to persist and to discover the formations of the unconscious. So what exactly was Freud’s position?

Freud first explicitly invoked the psychoanalyst’s “neutrality” (Alix Strachey’s translation for Indifferenz) in Observations on Transference-Love (Freud, 1958). In a discussion of the difficulties dealing with erotic impulses elicited in the analysand due to transference, Freud considered several possible options. He noted that denying

the satisfaction of the analysand’s demands on moral grounds merely reinforces repression. This is comparable to “summoning up a spirit from the underworld…[only] to send him down again without having asked him a single question” (Freud, 1958, p.164).

He also rejected returning the patient’s impulses as “fond feelings but at the same time avoiding any physical implementation of this fondness”; noting that any compliance on the part of the analyst in the hopes that it would gain “domination over his patient and thus enable him to influence her to perform the tasks required by treatment” 26

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Martin WINN

is more likely to result in the satisfaction of the hysteric’s aims and not those of the analyst (Freud, 1958, p.164).

Freud’s solution was “we ought not give up the neutrality [Indifferenz] towards the patient, which we have acquired through keeping the counter-transference in check” (Freud, 1958, p.164). 1 He added, “I have already let it be understood that analytic technique requires of the physician that he should deny to the patient who is craving for love the satisfaction she demands …[T]he patient’s need and longing should be allowed to persist in her, in order that they may serve as forces impelling her to do work and to make changes, and that we must beware of appeasing these forces by means of surrogates.” (Freud, 1958. p.165) The notion of neutrality also stems from Freud’s abandonment of hypnosis and suggestion, and with it, his abandonment of actively directing a patient’s thoughts and attention. Instead, in his recommendations for the technique of mastering the material of a treatment, he advised, “it consists simply in not directing one’s notice to anything in particular and in maintaining the same ‘evenly suspended attention’ (as I have called it) in the face of all that one hears” (Freud, 1958, p.111).

In 1956, Roger Money-Kyrle, in a key paper on countertransference, echoed Freud’s position when he stated that the term “neutrality” means “that the analyst is concerned for the welfare of his patient without becoming emotionally involved in his conflicts…it also implies, I think, that the analyst in virtue of his understanding of psychic determinism has a certain kind of tolerance which is the opposite of condemnation, and yet, by no means the same as indulgence or indifference” (Money-Kyrle, 1978, p.360). Here we run up against what appears to be a contradiction: Indifferenz, in Money-Kyrle’s definition, is “by no means the same…as indifference.” This requires a brief discussion of Freud’s term.

Indifferenz, “non-difference,” is not the equivalent of the English “indifference,” which is more commonly translated by the German word Gleichgultigkeit. This word implies, as does the English “indifference,” 1. “Ich meine also, man darf die Indifferenz, die man sich durch die Niederhaltung der Gegenüberuagung erworben hat, nicht verleugnen” (Freud, 1989, p.224).

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an affective disinterest and can have a negative connotation: “uncaring,” for example.

While Strachey’s translation of Indifferenz as “neutrality” avoided the implicit negative connotations of “indifference” in English, it is curious that Freud did not use the German term Neutralität. In fact, Indifferenz is a rather uncommon term. Perhaps Freud used Indifferenz for its reference to physics where it connotes a stable equilibrium: the stability of a pendulum means that it will return to its original position after its initial displacement by a force, or an object with a low center of gravity is more stable than one with a higher center of gravity.2 In advising analysts “not to give up” their Indifferenz, Freud is referring to an interest that doesn’t allow the patient’s demands to displace the analyst from an equilibrium that permits attention to be paid to the unconscious.

Indifferenz is a stability that allows the practice of “evenly suspended attention” in which the analysand’s “longing” is sustained and the analysis can progress.

Nevertheless, the term “neutrality,” thanks to Strachey, has entered the Freudian lexicon. Questions regarding Freud’s exact intention led Edmund Bergler to offer the phrase “benevolent neutrality” (Bergler, 1937). Along with the majority of American psychoanalysts, the French analysts Daniel Lagache and Sacha Nacht took up Bergler’s phrase. Meanwhile, Otto Kernberg described his concept of “technical neutrality,” formulated in the 1950s, as the means by which the psychoanalyst “interprets the meanings of the transference from a position of concerned objectivity” (Clarkin, Yeomans, & Kernberg, 2006, p.76).

There also ensued a polemic over neutrality itself. Traditional psychoanalytic “neutrality” was criticized as an attitude embodying a scientific, research-oriented practice to the detriment of the aim of “healing” the patient. One well-known critic, Owen Renick, deplored The Perils of Neutrality (Renick, 1996) and advocated a “practical psychoanalysis” (Renick, 2006) that in place of the “objectivity” of the psychoanalyst proposes “elective self-disclosure” to deal with countertransference issues (Psychotherapy.net, 2008). In Renick’s opinion, this had the advantage of swifter symptom relief and avoided the sterility of the supposed aim of “self-awareness” that he ascribed to the psychoanalytic orthodoxy.

A number of other critics, particularly those adherents of various relational schools, questioned the idea that it is even 2. “is equivalent to,” which comes from physics. See http://de.wikipedia.org/wiki/Indifferenz; see also “Stability Theory”; http://de.wikipedia.org/wiki/ Grenzstabilität

possible for the analyst to be “outside” of the analytic undertaking, observing and unimplicated in the exchange. They argued that the analyst is unavoidably influencing the analysand. Paul Wachtel wrote: “Socalled neutrality is but one more way of participating in the events of the therapeutic process, and is no less likely to influence ensuing events than any other way of participating” (Wachtel, 1982, p.263).

In my estimation, the debate stems from a misunderstanding of “the actual instrument of their work” (Lacan, 1981, p.18). If the critics of the orthodoxy correctly sense that the psychoanalyst is implicated in the process, this does not mean that an analysis is engaged solely with the exchange within a supposed patient and analyst dyad. What is at stake is not a duality, rather the intervention of

what appears is what Lacan labeled the “non-realized” (Lacan, 1981, p.22). The analysand may believe they are expressing themselves through speaking, but in fact, they discover they have no idea what they are actually saying; every speech act is at its base a demand addressed to the Other.3 The premise of every demand—always a demand for love—is that the Other, to whom the demand is addressed, is complete and thus allows the speaking being to believe, transitively, in the possibility of their own completeness. However, any response from the Other is doomed to fall short if behind every demand for the satisfaction of a need is a demand for absolute love that simultaneously questions the desire of the Other. Whatever then addresses the need—however satisfactorily—leaves the demand for love still open. Even when the

a third element. While it is not simple to grasp what it means to maintain an “evenly suspended attention in the face of all that one hears” (p.18), it is clear from this statement that the praxis of psychoanalysis is a matter of engaging in a particular way while listening to speech. Speech is the “actual instrument of [psychoanalytic] …work,” but speech must be understood as something other than a vessel for the conveyance or “communication” of meaning. What the analyst listens for are the breaks, gaps, hesitations, and so forth in speech where meaning stumbles and

Other responds, “I love you!” it is still possible to ask “But why?” or any number of other attempts to obtain that bit of certainty that the answer never quite provides.

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3. The primal mother speaks from the “Other” locus (Other than the subject) and appears to the infant as omnipotent, able to give—or withhold—whatever the infant needs, and whose decision to give or withhold is taken as a sign of love. The Other is initially seen as a totality, as complete without flaws or lacks. In the mirror stage the Other mediates the relation of the subject to their body through the stabilizing effect of the symbolic: “That’s you in the mirror!” The Other is also the locus of the symbolic: the repository and source of language, the law, and desire.

The subject of the unconscious desires recognition, seeks to discover the desire of the Other in order to be recognized by the Other, and is alienated in the desire of the Other (Lacan, 1963, July).

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The signifier, that with which language approximates the world, creates the signified, which is the concept of the thing indicated by the signifier. The real is what is left out of the signifier/signified relation, because it is impossible to name. One of three registers, along with the imaginary (register of images and identifications) and the symbolic (register of language and signification), the real is to be understood as what falls outside of the other registers. It is linked to them, but some portion of it always escapes. “The real, which is not the same as reality, is an effect of the symbolic, what the symbolic expels as it establishes itself ” (Vanier, 2000, p.2). There is always a remainder, that portion of the real that can never be articulated in the signifying chain, which endlessly provokes another demand for a complete signification with the same unsatisfying response. It poses itself as a possession of the Other, something the Other—as language— withholds. Lacan named this remainder objet petit a, the object leftover by the speech act, the object cause of desire. This remainder is an ungraspable object that can only be supposed, like an unknown algebraic x.

This is why Lacan advised retaining it untranslated in English, in order to emphasize this algebraic character.

Objet petit a is a very peculiar object in that it is a lacking object. It is an object in the sense that it is what is sought in the demand, the object that could bring total completion; but it is also a lack, in that it can never be materially delivered. It is an objectification of absence. It can “appear,” for example, in the uncanny or in the experience of déjà vu, where its presence produces anxiety.

Rather than accept that the object is unattainable, the Other’s unsatisfying response is taken as a “No,” ultimately associated with the law and what is forbidden. The Other’s response is understood to indicate that their desire is directed elsewhere, toward a love object other than the infant who articulates the demand.

This shows that the operation of the demand is already structured along the lines of the Oedipus complex. If the Oedipus complex structures the human’s relation to sexuality and the law, how does this come about? Lacan called the Oedipus complex “Freud’s dream,” stating that it needed to be interpreted like a dream. It is not the lived experience of the dream, but the recounting of the dream that is significant: only once the dreamer reports the dream, at the level of what is said, is it apparent that there is a knowledge that did not appear in the lived experience of the dream. Freud designated this knowledge under the name of the unconscious.

If we address the Oedipus complex as a dream, it is because it is not a question of

a lived experience, but of language and the functioning of language. If the Oedipus complex revolves around the question of castration, structured by the absence or presence of the phallus, we are dealing with the realm of the symbolic—not of some ineffable lived experience. In this way, speech as a third element introduces interdiction into any human exchange, which gives rise to desire.

In essence, every instance of speech is engaged in the Oedipal triangle in which the speaker runs aground on the rock of castration, since castration is the loss generated by the functioning of language. Language itself introduces the symbolic function of the father who forbids incest and bars the union between mother and infant. As Freud shows,

formations of the unconscious, where the analyand’s speech says something other than what was consciously intended and that evokes the Oedipus complex. In response to this speech, the Indifferenz of the analyst sustains the “No” of the law and thus sustains the incest taboo.

Indifferenz in the face of the demands of the analysand is a testimony to Freud’s single-minded pursuit. Freud, unlike Breuer, was not derailed by the encounter with a hysteric’s demand for love, but instead remained “stable” in the face of it, sustaining his position and, according to Lacan, sustaining his desire as a psychoanalyst.

On the face of it, we are confronted by the implications of this claim with

symbolic castration is the price to be paid for entrance into society. It is the law (incest taboo) that gives rise to indestructible desire as the corollary of this price, desire that is caused by the loss of objet petit a, which plays out in the metonymic shifting from one object to the next. All speaking beings, regardless of gender, are subject to the incest taboo and the price of symbolic castration.

This essential function is embodied in the transference—comprised of the analysand’s speech addressed to and including the analyst as Other. Only a position of Indifferenz allows the analyst to hear the

another apparent contradiction, in which Indifferenz is somehow equated with desire. To understand this, the term “desire” requires an explanation.

The desire of the psychoanalyst is not a question of an effect experienced by the analyst. Desire is not to be understood as a psychological reference to subjectivity, to passions. Desire should not be confused with pleasure. The pleasure principle, according to Freud, is one of homeostasis. Desire, on the other hand, Freud categorized as indestructible. Desire is caused by what is leftover as a result of the functioning of language and

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is an effect of language alone. Freud’s desire, in Lacan’s opinion, is what allowed Freud entry to the mechanisms of the unconscious (Lacan, 1981, p.12).

This indestructibility of desire is something that the analysand, due to castration anxiety, does not acknowledge, responding instead with phantasms and symptoms: refusing to acknowledge that it is not possible to ultimately obtain that missing piece, refusing to accept castration. Within the transference, the analysand’s supposition is that the analyst is in possession of the object and knows how the analysand could obtain it—the analyst is supposed by the analysand to know the ultimate answer to the analysand’s unhappiness, supposed to know how to avoid castration.

However, the analyst must never make the mistake of actually believing they are in possession of this knowledge. Through the experience of their own analysis, in acknowledging their own castration and sustaining desire, what the analyst knows, is that to answer—to step out of the position of Indifferenz—would be to take oneself as exempt from any loss; therefore, not recognizing oneself as castrated and desiring. It would make the analyst complicit with the analysand’s efforts to avoid recognizing the incest taboo. In respect to this, Lacan asserted in his seminar, L’Éthique de la psychanalyse

[The Ethics of Pschoanalysis], “The only thing for which one could be culpable, at least from the analytic perspective, is to have given up on one’s desire” (Lacan, 1986, p.368).

To give up on one’s desire is to refuse to recognize it, either through the phantasm of being “complete” or through surrendering in the face of the indestructibility of desire. Desire has an ethical dimension because desire arises in relation to the law, to the incest taboo, and is a manner in which the law is recognized.

The desire of the analyst is a support of the real (objet petit a)—always the same unknown x that can’t be articulated. The desire of the analyst, insisting on this x (Indifferenz of the pendulum), does not al-

low the analysand to avoid a confrontation with castration.

The functioning of the desire of the analyst through nonresponse to the demand, reconfirms for the analysand the impossibility of the satisfaction of desire: there is no final response, only partial responses.

This will eventually lead the analysand to the discovery that the objet petit a is not the object of a demand; it is not an obtainable object that is somehow missing or held out of reach. Rather, it causes desire because it is irremediably lost; no one has it. Through assuming this castration, the missing object 29

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can be mourned and ultimately abandoned— transformed from a lack into a loss.

Substitution becomes a possibility: relinquishing the quest for the forbidden, incestuous object, seeking instead a replacement that is perhaps similar, but ultimately a different one. The analysand discovers a new position in relation to the objet petit a— ceasing to aim toward it, ceasing to hope to reclaim some lacking thing whose absence is a constant source of unhappiness. Rather, the objet petit a is situated as a lost object behind the speaking being, as cause of their desire, pushing them forward.

Transference, as it embodies the fundamental structure of human exchange, engages both analyst and analysand in a process that engenders a loss. If the analyst manages to sustain their desire as the cure progresses, it will more and more substantiate this lost object. At the conclusion of a cure, the analysand will abandon the belief in the illusory figure of the analyst as the omnipotent Other, recognizing that it is nothing more than a remainder, objet petit a, that can be dropped.

In his seminar of 1969-1970, L’envers de la psychanalyse (Lacan, 2007), Lacan stated that the analyst occupies the position of objet petit a in the cure, and “this is the only meaning that one could give to analytic neutrality.” The analyst does not partake in passions, but rather occupies an “uncertain zone” in which, from a position of loss, the analyst puts the analysand to work on discovering the path of their own desire (Lacan, 2007, p.136). This is the “neutrality,” the Indifferenz, the desire of the analyst. z REFERENCES Bergler, E. (1937). Symposium on the theory of therapeutic results of psycho-analysis. International Journal of Psychoanalysis, 18, 125–189.

Clarkin, J.F., Yeomans, F.E. Kernberg, O. (2006). Psychotherapy for Borderline Personality: Focusing on Object Relations.

Arlington, VA: American Psychiatric Publishing, Inc. Freud, S. (1958). The standard edition of the complete psychological works of Sigmund Freud (Vol. XII, pp.159–173, 164–165). London, UK: Hogarth Press.

Freud, S. (1989). Schriften zur behandlungstechnikIch. Frankfurt, Germany: S. Fischer Verlag.

Lacan, J. (1963). L’Angoisse 1962–63. Unpublished transcript.

Lacan, J. (1986). L’Éthique de la psychanalyse. Paris, France: Seuil.

Lacan, J. (2001). Le transfert. Paris, France: Seuil.

Lacan, J. (2007). The other side of psychoanalysis. New York, NY: W. W. Norton & Co. Lacan, J. (1981). Four fundamental concepts of psychoanalysis. New York, NY: W. W. Norton & Co. Money-Kyrle, R. Normal counter-transference and some of its deviations. International Journal of Psychoanalysis, 37, 360–366. Reprinted in: The Collected Papers of Roger Money-Kyrle. Strath Tay: Clunie Press, 1978.

Psychotherapy.net. (2008). Interview with Owen Renick. Retrieved from http://www.psychotherapy.net/ interview/owen-renik Renick, O. (1996). The perils of neutrality.

Psychoanalytic Quarterly, 65, 495–517.

Renick, O. (2006). Practical psychoanalysis. New York, NY: Other Press.

Vanier, A. (2000). Lacan. New York, NY Other Press.

Wachtel, P. (1982). Vicious circles: The self and the rhetoric of emerging and unfolding. Contemporary.

Psychoanalysis., 18, 259–273.

INTERVIEW

A D/R Conversation with Jonathan Shedler What got you interested in psychoanalytic research? What is your research background (grad school, work, etc.)?

I’ve worn two hats from the beginning.

I graduated from the personality program at the University of Michigan. I worked with faculty mentors doing research in personality and social psychology. I also took the clinical curriculum. At the time, the Michigan clinical program was basically a psychoanalytic institute. So I lived in two worlds. When I was with the researchers, I was a researcher. When I was with the clinicians, I was a clinician.

My research mentors didn’t understand why I was interested in “all this psychoanalytic stuff.” At various times, I heard it referred to as religion, superstition, and a cult. I also encountered resistance from some of the psychoanalytic faculty who regarded me as an interloper. What I was trying to do just wasn’t “done.” There is a lot of talk these days about the science– practice schism. I was living the science– practice schism.

This experience shaped my view of the profession. I saw how clinicians and researchers did not talk to each other. I saw firsthand the insularity and arrogance of some of the psychoanalytic clinicians of the time. I also saw how arid, artificial, and

fundamentally unpsychological research in psychology could be and how irrelevant much of it was to the needs of real clinicians and real patients.

A certain amount of psychological research looks to me like a game of “let’s pretend”: let’s pretend we are studying something important while ignoring virtually everything that is psychologically meaningful. For example, too many studies rely on responses to self-report questionnaires.

If you believe that unconscious mental life matters, this kind of research can seem silly and superficial. I resolved that my own re-

search would always address unconscious mental life.

Living the schism sounds like a conflictual place to exist. How do you find yourself managing both sides, or have you been able to build an effective “bridge” between?

It has not always been an easy place.

I’ve been viewed with suspicion in both camps. There are academic researchers who try to dismiss me as a “psychoanalyst,” which has become a term of derision in certain circles. Some psychoanalysts want to put me in a compartment as “the researcher”—in other words, not really “one of us.”

As if conducting research is somehow a 30

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disqualification from being a legitimate psychoanalytic clinician or scholar.

It’s okay, because I’m not looking for “easy.” Easy is overrated. It’s easy for researchers to shape research questions to fit a certain research method instead of tackling questions that are psychologically meaningful. It’s easy for psychoanalytic clinicians to embrace a certain theoretical model and apply it to every patient whether it fits or not. Good research and good clinical work are not “easy.” We might benefit—individually and as a profession—from spending more time in “conflictual places.”

That said, I’ve found a number of bridges. One is my work on personality patterns and disorders using the ShedlerWesten Assessment Procedure (SWAP). My collaborator, Drew Westen, and I designed the SWAP to (among other things) assess the spectrum of psychological processes relevant to psychoanalytic case formulation—for example, characteristic conflicts, defenses, internal and external object relations, self-experience, transference propensities, desires, fears, fantasy life, and so on.

It’s an assessment instrument completed by clinicians, not patients, and it forces clinicians to consider a patient through multiple theoretical lenses. This research has made me a better clinician and deepened my understanding of psychoanalytic theory. It has helped me understand which theoretical models apply when, where they illuminate and where they obscure, and their practical treatment implications.

Initially, from a quantitative perspective, researching unconscious mental phenomena seems like a difficult process. How do you go about developing such a skill set?

First, you have to be a real clinician.

This means devoting time to clinical practice, treating a broad spectrum of patients, and undergoing personal psychotherapy or psychoanalysis. Psychoanalytic concepts are just abstractions unless you experience them firsthand, in clinical work and in personal therapy. You can’t really understand the concept of a transference–countertransference enactment, for example, just by reading about it.

Before we try to quantify any clinical concept, we should understand it at a deep level. In his book Outliers, Malcolm Gladwell described the “10,000 hour rule.” Basically, in any area of human endeavor—athletics, music, computer programming, creative writing, psychotherapy, anything—it takes 10,000 hours of focused practice to develop mastery.

I believe this. This is one reason why I’m

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skeptical of “clinical” research conducted by people who lack clinical practice experience.

The other piece of the puzzle, for me, is psychometrics: how to measure psychological phenomena. It sounds boring and people often take it for granted, as if it were something trivial or obvious, but it is not.

Psychological phenomena can be extraordinarily difficult to quantify. I worked with Warren Norman at Michigan and Jack Block at Berkeley, two of the greatest psychometric minds of their day. They weren’t clinicians, but they understood how to quantify complex, nuanced psychological processes.

Sometimes psychoanalytic clinicians who attempt research get disappointing results, not because their hypotheses are wrong, but because they do not appreciate the psychometric challenges they are tackling. Their measures may not capture the richness and complexity of psychoanalytic concepts, or they may end up with data that contain too much measurement error to be scientifically useful.

This brings us back to the science– practice schism. We have empirical researchers in the business of quantifying things, but they lack clinical experience and do not necessarily understand what is important to quantify. From a psychodynamic perspective, they sometimes end up studying trivia. We have sophisticated clinicians who may have a deep understanding of clinical phenomena, but they don’t know how to translate clinical ideas into researchable concepts. If people with these different skill sets valued one another, communicated, and worked together, great things might happen. But generally, they don’t.

How would you recommend that the profession begin to bridge the schism?

That’s above my pay grade. We’ve been hearing rhetoric about bridging the science–practice schism from the highest levels of APA leadership for as long as I can remember. The rhetoric waxes and wanes with APA election cycles. But it never amounts to anything more than rhetoric.

It might be more helpful to discuss some of the things that exacerbate and perpetuate the schism so we can see it more clearly. From my perspective, the schism is getting worse, not better. One contributing factor is that we have institutionalized the science–practice schism by bifurcating training in clinical research and clinical practice into PhD and PsyD programs, respectively.

There was a time when clinical psychology PhD programs at research universities included faculty members who identified primarily as clinicians and faculty members who identified as researchers. They came into contact with each other and developed some appreciation of one another’s perspectives. Even researchers who had no

professional interest in clinical topics developed some understanding of what clinical work is about. This is no longer so.

The demands at research universities to publish and get grants have become extreme. Faculty members cannot devote time to clinical practice; it would be professional suicide for an untenured faculty member to treat patients while others accumulate publications and grants. As clinicians have retired, they have been replaced by “clinical researchers” or “clinical scientists” with little practice experience. The trend is toward APA-accredited “clinical” PhD programs without clinicians. Faculty members at these programs may have no idea what good clinical work even looks like.

Science). I’m not singling out Professor Kazdin, whose research I respect. His comments reflect prevailing attitudes. Clinical researchers routinely extol the brief, scripted therapies studied in research laboratories and denigrate psychotherapy as most of us understand and practice it. Policy makers and the public are getting a steady diet of misinformation about psychotherapy, coming mostly from people who do not actually practice psychotherapy.

As clinicians have disappeared from research universities, real clinical training has moved increasingly to the professional schools. This bifurcation of the profession has consequences. In research-oriented clinical PhD programs, theory and research develop in isolation from the crucial data of

This is one reason we keep seeing comments in the news media from prominent researchers that are dismissive and denigrating of in-depth psychotherapy. Not long ago, for example, former APA president Alan Kazdin told Time magazine that individual psychotherapy is “overrated and outdated” and bemoaned that too few patients receive “evidence-based treatments like cognitive-behavioral therapy.”

I don’t think anyone who knows what good psychodynamic therapy looks like and can accomplish would consider 12 or 16 sessions of manualized Cognitive Behavior Therapy to be good psychotherapy. And scientific research does not show that it is more effective (see my blog, Bamboozled by Bad

clinical experience. In freestanding professional schools, clinical training can become divorced from the scholarly and intellectual traditions of university life and the critical thinking it fosters. Training in both kinds of institutions suffers and the science–practice schism grows.

These are structural problems without easy solutions. Research universities now depend on the grant money researchers generate, and they have no incentive to reward or encourage clinical immersion. Many freestanding professional schools have become profit centers, and they will continue to operate as they do so long as it is financially profitable. Both clinical research and clinical training have become industries.

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INTERVIEW

Can you describe some specific research findings that influence your work with patients, and offer a clinical vignette that illustrates the finding’s applicability?

A question can sometimes reveal more than an answer and that may be the case here. I know this question was drafted by the research committee and reflects a sincere desire to support research and demonstrate its relevance. But the question reflects

is likely to come. Our narratives should be dynamic, not static, so we are continually reworking and revising them as new information emerges (like Piaget’s concept of assimilation and accommodation).

For me, empirical findings are one of many streams of information that help shape the narratives that reflect our psychological knowledge and understanding.

The narrative transcends the information it incorporates and represents a synthesis of everything we learn from all sources—from our patients, from theory, from teachers and supervisors, from empirical research, from our countertransference responses, from our personal analyses. Everything is in the mix.

an assumption about the relation between research and practice that I don’t share. It implies there is or should be a direct relationship between research findings and clinical intervention: “Because this study showed X, I do this or that in psychotherapy.” That is not my understanding of the role of research.

Knowledge is about constructing narratives. A clinical case formulation is a form of narrative. So is a scientific theory. A narrative weaves information together in a way that makes sense of it. It helps us see how the pieces fit and relate to one another. A sound narrative is internally coherent, consistent with what we can know and observe, accounts for as much relevant information as possible, and helps us anticipate what

From this perspective, asking how a specific research finding influences my work with patients is the wrong question. The direction of influence is not one-directional, from research to clinical work. It is not even quite right to say the influence is reciprocal or dialectical, although that would be better. I would say, rather, that everything plays a role in shaping the narratives or working models that inform my clinical work. (See Shedler, 2004, for more on the relationship between psychoanalysis and research.)

I also don’t draw a sharp distinction between thinking clinically and thinking scientifically. Good science and good psychotherapy require critical thinking. Psychotherapy is, among other things, a shared, collaborative process of observation, hypothesis

These comments barely scratch the surface. Readers who want a more thorough discussion may want to read my article, “Why the Scientist-Practitioner Schism Won’t Go Away” (Shedler, 2006).

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generation, hypothesis testing, and hypothesis revision. When I do research, I am sharpening my clinical skills. When I treat patients, I am sharpening my research skills.

A psychoanalytic interpretation is really a hypothesis, and we generally present it to the patient as such: an idea for mutual consideration and reflection. What happens next provides data that help us revise, refine, or elaborate on the hypothesis, or discard it and formulate a different hypothesis.

I don’t mean to give the impression that psychoanalytic work is just an intellectual process. Far from it. We enter the therapy relationship with our whole selves. We immerse ourselves in the relationship and experience it from the inside. We experience it emotionally.

Yet, we must be able to shift between experiencing and reflecting on what we experience. A therapist who engages primarily on an emotional level, without stepping back to reflect and understand, is either participating in an unwitting enactment or else offering the patient little more than emotional pablum.

A therapist who approaches the work in an emotionally distant, intellectualized way will miss everything important. The work requires heart and head, yin and yang. In classical analytic language, we must be able to move fluidly between experiencing ego and observing ego, and we work to develop this capacity in our patients as well.

What is sometimes difficult to convey to people who are not psychoanalytically trained is that the most important data emerge from the therapy process, not just the manifest content of our patients’ words and actions. For example, they emerge in the transference–countertransference enactments that we inevitably find ourselves participating in as we engage with our patients. Our data are not limited to what our patients tell us. They include what they show us through their interactions with us, the emotional reactions we notice in ourselves as we engage with them, and what they communicate metaphorically or symbolically through their associations.

I know of exactly one book that explicitly discusses psychotherapy in terms of hypothesis generation and hypothesis testing and emphasizes how the therapy process—what happens in the room between patient and therapist—provides the crucial data. The book is Beginnings: The Art and Science of Planning Psychotherapy by Mary Jo Peebles. I recommend it to all my students and supervisees, from first-year graduate students and psychiatry residents to advanced psychoanalytic candidates.

I could, of course, come up with examples of how particular research findings influence my clinical work, but in doing so, I’m afraid we might miss a larger, more important truth.

INTERVIEW

So will you tell us about a specific research finding that has influenced your work with patients?

Now that I’ve discussed the misconception embedded in your question, yes. There’s still a certain amount of debate about the concept of borderline personality organization. The historical debates between Kernberg and Kohut are legendary, and the topic can stir rancor even now. Some psychoanalysts view the concept of borderline personality as a throwback to a “one-person psychology” that pathologizes the patient for experiences that are co-constructed in the therapy relationship. On the other end of the spectrum, I occasionally hear very classically oriented psychoanalysts reject the idea that personality can be organized around splitting (versus intrapsychic conflict) and dismiss the model with the ultimate psychoanalytic put-down: “It’s not psychoanalysis.” But there are empirical questions here. There is no use trying to resolve them through philosophical or ideological debate, or by appeal to authority, or through competing clinical case studies selected and crafted to demonstrate whatever a theorist wants them to demonstrate.

The defining hallmarks of borderline personality organization, as Kernberg conceptualized it, include splitting, projective identification, identity diffusion, and affect dysregulation. The Shedler-Westen Assessment Procedure (SWAP; Shedler & Westen, 2010) assesses all these phenomena. The SWAP consists of 200 personality-descriptive statements that a clinician scores according to their relevance to a patient, from “not descriptive” (scored 0) to “most descriptive” (scored 7). The possible combinations and permutations of SWAP items are virtually infinite. They allow a knowledgeable clinician to provide a comprehensive description of a patient’s personality functioning in a way that captures the person’s psychological complexity and uniqueness.

We used the SWAP to study personality in large national samples of patients. In a recent study, 1,201 psychologists and psychiatrists described a patient randomly selected from their practices. We used statistical techniques to identify naturally occurring diagnostic groupings in the patient sample—that is, groupings of patients who share core psychological features in common that distinguish them from other patients (Westen, Shedler, Bradley, & DeFife, 2012).

In every sample we studied, we found a grouping of patients that unmistakably fit the theoretical description of borderline personality organization. Some analysts may object to the concept on philosophical or ideological grounds, but burning the map does not destroy the territory. The phenomenon exists.

And guess what? The core, defining features of borderline personality organization

do include splitting, projective identification, identity diffusion, and affect dysregulation.

These are theoretical terms. The actual SWAP items are written in plain English, not theoretical jargon.

SWAP items like the following helped capture the phenomenon of splitting: When upset, has trouble perceiving both positive and negative qualities in the same person at the same time (e.g., may see others in black or white terms, shift suddenly from seeing someone as caring to seeing him/ her as malevolent and intentionally hurtful, etc.).

Expresses contradictory feelings or beliefs without being disturbed by the inconsistency; has little need to reconcile or resolve contradictory ideas.

SWAP items like the following helped capture the phenomenon of projective identification (considering the meaning of the items in combination, not singly): Tends to see own unacceptable feelings or impulses in other people instead of in him/ herself.

Manages to elicit in others feelings similar to those s/he is experiencing (e.g., when angry, acts in such a way as to provoke anger in others; when anxious, acts in such a way as to induce anxiety in others).

Tends to draw others into scenarios, or “pull” them into roles, that feel alien or unfamiliar (e.g., being uncharacteristically insensitive or cruel, feeling like the only person in the world who can help, etc.).

Tends to confuse own thoughts, feelings, or personality traits with those of others (e.g., may use the same words to describe him/ herself and another person, believe the two share identical thoughts and feelings, etc.).

These are examples of SWAP items that consistently received high scores for patients in the empirically identified borderline grouping. They received high scores from clinicians of all theoretical orientations. In other words, it didn’t matter whether or not the clinicians understood or “believed in” the theoretical concepts (or had ever been exposed to them at all). When asked to describe their actual patients using descriptive statements written in plain English, this is what clinicians of all theoretical orientations observed and reported. (For more information about SWAP, visit www.SWAPassessment.org) So it turns out that the concept of borderline personality organization, as concep33

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tualized by Kernberg and more recently explicated in Nancy McWilliams’s classic book, Psychoanalytic Diagnosis, is empirically sound. Clear treatment strategies follow from this. Among other things, we need to recognize and interpret splitting where it occurs. This means helping a patient hold in mind, at the same time, contradictory attitudes and feelings that he or she is accustomed to compartmentalizing.

For example, I am now treating a patient with narcissistic personality dynamics, organized at a borderline level. He oscillates between feeling superior and feeling inadequate but he doesn’t experience this inner contradiction. When he feels superior, that is what is real to him and his coexisting feelings of inferiority seem inaccessible and irrelevant. Likewise when he feels inadequate. When he expressed both sets of feelings sequentially during the same session, I had an opportunity to do some work around this. I said, “Sometimes you feel that you are better and smarter than everyone else. And sometimes you feel that everyone else is better and smarter than you.” My comment was aimed at bringing together what my patient had been keeping apart. I will likely be making comments along these lines throughout the treatment. I’m also experiencing splitting in the therapy relationship. At the moment, I’m a good, idealized object. I have little doubt that soon enough, I’ll be a bad, devalued object, and I will be prepared to interpret that too.

Here is an instance where there is convergence between psychoanalytic theory, my subjective experience of my patient in the therapy relationship, and a specific research finding. z REFERENCES Gladwell, M. (2008). Outliers: The story of Success. New York: Little, Brown and Company.

McWilliams, N. (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Second Edition. New York: Guilford Press.

Peebles, M.J. (2012). Beginnings: The Art and Science of Planning Psychotherapy, Second Edition. New York: Routledge.

Shedler, J. (2004). Review of the book Clinical and observational psychoanalytic research: Roots of a controversy, edited by J. Sandler, A-M. Sandler, & R. Davies. Journal of the American Psychoanalytic Association, 52, 2. Retrieved from http://jonathanshedler.com/writings Shedler, J. (2006). Why the scientist-practitioner schism won’t go away. The General Psychologist, 41(2), 9–10.

Retrieved from http://jonathanshedler.com/writings Shedler, J. (2013, October 31). Bamboozled by bad science: The first myth about “evidence-based” therapy.

Retrieved from http://www.psychologytoday.com/blog/ psychologically-minded/201310/bamboozled-bad-science Shedler, J., & Westen, D. (2010). The Shedler-Westen Assessment Procedure: Making personality diagnosis clinically meaningful. In J. F. Clarkin, P. Fonagy, & G. O. Gabbard (Eds.), Psychodynamic psychotherapy for personality disorders: A clinical handbook. Washington, DC: American Psychiatric Press.

Szalavitz, M. (2011, September). Q&A: A Yale psychologist calls for radical change in therapy. Retrieved from http://healthland.time.com/2011/09/13/qa-a-yale-psychologist-calls-for-the-end-of-individual-psychotherapy/ Westen, D., Shedler, J., Bradley, B., & DeFife, J. (2012).

An empirically derived taxonomy for personality diagnosis: Bridging science and practice in conceptualizing personality. American Journal of Psychiatry, 169, 273–284.

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Toe to Head: Magritte and Bataille One of the first wall labels we encounter at the recent Museum of Modern Art (MOMA) show, Magritte the Mystery of the Ordinary, aligns us upon a certain trajectory for thinking about surrealism’s project.

The painting, Entr’acte (1927), we are told, viz Magritte, “shows his preoccupation with bodily fragmentation.” And, for sure, there it is scattered all around the galleries of MOMA, a body in pieces: morselized limbs and feet, torsos minus heads, arms as cudgels, as well as orphaned skulls, breasts, legs, and feet. The dates of the works in the show range from the late 1920s, when Magritte was living and working in Paris, and was at his closest to André Breton and the Paris group of surrealist artists and writers, up through the 1930s, when he had returned to the more parochial scene of Brussels.

Given those dates, there is no doubt the human and psychological detritus of World War I foreshadowed this “preoccupation” of Magritte’s. Unsurprisingly, it was not a lonely preoccupation. Many a contemporary of his on either side of the defunct, but soon to be rehabilitated, Western front would attest in their own work to this same preoccupation.

In Germany, Otto Dix cornered the field for rendering “war cripples.” In France, the traumatized body surfaces—merely staying within the surrealist group—in photographs of Brassaï and Jacques-André Boiffard, collages of Max Ernst, and assemblages of Hans Bellmer, to name only the most obvious. This same deformed figuration, or is it re-formed, of the human body executed by many of the most notable of the surrealists, including Magritte, would later adorn the covers of the surrealist journal Minotaure.

And importantly, as our concerns will develop here, within said journal we will find essays by a youthful Lacan; especially one on the notorious crime of the Papin sisters, wherein the aforementioned sisters murdered and gruesomely dismembered their employers. Indeed Lacan was attentive to and “inspired” by, as Elizabeth Roudinesco offers (1990, p.26), the “encounter between the Freudian unconscious, language and the decentering of the subject” that he witnessed in his various outings with of the surrealist group. In short, while “war cripples” inhabited the paintings and the streets of Europe, it is fair to say that the disorganized body is everywhere in surrealism. For the surrealists, this was not mere reportage of the recent hostilities. Rather, in the shadow of and very much contrary to the nation’s loudly promoted “Return to Order” (Lyford, 2007, p.7), the surrealist project sought to disorganize the very social body of the good bourgeoisie of France.

Laurence HEGARTY

The Paris that Magritte found himself in during the interwar years was one of the centers of the European avant-gardes.

Dada’s moment of doubt and fame had passed in Zurich. Founder Hugo Ball was already eying a return to Catholicism and co-conspirator Richard Huelsenbeck—back in Berlin as early as 1919—was organizing a Dada cell there. By the 1920s, many of the other originals had moved to sundry European cities as well as New York, Europe’s North American outpost, to establish the heterodox future of their move-

the pope of surrealism and the mantle of Dada was to be shared with those of Rimbaud and Apollinaire.

The missing player in this coalition thus far is Freud. As described by Breton and colleagues, psychoanalysis—its particular version of an unconscious, its techniques of word association—was little short of the muse to all future poetry. It is often said that Freud came late to France. He lacked an invitation on grounds both anti-German and anti-Semitic is the frequent conceit.

Roudinesco argues that Freud was in clini-

ment. In Paris, Tristan Tzara, author of the first published Dada manifesto, (the prior Dada manifesto by Ball had been read but not published) was eagerly embraced by Breton’s circle. Though Breton allied himself with Tzara and Dada, he also sought to shift the center of gravity toward his own concerns with the legacies of Arthur Rimbaud and Guilliame Apollinaire. In the former, he identified a poetry that most prefigured the surrealist canon-to-be, while from the latter, he borrowed and rode the word surrealism to apotheosized heights.

Thus, if Breton was to ultimately be in charge, and he surely was, he was dubbed

cians’ minds as early as 1914, but she argues he was there less as a clinical technique and more as psychobiograpical tutor—a way of conceptualizing a conflated picture of pathology and personality (Roudinesco, 1990, p.12). However, Freud’s most open invitation to France was not medical—though not exactly not clinical—but literary. Breton and Louis Aragon, friends, surrealists in the making, and medical students during World War I, tried their hands at psychoanalytic technique. In 1917, Breton was an orderly in a psychiatric unit in Saint-Dizier. His patients were the “war cripples” of many a painting to be. Flush with rudimentary

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psychoanalytic knowledge, Breton interviews the patients, able, as one biographer attests, “to try out experimentally on the patients the process of psychoanalytical investigation” (Balakian, 1971, p.27).

We do not know of Breton’s clinical acumen or the true details of his clinical practice. That scene is perhaps most important as a prologue to the fudged boundaries between the clinical and the literary that he is already courting. In the 1920s, French attitudes toward insanity, despite the efforts of dynamic psychiatry, remained hungover with notions of degeneracy. The Freudian unconscious, as Breton and others read it, was not withering away from some

Freudian unconscious was neither a moment of pathology, nor a sign of degeneracy; it was instead at work relentlessly undoing the reasoning subject. Though it was neither Bolshevik, nor Spartacist, in surrealist hands, psychoanalysis was certainly not going to be part of France’s return to order. In this manner, two largely German accents—Freud and Dada—arrived in Paris via the protosurrealists.

T. J. Clark has recently offered that “it is very hard for us…to conjure back the feeling of the circumstances in which, for much of the 20th century, modern art got made” (Clark, 2014, p.6). A world war behind them, a world war ahead of them, in-

ideal nondegenerate form of a good Europe, who knew its place in class and nation and would return to that place in class and nation posthostilities. It was, rather, a potential, an access point to “the marvelous”: that magical philosopher’s stone of surrealism where the quotidian abruptly became extraordinary, surreal. Appropriated thusly, this theory of the unconscious sanctioned a part of human existence that was neither rational nor constrained by reason. In doing so, it undid the whole logic of degeneracy. In 1920s Europe, reason itself seemed a swindle; if nothing else, Verdun and the Somme showed that. In this context, the

cipient or actual fascism afoot, artists across Europe were reimagining a social form as much as the form of the work itself. Dada artists had abandoned national affiliations (albeit temporarily) through reclusion in Zurich. Breton and the other surrealists were busily abandoning the coordinates of their bourgeois caste (Breton ditched medical school). There were relentless public excoriating attacks upon the clergy and the venerated cultural elite and most individual surrealists sought a close affiliation with the communist party. It was as if an identity that would not go along with the low dishonesty of the times was the task of modernism 35

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itself. And so, writing with Louis Aragon in 1928, Breton valorized “madness” itself, announcing that “hysteria was the greatest poetic discovery of the latter part of the century” (Roudinesco, 1990, p.7). In this embrace of madness, Breton and others genuflected before Augustine, Charcot’s young hysteric of much photographic fame from the Salpêtrière. They saw the hysteric’s body as “a supreme vehicle of expression” (Roudinesco, 1990, p.6). In its way— Breton fulminated—hysteria was not pathology at all but a form of poetic utterance. In a way, Breton’s argument is the struggle of modern art and of modernism; the struggle to find the right form. Breton and the poets and painters he gathered around him were struggling to find, through automatism, the right form for a poetry of 1920s Europe. With automatic writing, with free association, with dream imagery, it seemed to them they had learned their lessons from “madness” and from psychoanalysis.

In this image-rich history of the Salpêtrière, which was embraced by the surrealists, and with Magritte’s “preoccupation,” we see the infirm and broken body as a nodal point of that struggle. Whatever form the body will deploy, it is not a voluntary body; rather, it is impelled by trauma in its amputations or contortions and by unconscious impulses in its desires. What shall the evolving social subject of a destroyed Europe wear as its outer skin or form? How will the mutileés return to being French men? Split and riven by trauma, trench warfare, or rape—as in the case of many of Charcot’s hysterics—the body, the subject of an evolving European modernity, was in need of renegotiation.

Against this interwar chaos, it can be said that Magritte has a style of painting, of rendering, wherein the rendered object is visually clear and recognizable (his style has ungenerously been referred to as a “paint by numbers” style). Yet the dynamic at play within the painting, either between elements within the canvas or in the dynamic of reading set up between canvas and viewer, hinges upon visual or linguistic misrecognition. “This is not a pipe,” Magritte assures us. Neither the image painted, nor this word “this” is a pipe.

Such semiotic mischief generically undoes representation, but also, and more importantly for our concern here, such images as The Titanic Days (1928) or The Acrobat’s Ideas (1927) present a noncongruent rendering of a human form. A human form not bounded and not delimited, even though at first glance it appears to be so.

Imaginary misrecognitions such as these abound in the work, alongside doppelgangers in bourgeois bowler hats and mutilated, wounded human bodies. Formally

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his painting is bland, unimaginative, pedestrian, but the bodies formed and the sense of identity formation they convey is monstrous—the deformed or the unforming. Notwithstanding the clichéd presence of Magritte posters in sophomore dorm rooms, the imaged human forms he deploys are unsettling and disorienting.

Two registers then—the visually seen and the affectively known. I see clearly and I feel haunted. I see clearly, yet I feel an uncanny presence. Magritte is exploiting a certain aspect of rendering, to wit, resemblance. Despite their style, his paintings never, of course, achieve the status of photographic verisimilitude. And yet, their proxy style for realistic rendering toys with and courts a certain truth-value that photography claims as its own. In the inevitable Magritte twist, that truth claim is torqued beyond tolerance. Magritte’s paintings propose that what you are seeing exists in the world beyond the canvas’s rectangle. This proposition is not exactly believed, but the viewer’s grasp of what they see toggles back and forth in some imprecise space of knowledge and disavowal.

In appropriating this terrain of rendered visibility—resemblance—the paintings also invoke a quality of the viewer. If there is a coherence to what the viewer sees, is there not surely a coherence to the viewer, a unified coherent form of identity lurking somewhere in the proximity of the spectator? By proposing this and pulling the rug out from under such an implied contract, Magritte spikes this imaginary formation of identity. It is here, on the far side of the failed proposition of coherent identity, that the affectively known is found.

Rosalind Krauss, in writing about surrealist photography, nails this psychic operation that Magritte is negotiating. After invoking Lacan’s theory of the imaginary constitution of subjectivity, or more accurately, his theory of the failure to constitute a coherent subjectivity (which in turn is an attempt to rethink Freud’s failed proposition of a coherent ego), Krauss offers: To produce the image of what one fears in order to protect oneself from what one fears is the strategic achievement of anxiety, which arms the subject in advance against the onslaught of trauma, the blow that takes one by surprise. (Krauss, 1985, p.86) The blows, the traumas are many and varied. And indeed, surrealism saw itself, at least in part, as in the business of administering such blows to the French social body already on its knees from WWI. Krauss offers a thread to follow through the bewildering maze of traumas. Against the modernist quest of finding a form, she invokes,

in her words, “renegade surrealist Georges Bataille” (Krauss, 1985, p.57). It is Bataille’s motif of the formless—in Krauss’s rendering, the unformed—that is to be mobilized to hold the renegade line. Formless arises in Bataille’s journal Documents. The journal, his “war machine against received ideas,” was published between 1929 and 1930 and was a precursor to the already mentioned, much more well-known, more highly produced, and far less war machine-like, surrealist journal Minotaur. Over its brief existence, Documents was a heterogeneous container of essays and images. Its masthead offered that it contained a formidable grab bag of “doctrines, archaeology, fine arts, ethnography.” Contents that ranged from Eli Lotar’s photographs of the Paris slaughterhouses to an essay on S. M. Eisenstein’s films by expelled surrealist poet Robert Desnos. There were images of Joan Miró’s painting, a photo essay on the Chicago gang wars of the 1920s, reproductions of lurid covers from detective fiction, and full-page images of the Roman Catacombs chock-full of human skulls. Bataille’s Formless comes to life as a relatively brief entry in a subset of the journal The Critical Dictionary. This “dictionary” was something of a cabinet of intellectual and cultural curiosities even by Documents’s standards. Its most frequent contributors were Bataille’s closest circle, ex-surrealists and writers associated with Paris Dada.

The entry for Formless defines the word as “a term serving to declassify”; a word to undo the already done because, as Bataille conceived it, “a dictionary would begin when it no longer provided the meanings of words, but their tasks.” And what was to be undone? The “academic’s” need for “the universe to take on a form.”

Because the “universe resembles nothing at all and is formless, which amounts to saying that the universe is something akin to…a gob of spittle.” Resemblance, then—a noted identity between things, or its noted absence, is jettisoned, spat out we might say. Clearly, the entries in The Critical Dictionary were not limited to definitions, nor to revealing words’ “tasks.” There was also—the occluded truth of all dictionaries—an ideological battleground to contest (Bataille, 1985, p.31).

Krauss, in her essay on surrealist photography, Amour Fou, allies with Bataille’s Formless to examine the usurpation of photographic verisimilitude; that is, its formal undoing or unforming. Scanning photographs of the human body shot by surrealist photographers Man Ray, Brassaï, Lotar, or Boiffard—many of whom were to be found in Documents—she notes that the body is made strange, “unfamiliar.” Strategies for this vary. Sometimes through what amounts to a system of 36

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anamorphosis, where through the rotation of the camera’s point of view and a deep plunging sight line or an extreme foreshortening of the photographed subject, the body appears as a “beast.” Photography, surrealist photography, creates monsters.

In this body of work, the human body becomes a never fully and stably recognizable form. The human body coheres into view and slips away again. Or perhaps the

body is mis-recognizable; it is a body “becoming,” but becoming what? In this photographic work, identification is never to be fully achieved. Identification is always unachieved, underachieved, or undone.

Anamorphosis sets up a point of view of an “Other” within the seen scene; it is as if what I am seeing is seen from another subject-position simultaneously. My authority, my uniqueness, my constitution of and by the scene is brought into question by the possibility of another point of view for which the scene is organized. Indeed, if we return to Lacan, he goes further. Lacan references, on numerous occasions, Hans Holbein’s painting, The Ambassadors, with

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its famed anamorphic rendering of a death’s head, asserting that Holbein’s anamorphosis guarantees that the “subject is annihilated” (Lacan, 1988, p.88). Moreover, when the entire image’s point of view is shaped by anamorphosis, it is I who is out of place, in the wrong position—annihilated, as Lacan has it.

He, who is seeing from the other point of view which, it is implied, is not anamorphic, is seeing the clearly organized picture orga-

nizing him as a subject for whom this scene is clearly laid out. Anamorphosis sacrifices human congruity and uniqueness in much the same way Magritte does in The Titanic Days or Entr’acte.

And perhaps, in more than a punning association, we could wonder if the word sacrifice or the word annihilation have a more resonant tone than they first signal.

As Neil Cox (Ades & Baker, 2006, p.106) has pointed out, though there is no entry in Documents, nor The Critical Dictionary for sacrifice itself, its presence nonetheless abounds therein. And, throughout his work, Bataille turned his eye, mind, and pen toward sacrifice again and again and again.

In Documents, Lotar’s already mentioned images of the Paris slaughterhouses are commissioned to accompany Bataille’s dictionary entry on animal sacrifice, Abattoir.

It is Bataille who is most often credited as the author of the polemical attack upon Breton, published as the pamphlet Cadvre (1930), wherein Breton’s image, crowned with thorns, is given as an obituary for the very much still living surrealist leader.

Later in 1930, Bataille wrote of Van Gogh’s severed ear as animist sacrifice. As early as 1926, wearing an ill-fitting anthropologist’s hat, Bataille wrote of Aztec sacrificial rituals. Images interpreted by him as depicting Aztec sacrifice, though now said to depict birth, appeared in Documents from Codex Borgia (Bataille, 1985). In the 1940s, Bataille continued to research and write about the same in Sacrifices and Wars of the Aztecs (Bataille, 1985). He moved on to Marcel Mauss’s theorization of Potlatch, elaborating upon the same practice of senseless waste, expenditure, and sacrifice. And most notoriously, later in the secret society Acéphale, it is rumored that Bataille eagerly planned for this group to actually carry out a human sacrifice (Irwin, 2002, p.38).

Beginning in 1925, for a little over a year, Bataille was in analysis with Adrien Borel. Paths crisscross many times over here, and provenance regarding knowledge, regarding image becomes hazy.

According to Roudinesco, at the beginning of the treatment, Borel handed Bataille an infamous photograph by Louis Carpeaux (Roudinesco, 1977, p.12). The image was of a Chinese man being executed by the, probably apocryphal, process of “death by a thousand cuts,” but was described by Roudinesco as a man being “cut into a hundred pieces.” Michel Surya, Bataille’s biographer, places Borel himself at the scene of the execution, taking the photograph that he later “sent” to Bataille (Surya, 2002, p.93). The victim of the far from apocryphal execution has, it is reported by both writers, been injected with opium to prolong rather than to anesthetize the process, and this opium is speculated to account in part for the presumed ecstatic countenance on the victim’s face.

With Surya, the photographs inexplicably become plural and we are told that they “obsessed” Bataille; “he spoke of them often and always kept them” (Surya, 2002, p.94). Per Surya, “The photographs Bataille discovered in 1925 and published a year before his death, in 1961…welled up in his work like one of its essential springs” (p.94).

We are perhaps in the presence of a devotional act on Bataille’s behalf. But, there too is an act of interpretation or—and perhaps this is the same thing—empathy. Bataille regards the cuts and the tortured body, but 37

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also the face of the victim. He writes of the victim, “The young and seductive Chinese man…communicated his pain to me” (Bataille, 1988, p.120). For Bataille, looking into the face of this victim, there is an ecstasy of empathic connection. Bataille’s ecstatic reverie collides with Magritte’s “preoccupation.” And yet, Magritte’s undergirding device—resemblance—is ambushed and undone. Bataille reaches out to the sacrificial victim; he strains for resemblance, identification. Yet, the body is being literally undone, unformed; literally it is being put asunder. No resemblance, no form, little more than a “gob of spittle.”

There is a particular figure, the Acéphale, which after the mid-1930s comes to be the cypher for Bataille’s thought. And though it is never named as such, this figure is relentlessly at work in Magritte’s oeuvre.

Indeed, it is blatantly there in Entr’acte, the painting where Magritte’s “preoccupation” is first noted at MOMA. It is there in The Lovers (1928), the painting that is often cited as referencing Magritte’s mother’s suicide. Indeed, this headless or faceless figure recurs again and again throughout Magritte’s career. For Bataille, it is André Masson’s drawing, published on the cover of the first edition of Bataille’s eponymous magazine, that illustrates the Acéphale.

Masson’s drawing gives a human(ish) figure based on Da Vinci’s Vitruvian Man; it is a headless figure, a body minus its locus of rational thought. The head has become a skull and has been displaced southward to become as a fig leaf. The Acéphale, the headless man, is seen as representing the end of reason (which is certainly one way to think of the surrealist goal). This is also perhaps the best proposition of the interwar years; European social subject coming into being—lost to reason, not in control of motivations and action, locus of identity banished or displaced, traumatized and scarred, acéphalic man is the prototypical, mid-century subject shared by psychoanalysis and surrealism. Indeed, it is at mid-century proper (1951–1952), a full twenty years after Bataille, that Lacan, in addressing Freud’s mass psychology and the analysis of the ego, will work out his own theory of the polycephalic and ultimately acéphalic subject. For Lacan, “If there is an image that could represent for us the Freudian notion of the unconscious, it is indeed that of the acéphalic subject” (Lacan, 1974, p.166).

Whether Lacan’s debt to Bataille is acknowledged or not, it is of note that heads—lost, gone, switched, and crowned with thorns—populate Bataille’s arcanum and so too do other body parts. In Documents, Boiffard’s images of the big toe accompany Bataille’s article of the same name. Boiffard’s images offer the

ART

body part rising out of the pitch dark, dismembering background; grotesque and anonymous, but labeled male and female.

Bataille’s essay is littered with a vocabulary of violence and death. Toes are “hideously cadaverous,” they give “shrill expression to the disorder of the human body”; the toe is “always, more or less tainted and humiliating” (Bataille, 1985 p.22). Thus, big toes are gendered, poised, loaded, and here staged rather melodramatically upon their dark grounds. Bataille ponders the seductiveness of this fetishized part-object. Yet, his words arrive at the irreducible base materialism of this particular body part, “with their feet in the mud but their heads somewhat approaching the light, men obstinately imagine a tide that will elevate them” (Encyclopaedia Acéphalica, 1995, p.87). Bataille’s conclusion is that the tide is far, far out, and if it ever arrives, we should expect it to be fouled with our own abject flotsam.

Many of Boiffard’s other images in the magazine drive to the far north of the body. There is a suite of four photographs of anonymous men dressed in regular street clothes but with heads obscured—in their way gone—by grotesque carnival masks.

The trickster photographer gives us street clothes that beckon, but the grotesque masks repel all possibility of identity, resemblance, or empathy; the soul is missing in action with the head. Masks acéphalize the wearer and the unformed body becomes the totemic figure of surrealism’s historical moment.

Perhaps it is important to acknowledge that there are divergent readings of Freud to be disinterred in surrealist circles.

Lacan is reconstructing Freud according to his own architecture of psychoanalysis, while Breton and Bataille are all but competitively reading Freud hot off the translator’s press. And it becomes increasingly apparent that each of the latter read Freud in his own way. Sometimes it feels as if Bataille reads Freud contra Breton almost as part of their ongoing feud. Breton valorizes, in Walter Benjamin’s phrase, the “magical realm of words” (Benjamin, 1929, p.232). Breton can translate trauma with words. Trauma is legible, transcribable and knowable. The hysteric’s language can be joined. It is an utterance that can be responded to rather than a babble written off as degeneracy. With Bataille, trauma is revered, it is all but sacred. In Magritte, as in Dix and others cited at the top of the essay, there is too an ironic reverence for the war injured. But for Bataille, trauma is all but an aspirational moment. Bataille, seemingly entranced, genuflects before trauma. He is impaled by a shared ecstasy of the victim. There is a reverence but also

a joining with the victim’s body. Breton reads Freud and finds a world of liberated signs. Bataille reads Freud and finds the tortured body—torn, traumatized, and base—but nonetheless a body.

In Bataille’s response to the other’s trauma, there is something beyond the moment of empathy that might connect two persons, say an analyst and analysand; say Borel and Bataille. There is an experience of communitas. Communitas is to be taken as a moment of vanishing or disso-

REFERENCES Ades, D., & Baker, S. (Eds.). (2006). Undercover surrealism: Georges Bataille and Documents. Cambridge, MA. MIT Press.

Balakian, A. (1971). Andre Breton, magus if surrealism.

Oxford, UK: Oxford University Press.

Bataille, G. (1985). Visions of excess: Selected writings, 1927–1939. Minneapolis MN: University of Minnesota Press.

Bataille, G. (1988). Inner experience. New York: SUNY Press.

Benjamin, W. (1929). Surrealism: The last snapshot of the European intelligentsia. In One way street. London, UK: Verso.

Clark, T. J. (2014). At Tate Modern. The London Review of Books, 36(1).

lution of unique identity. Often, communitas is achieved around some shared rite of passage. The traumatized body, empathically embraced, is for Bataille that rite of passage. There is a debt owed by Bataille to “the young and seductive Chinese man” in the photograph. His trauma allows Bataille an intense moment of joining with the other’s torn body; like a jump cut from my point of view to your point of experience. As with the dissolution of identity engendered by the anamorphic point of view, the look upon the victim’s face in Borel/Carpeux/Bataille’s photograph seems, for Bataille, to transcend the recognition of an individuated self across the gap between observer and seen. z

Lebel, R., and Waldberg, I, (eds), Encyclopaedia Acphalica (Atlas Arkhive). London, UK: Atlas Press, (1995).

Irwin, A. (2002). Saints of the impossible: Bataille, Weil, and the politics of the sacred. Minneapolis, MN: University of Minnesota Press.

Krauss, R. (1985). L’amour fou: Photography and surrealism. New York. NY. Abbeville Press.

Lacan, J. (1974). The seminar of Jacques Lacan: Book II: The ego in Freud’s theory and in the technique of psychoanalysis, 1954–1955. New York, NY: W. W. Norton & Company.

Lacan, J. (1988). The seminar of Jacques Lacan: Book IV: The four fundamental concepts of psychoanalysis. New York, NY: W. W. Norton & Company.

Lyford, A. (2007). Surrealist masculinities. Berkley, CA: University of California Press.

Roudinesco, E. (1977). Jacques Lacan. New York, NY: Columbia University Press.

Roudinesco, E. (1990). Jacques Lacan & Co: A history of psychoanalysis in France, 1925–1985. Chicago, IL: University of Chicago Press.

Surya, M. (2002). Georges Bataille: An intellectual biography. London, UK: Verso.

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ON POETRY

The Air of Another Time and Place: A Poem by Seamus Heaney

Henry M. SEIDEN

Those who follow—even if only glancingly—the world of poetry will know that one of the great poets of the 20th century, Seamus Heaney, died in Dublin in August 2013. His life and work have been much celebrated—volumes of poetry, criticism, and translation, including an outstanding translation of Beowulf from the Anglo Saxon.

His honors included a Nobel Prize in Literature in 1995. The New York Times in its obituary (of August 13, 2013) described him as: “A Roman Catholic native of Northern Ireland,…renowned for work that powerfully evoked the beauty and blood that together have come to define the modern Irish condition.” Heaney managed to be hopeful without being sentimental, and political without being polemical. He was learned but never obscure and so was a poet of great popularity.

Here’s a lovely example—at once simple and nostalgic and complex and evocative. As in all great art, craftsmanship disguises the labor that goes into making it.

Like Heaney’s work generally, A Kite… is immediately accessible and can be enjoyed with little explication. The reader feels that he or she can almost breathe that “air of another life and time and place.”

But some context deepens the pleasure: Aibhin is the name of Heaney’s new-born granddaughter. This poem was written to celebrate her birth and recollects an earlier poem for his sons called A Kite for Michael and Christopher. Anahorish, as is perhaps obvious, is Heaney’s childhood home, a township in County Derry. But one would not necessarily know that the name in Gaelic means “a place of clear water.” In another poem, Heaney calls it “the first hill in the world where springs washed into the shiny grass.”

And the poem by Pascoli, L’Acquilone, is a poem Heaney translated into English from the Italian as The Kite. In Pascoli’s poem, remembered joy and happiness are mixed with bitterness over the death of a fellow student. It includes the phrase, “air from another life and time and place.”

So underlying the apparently simple nostalgia of Heaney’s poem and complicating the sweet, bright memory, there are complex resonances (deeper currents, it might be said, under the surface of the clear water): the continuity of family, a celebration of the fragile temporality of our lives; elation, of course, but even in that moment of elation, separation—and a falling and a dying.

Psychoanalysts will not be surprised to find that here, as elsewhere, nostalgia is complicated. In classical terms (see, for example, Werman, 1977), we have treated nostalgia as screen memory—defensive, a saccharine recollection covering things that are not so sweet. And we distrust nostalgia as sentimental—having learned from Winnicott (1949) that sentimentality is the suppression of what he called “hate.”

A Kite…is certainly nostalgic and pleasurably so, but is no exercise in sentimentality—despite the lovely images. And despite the implicit innocence of the rhymed verse (a slant-rhyme handled so skillfully that one hardly realizes it is there). The moment of elation reaches its peak—but ends when the kite string snaps. (One is reminded of what Winnicott made of “down will come baby cradle and all.”)

And while we’re tempted to take the “windfall” as a kind of liberation, we understand that it can only be a falling, the beginning of the end.

High-flying young life is precious even as and because it ends in death.

The literary critic Frank Kermode in a now classic essay called The Sense of an Ending (1966) has much to tell us about the function of nostalgia. We in the Western world are dogged, he says, by our culturally bound view of time as linear. We know time passes; it must have a beginning, a middle, and, inevitably, an end. We live our lives oppressed by the certainty of that ending. We invent elaborate “fictions” (defenses of a kind, although he does not use that word) to make our apprehension palatable—religious fictions notable among these.

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And one way we tell ourselves the story of our journey through time is the embrace of sweet times past—nostalgia—a way of living, if only partly persuasively, in the good old days. I’m inclined to think that nostalgia gives us, too, a sense of sweet times future: as in The Kite…, a sense of those exhilarating days when all our precious but fleeting future was before us. z REFERENCES Kermode F., (1966). The sense of an ending. New York: Oxford University Press.

Werman, D.S. (1977) Normal and pathological nostalgia. Journal of the American Psychoanalytic Association (JAPA), 25, 387-398.

Winnicott, D.W. (1949). Hate in the counter-transference. International Journal of Psychoanalysis, 30:69-74.

A Kite for Aibhín

After “L’Aquilone” by Giovanni Pascoli (1855-1912)

Air from another life and time and place, Pale blue heavenly air is supporting A white wing beating high against the breeze, And yes, it is a kite! As when one afternoon All of us there trooped out Among the briar hedges and stripped thorn, I take my stand again, halt opposite Anahorish Hill to scan the blue, Back in that field to launch our long-tailed comet.

And now it hovers, tugs, veers, dives askew, Lifts itself, goes with the wind until It rises to loud cheers from us below.

Rises, and my hand is like a spindle Unspooling, the kite a thin-stemmed flower Climbing and carrying, carrying farther, higher The longing in the breast and planted feet And gazing face and heart of the kite flier Until string breaks and—separate, elate— The kite takes off, itself alone, a windfall.

From Human Chain by Seamus Heaney. Published in September 2010

By Farrar, Straus and Giroux, LLC. Copyright © 2010 by Seamus Heaney.

All rights reserved.

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SIDEBAR

Misconceptions and Negative Stereotypes: What Can the Division Do? Jonathan SHEDLER

In your interview in this edition of DIVISION/Review, you alluded to the widespread misconceptions and negative stereotypes about psychoanalysis.

What can the division do?

Quite a lot, actually. But our challenges are internal as well as external.

Psychoanalysis as a profession has a deeply rooted culture of insularity. We tend to occupy ourselves with internecine issues instead of engaging with professional colleagues outside our own circles. This no longer serves us. Actually, it is suicidal.

The perception of psychoanalysis in the eyes of policy makers and the educated public could hardly be worse. Barely a month goes by without an article in a major news outlet saying that manualized, “evidence-based” therapy is superior.

Misinformation and disinformation about psychoanalytic treatment abound.

Here’s one concrete example of something the division could do. In the midst of all the buzz about “evidence-based” therapies, the American Psychological Association

actually commissioned a blue-ribbon panel of experts to review the scientific literature.

They concluded that the therapies that are being promoted and marketed as “evidence based” are not more effective than other forms of psychotherapy. APA (2013) issued a formal policy resolution saying so. (For more on this, see my blog Bamboozled by Bad Science.)

How many Division 39 members even know about this APA resolution? How many are talking about it? If the division can’t find ways to educate the public, we could at least launch an information campaign to inform our own members. So, the next time any division member talks to a patient who has been told that “evidence-based” therapy is superior—or to a fellow psychologist, or a medical professional, or a student or supervisee, or a journalist, or simply an interested layperson—they could say, “No, actually, scientific research does not show that. That is not just my personal opinion.

That is the official scientific conclusion of the American Psychological Association.”

If every division member could have

this conversation, it would go a long way to changing the dialogue in our profession.

There are many more things the division could do, but our collective attention seems to be elsewhere. Change begins with self-examination. We need to examine our tendency to retreat into intramural quibbles at the expense of our survival. We need to reflect on why we communicate in arcane jargon, which creates an impenetrable barrier for many students and colleagues who would otherwise be receptive to psychodynamic thought. They are interested and curious, but they find a “not welcome” mat at our door. We need to reflect on how we ourselves have contributed, and continue to contribute, to the misunderstanding and prejudice that threaten what we cherish. z REFERENCES American Psychological Association. (2013). Recognition of psychotherapy effectiveness. Psychotherapy, 50, 102–109.

Shedler, J. (2013, October 31). Bamboozled by bad science: The first myth about “evidence-based” therapy.

Retrieved from http://www.psychologytoday.com/blog/ psychologically-minded/201310/bamboozled-bad-science

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— From the Introduction by Nancy Goodman Edited by Arlene Kramer Richards, Lucille Spira, and Arthur A. Lynch Encounters with Loneliness: Only the Lonely

This remarkable anthology of fascinating papers on loneliness is unique in the psychoanalytic literature. Although loneliness is a universal ubiquitous experience, it has not previously been discussed in the rich variety of its sources and manifestations.

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NOTES ON CONTRIBUTORS

Gemma Marangoni Ainslie practices psychoanalysis and psychotherapy in Austin, TX. As well as serving in multiple roles within the division, including President of Sections I, III, and IV, she is on the editorial board of PsyCritiques and co-edited Psychoanalytic Reflections on a Gender-Free Case: Into the Void and a faculty member at the Center for Psychoanalytic Studies.

Harriet I. Basseches is a training and supervising analyst and on the permanent faculty of the Contemporary Freudian Society (formerly the New York Freudian Society).

In 2014, the edited book, Battling the Life and Death Forces of Sadomasochism: Clinical Perspectives, edited by Harriet I. Basseches, Paula L. Ellman, and Nancy R. Goodman, was published by Karnac. Harriet is in private practice of psychoanalysis and psychotherapy in Washington, DC. Fred Busch is a training and supervising analyst at the Boston Psychoanalytic Institute, and a supervising analyst and member of several institutes. His third book, Creating a Psychoanalytic Mind: A Method and Theory of Psychoanalysis, was published by Routledge in 2013.

the National Psychological Association for Psychoanalysis, NY. She is on the editorial board of The Candidate: An Evolving Community. She also teaches as an adjunct assistant professor at the New School.

is best known for his article The Efficacy of Psychodynamic Psychotherapy, which won worldwide acclaim for establishing psychodynamic therapy as an evidence-based treatment.

Catherine Sancimino leads a school-based behavioral health program in Berkeley, CA. She is a board member of Division 39, Section II: Childhood and Adolescence and will be presenting a poster at the 2014 APA Convention in Washington, DC.

Mark Stafford is a practicing analyst, a member of Apres-Coup Psychoanalytic Association, and faculty member of the New School University, the School of Visual Arts, and the Westchester Institute for Psychoanalysis.

His publications include Being Human: The Technological Extensions of the Boundaries of the Body (Agincourt/Marsilio).

Henry M. Seiden is a regular contributor to this review and maintains a private practice in Queens, NY. Jonathan Shedler is Clinical Associate Professor of Psychology at the University of Colorado School of Medicine and was formerly Director of Psychology at the University of Colorado Hospital Outpatient Psychiatry Department. He

Todd Dean is a psychiatrist and psychoanalyst in St. Louis, MO, and a founding member of the St. Louis Lacan Study Group.

Laurence Hegarty is an artist and writer as well as a psychotherapist in New York City.

He teaches both BFA and MFA classes in studio art and cultural studies at Parsons, the New School.

Norka T. Malberg, President, Section II (child and adolescence), Division 39. She is a member of the Contemporary Freudian Society and a special member of the Western New England Society. She is coeditor of the Lines of Development Book Series published by Karnac book and coeditor of the book The Anna Freudian Tradition: Evolution and Practice over the Decades.

Victoria Malkin is an anthropologist and psychoanalyst in private practice. She completed her psychoanalytic training at the William Alanson White Institute, NY, and 44

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Martin Winn is a Lacanian psychoanalyst practicing in New York. He is an analyst, supervisor, and member of Après-Coup Psychoanalytic Association. As a member of the Après-Coup faculty, he conducts a yearly workshop in the Après-Coup Formation Program Foundation Series.