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An early 70’s art school dinner date (okay, pizza) was interrupted by sudden tears over a mysterious friend that was leaving the country for good. “I can’t cry like movie stars do” cautioned Martha down from Bennington. The relationship progressed and months later I stood in a hallway at her parents home in Connecticut looking at a family picture on the wall that included her and another older boy. “Its my Brother, he was shot down in Viet Nam, he’s dead” she answered. Not one tear.
Around the same time a group of international artists began to transfer the performative elements of post minimalism and Arte Povera from the gallery space onto their own bodies now deemed a site for rigorous physical and psychological interrogation. The adventurous yet mercantile gallerists of the soft 70’s art market implored1. these artists for ‘something to sell’ which took the form of schemata, humble black and white photography or nascent video when available. Artists as diverse (and notorious) as Yoko Ono, Vito Acconci (my instructor at SVA), Cosey Fanni Tutti, Gina Pane, and Chris Burden in both public and private submitted themselves to often harrowing regimens of physical and mental extremes captured by the camera’s merciless eye in the production of documentation or ‘bi-product’, a period term. In hosting ‘body art’ ‘white cube’ art contexts here and abroad were adapted into behavioral laboratories open to the pubic for the observation of artist/performers.
Some 40 years later I picked up Laurel Nakadate’s publication ‘365 Days: A Catalogue of Tears’ (2011) and was intrigued by what I interpreted as a grounding in the above artists and specifically to Bas Jan Ader (1942-75?). I had first encountered his single image of an anguished man in Lucy Lippard’s ‘6 Years’ (1973) an early bible of conceptual art that included his ‘I’m Too Sad To Tell You’ (1970) a document of a performance or, like Nakadate’s series, an action whose sole purpose is to generate a picture.*(2) While body artists tested the water around ‘fear’ ’sadness’ was rarely a material in art*(3) and Ader’s portrait crops out and withholds everything necessary to establish a satisfying explanatory narrative. He can’t tell us, he's too sad. The mythology around BJA endures, he disappeared crossing the Atlantic in a sailboat as part of a piece romantically titled ‘In Search of the Miraculous’ which was announced via a postcard. Or did he?
Over one busy year Nakadate (no romantic) photographed herself weeping daily in both intimate and the occasional semi-public setting. This meta-diary frequently replicates the insulated singular momentum of a road trip or tour signaled by the hotel bathrooms and seat windows in airplanes. An accelerating art world career demands frequent often international travel to exhibitions, artist talks, residencies and academic conferences. Some individuals revel in this, others buckle under the pressure. How did this appealing relatable artist ‘reduce’ herself to tears in the service of an idea? Does it matter? ‘Method’ acting or even Arthur Janov’s discredited ‘Primal Therapy’ comes briefly to mind having watched Karen Finley wind herself into an incantatory trance before tearing off her clothes and dowsing herself with Hershey’s syrup before an encouraging audience. I’ve never designated Nakadate as a provocateur (who like Kanye are taking a hard right) new age empath, or saint like Marina Abramovic or Nan Goldin, another complex persona. Yet my insistence on Nakadate’s historical lineage may read as dated and imprecise, not serving the artist that well. It may be more useful to regard her as someone new, a nomadic media trickster/operative bracketed between the darker transactional space of the camera and the photograph where truth has taken something of a beating in our digital age. Ader’s ‘I’m Too Sad’ is a mute single image situated before (or after) any critical information is imparted. Nakadate expands upon and cinematize’s what is generally excised or portioned out in ‘warts and all’ film vehicles like Madonna’s shrewd ‘Truth or Dare’ (1991).
We don't always look like movie stars. The ubiquitous selfie was gaining traction in 2011 and is now embedded into our social habits transforming any tourist into a performer and relegating breathtaking scenery or important art into background or prop. Andy Warhol, great grandfather of the proto-selfie was advised by curator Henry Geldzahler to introduce ‘a little death’ into the frothy pop scene of the early 60’s which informed his ‘disaster’ and ‘electric chairs’ paintings. Perhaps in courting death he paid some form of price by decades end. Last month Queen Elizabeth was buried with enough pageantry to occupy a sequence in one of neo-body artist Matthew Barney’s lavish occult sagas. I shed not a tear, but watching this micro-managed post-pandemic spectacle (with an upcoming issue of D/R in the back of my mind) brought me unexpectedly back to Laurel Nakadate’s intentional daily manifestations of inscrutable trauma. z Tim Maul 10/22
1. Purple Magazine, Vito Acconci Interview with Jeff Rian, S/S 2014 Issue 21.
2. ‘Im Too Sad To Tell You’ exists as a series of images, a short film, and an annotated postcard which was reproduced in Lippard’s indispensable book.
3. Marcel Duchamp’s painting ‘Nude Study: Sad Young Man on a Train’ (1911) in title bears some relation to Nakadate’s projects around voyeurism and travel.
Images Courtesy of Leslie Tonkonow Artworks + Projects tonkonow.co
Division/Reveiw: Please tell me a bit about what led you to write the book.
Orna Ophir: The initial reason was quite prosaic. First, it was a commissioned book. Pascal Porcheron, who was at the time an editor at Polity, started a new series about the history of health and illness, and he contacted us at the DeWitt institute for Psychiatry: History, Policy, and the Arts at Weill-Cornell Medical College here in Manhattan. He kindly asked me whether I would consider writing a book about the history of schizophrenia and whether, together with my colleagues, I could help him identify other authors who would write for the series about other psychiatric illnesses. At the time, I was working on a manuscript about the reception of Melanie Klein’s thought in America for Routledge, with the planned ironic title Klein in America (klein meaning “small” in German). Still, I also taught a course about the history of madness at the Humanities Center at Johns Hopkins University, a course which I have continued to offer at NYU’s Gallatin School for Individualized Studies since 2017. So, the idea of writing a book about the history of mental illnesses, in this case, schizophrenia, and of being further involved in advising the series indirectly was very appealing.
D/R: In my mind, the book broadly appeals to clinicians and academics interested in the history of psychosis and its treatment. I’m curious, though, if you anticipate it being received by psychoanalysts in the U.S. in any particular way.
OO: It was very satisfying to hear that the book also appeals to clinicians, which I heard from a few other colleagues. My hope and intention were to reach a wider readership, including those “in the trenches” of treating patients with these difficulties. I make the point in the book that, as clinicians, what we know about “schizophrenia” is often what we learned about it in our training. We are taught that “if it walks like a duck, swims like a duck, and quacks like a duck, it must be a duck,” or, in our case, if the patient hears voices or demonstrates disorganized behavior and speech, next to a flat affect, etc. then they surely must have schizophrenia. But I suggest that when it comes to theorizing or treating schizophrenia, or whatever other name we learn to call it, we should always try to be of “two minds.” Since my history points to what seems now like a shift in our diagnostic paradigm--one that passes from having clearcut categorical DSM diagnoses of disorders
like schizophrenia, paranoid schizophrenia, or disorganized schizophrenia to the invocation of spectrums or dimensions such as the schizophrenia spectrum disorder (that also includes relatively mild cases of schizoid personality disorder or brief psychotic disorder)—I remind the readers of Thomas Kuhn’s (and, earlier, Ludwig Wittgenstein’s) famous reference to Joseph Jastrow’s image of the duck-rabbit illusion. Kuhn writes that when a scientific revolution takes place, and the paradigm shifts, what was a “duck” in the scientists’ view before the change (in what was up till then a “normal science”) becomes a “rabbit,” incommensurable with the preceding paradigm, after the revolution. As clinicians, I suggest instead that, when we are sitting with our patients, we might, at times, need to see and treat them as “ducks,” in other words, attributing to them terms of a different “kind” or “category,” while, at other times, we may need to see and approach them as “rabbits,” in other words, as being different only in degree from us. According to the latter view, such patients would be viewed and helped as being on the very same continuum or spectrum, albeit suffering the same anxieties, defenses, and object relations that those considered “normal” have but with a different intensity. In any case, I argue in the book that our patients are always much more complete as whole persons than our limited perception allows us to grasp and much more complicated than our restrictive categories of psychological and medical understanding instruct us to use.
A younger colleague, a psychologist whose insight and work I trust, wrote me a text after reading the book, saying it helped her to see her patient, now as a “duck,” then again as a “rabbit.” And the idea that something in this book could help a clinician in her everyday encounter with a patient in her office was deeply gratifying. But you asked, more specifically, how psychoanalysts in the U.S. did receive the book, and I must admit that I had two previews of how this might play itself out and what to expect well before the book was even published. When the two anonymous reviews of the submitted manuscript arrived, the first stated with enthusiasm: “wow, you managed to get psychoanalysis into this story, and even Klein, Chapeau.” Yet a second reviewer was devastated that there was a chapter about psychoanalysis at all and mortified that Melanie Klein was mentioned in it, implying that the chapter in question was an aberration in what was further a laudable project in the intellectual history of psychiatry. It should probably not have surprised me that psychoanalysis would evoke such strong passions even in very informed readers. Still, I had a genuine trial by
fire when I presented the chapter on psychoanalysis to our esteemed group of colleagues in the history section at the DeWitt Wallace institute at Weill-Cornell. These psychoanalysts, who largely trained in the United States in the 1950s-1960s and are also medical doctors and psychiatrists with extensive clinical experience working in hospitals, have very strong opinions about the nature of mental illnesses and, especially what psychoanalysis is and should be. To my pleasant surprise and relief, they seemed, without exception, intrigued by my overall argument and proposal, which was exactly what I had wished for.
D/R: What is fascinating about the history you trace in the book is that the debate around category versus spectrum goes back thousands of years, though with very different idioms and aetiological theories, not to mention treatment approaches. In psychoanalysis specifically, the same distinction seems evident in—on the one hand —Freudian (including Lacanian) distinctions between neurosis and psychosis, and—on the other hand—Kleinian object-relations conceptualizations. The latter lend themselves more to a dimensional approach, while the former is categorical or structural. All this to say that within psychoanalysis, not to mention psychiatry—we have the same debate as the ancients!
OO: Yes, and this is the case, perhaps, because we seem to have two ways of thinking about differences, either qualitative or quantitative. Freud sometimes sees an “absolute difference” between different categories of psychopathology, while, at other times, he imagines the different pathologies to be on a continuum. In any case, he is clearly not that impressed by what he calls the “academic question of diagnosis” but is more interested in “working with the living material,” which always escapes our definitions. What is common to Freud, Lacan, and Klein when it comes to the question of the psychoses is that they all had read judge Schreber’s memoir and used it as a point of reference when thinking through the difference between the neuroses and the psychoses. Freud, on the one hand, found profound similarities between Schreber’s more severe pathology and the neuroses, notably in the latter’s use of splitting between the upper” and “middle Flechsig” or between the “lower” and “upper” God as well as in the experienced conflict between love and hate regarding the parental object. Yet, on the other hand, he also emphasized the difference, which is found in the withdrawal of the libido from the world of objects and, hence, in the inability to form relationships of transference in patients diagnosed with schizophrenia. In the same way, in reading Schreber he writes that
even though while listening to the delusion, we find ourselves on familiar ground (known from dreams, myths, and creative writing), we must likewise acknowledge important differences and realize that there are abnormal changes in the ego, a structural defect, which set this mental illness clearly apart.
Nathaniel London has observed that Freud had two theories about schizophrenia: the unitary theory, which sees the difference between the normal and the different pathologies in quantitative terms, and the specific theory, which sees the difference in question as a matter of qualitative discernment. According to the unitary theory, the difference lies in the degree of regression, such that, in schizophrenia, we see merely a more severe manifestation of the very same behavior, with the trauma of greater significance having occurred earlier and thus rendering the pathology far more pronounced. According to the specific theory, schizophrenia is seen as categorically different, marked by a qualitative difference, with the inability to engage in transference relationships being its main distinguishing feature.
We see this duality in Freud’s work prevails in his legacy in post-Freudian psychoanalysis when it comes to schizophrenia, and this nowhere more clearly than in what came to be known as the so-called “defect school” and “conflict school,” respectively. The defect in the ego that is responsible for schizophrenia is seen as either a constitutional defect or attributed to early object relations. In contrast, the conflict that results in schizophrenic symptoms is only different from the neurotic conflict in terms of its intensity. Karl Abraham, who continued the work with psychoses after the Burghölzli clinic’s “divorce” from psychoanalysis, followed Freud’s conflict model along these lines. Abraham’s work on psychosexual development and the aggressive drive significantly influenced Klein’s view on development in its relationship with pathology.
In Klein, as you rightly point out, it is abundantly clear that everyone is suffering from primitive anxieties, just as all use similar defenses and construct typical object relations. The only difference is that these reactions are excessive in the more severe pathologies, thereby characterized by a quantitative difference, not a difference in kind. Klein, who also read Schreber’s memoir, commented on the excessive use of splitting that divided the judge’s doctor into no less than forty-six different souls and inflicted fragmentation on Schreber’s ego. Bion, who would continue Klein’s work on schizophrenia, similarly writes about the excessive death drive in schizophrenia. And Meltzer, finally, writes about massive projective identification. We can see, then, that this
psychoanalytic school of thought revolves around the themes or poles of libido and aggression, or love and hate, of integration and splitting or fragmentation, and portrays them as being located on a scale, in other words, on a continuum. It is worth mentioning, in this context, that also Harry Stack Sullivan, as an analyst who worked with patients with schizophrenia and suggested that the schizophrenic is the most disorganized of all patients, believed that there is a spectrum on whose sides we find, on one extreme, organization and, on the other, disorganization.
D/R: I’d like to ask a concluding question that is more political. Your book culminates in discussing recent efforts by those with lived experience of psychosis in advocacy. There has been the rise of hearing voices groups and peer-based work aimed at empowerment, not to mention basic dignity, given the perilous history of psychiatric treatment. What is your sense of psychoanalysis’ reception, or even awareness, of such efforts? Are there opportunities for psychoanalysis and dynamic therapies to have a place in addressing psychosis, given the shifts occurring at the level of broader social changes in the discourse around serious mental illness, as well as the inclusion of those with lived experience in clinical and academic settings?
OO: As psychoanalysts, we always work with the lived experience of our patients, and what we value most is how patients learn from their experiences as we do from ours. Psychoanalysis as a profession does not need convincing that what matters first and foremost is the lived experience. Still, we work with the individual patient rather than with the experience of special interest groups, associations, or organizations. We also assume that there is more to the experience than the conscious one the individual is reporting. Therefore, whether the individual who seeks the help of a psychoanalyst identifies themselves as voice-hearers, as neuro-diverse or as survivors, as service-users, clients, or patients, what matters most is the meaning they attribute to any of these self-identifications. As analysts, we listen to what they say, but also to their dreams and what they do not say, and communicate non-verbally instead. As much as individuals are being helped and supported by peer groups pressing to drop the label “schizophrenia” and to normalize or demedicalize voice-hearing, others have different experiences. When I spoke about the book in a Soteria House in Israel and presented the chapter on the hearing-voices movement, one of the younger female residents said she would not want to be forced to give up the label “schizophrenic.” I asked her to tell me more about this statement, and she said there was something about the word, the way it
sounds and its strangeness, that feels most accurate in describing her experience.
To come back to your question, I want to believe that, as psychoanalysts, we are also aware of ourselves as citizens in a specific political climate and thus be informed of broader social changes. Historically, individuals who were diagnosed and treated (or rather mistreated) in institutions for the mentally ill have managed to organize and bring about significant changes. The first petition by a group of patients I know of was at the notorious Bethlehem hospital in the early seventeenth century. One can see how these resistances have been both empowering for individuals involved and had powerful effects on reforms in society. But, in the analytic hour, there is something about the “negative capability,” what Bion refers to as ‘no memory and no desire’ (which I am almost reluctant to cite here since it is already so saturated with meaning), that is, precisely, what makes psychoanalysis unique as a method. Our patients are, of course, always part of a larger socioeconomic context and political climate. But what usually comes up in our sessions with them is the here-and-now, which is heavily influenced by the transference relation. Only today, an exact week before the winter break, I heard from three different patients about their phantasies related to homelessness. None of them is near becoming the mentally ill unhoused person we see in the subway and on the streets, and who seemingly instigated these phantasies. Yet in the context of analysis, not to mention the coming and going of winter/Christmas or holiday breaks, they are connected to this more primitive anxiety, which sadly enough is also the empirical, external reality of all too many mentally ill individuals in the city. We can ask whether psychoanalysis could be helpful also for these people. As we know, once psychoanalysis widened its scope—to use Leo Stone’s term from his well-known 1954 paper—we have come to see psychoanalytic thinking and psychoanalytic work expand and immerse itself in settings we couldn’t imagine before that. They include populations whose supposed diagnosis was traditionally considered a counter-indication, unfeasible for any psychoanalytic work. As you may remember, Stone referenced the theoretical innovations of the work done by Karl Abraham on “manic depressive insanity,” but also the institutional efforts undertaken by Ernst Simmel, as he opened the psychoanalytic sanatorium in Berlin and started working with psychoses and addictions, the efforts by Aichhorn working in Vienna with juvenile delinquents, and, of course, Anna Freud’s and Melanie Klein’s treatment of young children.
Some people who hear voices or have auditory hallucinations (the wording depends on who is describing the phenomenon),
especially in the West, are treated in institutions, whether in the mental health industrial complex or the prison industrial complex. So we could ask ourselves what kind of salutary role psychoanalysis could play in these cases. This summer, I heard a fascinating seminar about psychoanalytic work done with mentally ill patients locked in the Broadmoor High Security Hospital in the UK for having committed inexplicable violent crimes. It was inspired by the clinical work of Leslie Sohn on psychosis and violence. Unlike New York City Mayor Eric Adams, who wants to enforce psychiatric treatment on those unhoused individuals who, as he claims, pose a danger to themselves and others, Sohn used psychoanalysis to understand better and help those who, due to their psychotic illnesses, have committed seemingly unprovoked assaults.
This British tradition suggests that psychoanalysis is at its best when it emphasizes the development of responsibility to others before and above anything else. This lies at the heart of the Kleinian understanding of the shift from the paranoid-schizoid kind of
power relations—call it politics, if you want-to the depressive one, in which one takes responsibility for one’s inevitable aggression as it makes efforts to repair the damages caused to the object. In that sense, I think it’s great that people with expertise from experience organize and share their knowledge with psychoanalysts and scholars. I believe that being part of such a group or a mission is meaningful and could have a curative effect in and of itself. I also think that there are many good options for those seeking treatment for Serious Mental Illnesses (SMI) other than psychoanalysis and that are nonetheless far more comprehensive and effective than the reductionist psychopharmacological regimen patients are subjected to. A case in point is the Finnish Open Dialogue treatment. But being aware of all of these alternative forms of treatment does not, all by itself, change the way I listen to individuals who come to me for psychoanalysis or psychoanalytically informed psychotherapy. As a psychoanalyst, I listen to the individual and the more infantile, primary layers of their mind provoked by the transference relations.
Part of my training as a psychoanalyst was almost two years of infant observation, which continued in a minimal but meaningful way once a year for the last ten years. When I work as a psychoanalyst, I remain attuned to the infantile parts of the personality, psyche, or mind, to these early paranoid-schizoid phantasies and their depressive counterparts. I do it when I see very troubled patients, who, most of the time, would not even be able to advocate for themselves, let alone organize and demand institutional change, just as I do it when I work with patients who are otherwise high-functioning individuals, who would hardly get any diagnoses of mental disorder. In sum, the short answer to your question is that psychoanalysis always works with lived experience, to begin with of the individuals who seek our expertise as analysts who are trained to listen to unconscious phantasies as they are communicated verbally and non-verbally in the transference-countertransference relations. These relationships, as we know, have their own fraught ethical and political aspects, which we can hear and analyze in the hour, in whatever setting we end up meeting our analysands. z
Accommodating to Covid, Paul Wachtel and I met online on a late January morning. In ways, the meeting reminded me of one of our lunchtime meetings at New York’s Café Fiorello over the years. Paul and I are friends, having met at first when I consulted with him about my growing interest in psychotherapy integration “from the analytic side,” in the mid-eighties.
Via Zoom, I started by asking Paul how he found his way to psychology. He chose to begin with his past as—of all things—an undergraduate physics major at Columbia University. For three years while earning A’s in math and science courses, he also experienced a growing sense that physics was not really what he wanted to devote his life to. But he did not have a clear sense of what alternative would really be his passion, and at the end of his third year at college, a sort of panic set in as he struggled to find his true vocation. He used the metaphor of a Ouija board to describe going to the college bookstore one day, almost in an altered state of consciousness, and just seeing what section
Kenneth A. FRANKhe was “drawn to.” Thankfully for our field, it was Psychology.
At graduate school at Yale, Paul was exposed to the thinking of many analysts, including his mentor, Sidney Blatt; George Mahl, who taught psychoanalytic theory both at Yale and the Western New England Psychoanalytic Institute; Roy Schafer and Ernst Prelinger, with whom he had an intensive year-long seminar on psychoanalytic theory and practice; and a range of psychoanalytic psychiatrists at his internship at the Yale Psychiatric Institute. He found these psychoanalytic ideas, as well as the broader field of clinical psychology fascinating, but also felt a kind of “intellectual claustrophobia” that called on him to diversify his studies through outside study groups centering on literature, sociology, and social criticism. Intellectual confinement does not suit Paul.
As a psychoanalytic candidate at NYU Postdoc, Paul welcomed the range of views he was exposed to in the years before Postdoc split into separate “tracks.” He was particularly drawn to interpersonal psychoanalysis and
its interest in the impact of the world around us and of the actual relationship in the room. John Dollard, Paul’s first therapy supervisor at Yale, had hoped Paul would go to the New York Psychoanalytic Institute, and one must wonder how that would have played out. (Paul suspects he would have dropped out after a year or so.)
For much of the time Paul was at NYU Postdoc, he was also a faculty member at NYU’s doctoral program and part of NYU’s psychoanalytically oriented Research Center for Mental Health, headed by George Klein and Robert Holt. At one point, Klein was invited to participate in a panel at APA addressing Walter Mischel’s critique of psychoanalytic thought. Klein was too busy and handed it off to Paul. Paul found some parts of Mischel’s critiques of psychoanalysis naive and misinformed, but in other respects his encounter with the research Mischel cited in his arguments, and especially, his first real encounter with behavior therapy, which up till then he had paid little attention to, was eye-opening. He was both impressed with the evidence that behavior therapy could in fact
create significant clinical change and not just “symptom substitution” and struck by ways in which these two seemingly incompatible theories and approaches could in fact be complementary and synergistic. These were new and surprising conclusions for him, and led eventually to his theory of cyclical psychodynamics, a revised understanding of the essence of psychoanalytic thought itself.
In later years, Paul’s integration of psychoanalytic and behavioral methods was paralleled by integrations with other approaches as well. At the time he was working on his first book, Psychoanalysis and Behavior Therapy: Toward an Integration, his wife, Ellen, was studying family therapy at the Ackerman Institute, and he began to see ways in which family systems theories intersected with his cyclical psychodynamic theory and in which family therapy methods could similarly enhance psychoanalytically oriented work. The result was a book, written with Ellen, called Family Dynamics in Individual Psychotherapy. In these same years, he wrote The Poverty of Affluence, a book of social critique that pointed to still further ways in which context needed to be taken into account in our understanding of individual experience. Around the same time, he was one of the co-founders of the Society for the Exploration of Psychotherapy Integration (SEPI), an international organization devoted to breaking down the barriers that keep therapists of different orientations from knowing each other’s work and learning from each other. Opportunities to interact with therapists from a wide range of views through SEPI have been a seminal influence on his thinking ever since.
Through all these developments, Paul credits as a major source of stimulation and encouragement, his membership on the faculty of the clinical psychology doctoral program at City College of New York, with its strong dual commitment to psychoanalytic thought and practice and to promoting social justice.
With this material as background, Paul and I referred to our list of questions.
KF: Paul, it seems that you came to psychotherapy integration and your central concept of cyclical psychodynamics—recognizing the mutual influence of the inner and outer worlds—quite early in your career. In ways, your ideas have evolved with the times, indeed have played a major role in shaping many of our newer ideas. Yet it strikes me that many of your most fundamental beliefs about the workings of personality and psychotherapy have remained quite consistent over the 50 years you’ve been publishing. Would you agree?
PW: That’s a very stimulating question. I think the biggest leap was stepping outside
the “loyalty trap.” I was brought up professionally essentially to think, “Psychoanalysis good, all else bad.” Those trained in other orientations mostly received the equivalent messages. To actually consider that behavior therapy had something to offer—that it could add something that psychoanalysis did not provide or that it could actually be compatible with a psychoanalytically inspired way of thinking and working—required a major leap. Respected mentors, supervisors, and colleagues referred not only to behavior therapy, but to the parallel emergence of family therapy, community psychology, and other developments as if they represented the invasion of the Visigoths. As a symptom of this binary “us-them” thinking, to this day I encounter some people in the psychoanalytic world who—thinking of it simply as descriptive—refer to me as a “behaviorist.” Not only does that characterization seem to erase what is still my primary identity, which is as an integrative psychoanalytic or psychodynamic thinker and therapist, but it actually misses the most central element in what I discovered as I studied behavior therapists closely—that very few of them were really behaviorists.
As I have spelled out in a number of places, they are actually more phenomenological and introspectionist in their methodology than behaviorist. They are behavioral—that is, paying attention to our actual behavior in the world—but not behavioristic, which is an ideology that ignores subjectivity.
Once I made that leap—that an interest in and respect for other approaches did not contradict or weaken my psychoanalytic identity or understanding (though it of course modified my views of what is the essence of such an identity and understanding)—the rest did follow more smoothly and gradually.
To this day, as I continue to examine and integrate new methods and perspectives, I build upon that initial leap, that rejection of the “us-them” foundation of our field. I also build on the cyclical psychodynamic perspective that first emerged in my efforts to integrate psychodynamic and behavioral methods. In that perspective, the key unit of analysis is the repeated cyclical patterns—both vicious and virtuous circles—that characterize the dynamics of personality and that link the past and the present in a way that does not downgrade the importance of either. This perspective aims to transcend binary distinctions between a “deep” internal world and relatively superficial “external” influences. It traces development in terms of how, from very early in life, the way we see things and experience things leads us to act in certain ways, and how, much of the time, the result is that we draw forth responses from other people that lead us to continue to see things and experience things in the same way. Most of this goes on unconsciously, but the unconscious needs
to be understood not simply in terms of representations but, beyond that, with regard to how we live our lives. We do not live in an “inner world.” The feelings, perceptions, fantasies, desires, experiences of self and other— both conscious and unconscious—that have often been discussed in psychoanalytic discourse as “internal” are absolutely critical to my thinking. But they cannot be adequately understood without understanding them in relation to the continuing events and experiences of our lives and to the ways in which “inner world” and “outer world” are, to a very large degree, products of each other. I have used the metaphor of the Moebius strip to highlight the ways in which the “inner” is not “deeply buried,” in archaeological fashion but is inextricable from what we sometimes call the “outer.”
Using this foundation, my integrative efforts proceeded from behavior therapy, to family therapy, to a still broader range of experiential, attachment-focused, and mindfulness and acceptance-based approaches. This same foundation pointed as well to ways of integrating concerns about culture, race, ethnicity, materialism and a number of other factors that I again tried to rescue from earlier formulations that treated them as “external” and to instead understand them as critical elements of the very deepest reaches of the self. So yes, I have continued to build on the foundation that emerged from my first encounter with transcending the “us-them” definitions of what is psychoanalytic, but, like personality itself, my understanding has both stayed the same and changed with new experiences and challenges.
KF: If I may, Paul, I’d like to underscore and extend one important point you made— that knowing other modalities does not make one “less analytic,” as it were. Rather, by providing multiple lenses for viewing and understanding clinical phenomena as well as additional rationales and strategies for intervening, it allows one to become more analytically creative as a practitioner.
Now, I imagine you’d agree that over time, your ideas, which during the 70’s and 80’s I saw as visionary, have come to comport well with relational developments—Steve Mitchell’s relational synthesis, including interpersonal psychoanalysis, for example, and his notion of the “relational matrix” and subsequent relational developments.
PW: The early publications depicting the cyclical psychodynamic perspective predated the appearance of the earliest relational writings, but you are correct that cyclical psychodynamics is grounded on many of the same assumptions and reexaminations as Mitchell’s theory and as other relational perspectives as well. The overlap became increasingly apparent to me over time, and I now think of
cyclical psychodynamics as a version of relational thinking. Although I had formulated and published a version of the cyclical psychodynamic point of view as early as 1973, the first full scale elaboration of the theory and its implications was in my 1977 book, Psychoanalysis and Behavior Therapy: Toward an Integration. It was then extended to include family systems thinking in a 1986 book I wrote with my wife Ellen, called Family Dynamics in Individual Psychotherapy. When Steve Mitchell’s «Relational Concepts in Psychoanalysis» came out in 1988, I was struck by many ways in which his thinking was compatible with my own, even though there were also differences in emphasis, style, and content and although he had come to his ideas via a different path. As my own ideas continued to evolve, I increasingly also was attending to developments “next door,” so to speak, in the evolving relational movement. At some point along the way (I don’t recall what year), Lew Aron, who was then the head of the relational track at NYU postdoc, where I was already on the faculty, met with me to discuss my joining the relational track, since he felt my theoretical views were really a form of relational thought. I said yes and have been a member of the relational faculty ever since.
I had periodic discussions with Steve Mitchell about the similarities and differences in our thinking, and at one point invited Steve to participate with me on a panel at SEPI. This led, a bit later, to my asking Steve to join the advisory board of SEPI, since his thinking, albeit not so much focused on integrating psychoanalysis with “something else,” was quintessentially integrative. Steve accepted and served on SEPI’s advisory board for a couple of years, but then contacted me to step down because he felt that his efforts were so focused on integrations only within psychoanalysis that he did not want to spread himself thin by also addressing the kinds of further integrations SEPI was largely about. I understood Steve’s point, but also regretted his decision because he was one of the finest integrative minds I have known. Notwithstanding Steve’s resigning from SEPI, he and I stayed in touch, and—unfortunately, just a relatively short while before his untimely death—we were beginning to meet more regularly to discuss the convergences in our thinking. We were colleagues rather than friends, but we were greatly enjoying these exchanges, and the relationship seemed to be moving toward a real friendship when tragedy struck. I’ve thought often of what might have emerged from our conversations had Steve lived.
Apropos another (and related) part of your question, The concept of the relational matrix is indeed one of the most important links between the two lines of thought. I use that term and that concept frequently in my writing, and it is a key element in my thinking
about what I call “the contextual self,” a term I use to elaborate on the ways that attention to early experiences and the intrapsychic can be integrated with attention to the ways we are also keenly responsive to subtle variations in the relational context. This was also an idea I discussed a number of times with Merton Gill, who I had gotten to know at the Research Center for Mental Health at NYU and at meetings of the Rapaport-Klein Study Group. I screwed up my courage and, on a long shot, asked Merton if he would read the manuscript of my first book, Psychoanalysis and Behavior Therapy, and consider an endorsement. I considered it a long shot, since at the time he was one of the most influential thinkers in psychoanalysis and I was still a young junior faculty member. I was grateful for his generosity in agreeing to consider it (Merton was not the kind of man who suffered fools gladly), and when he agreed to actually endorse the book, even though it raised questions about some of the positions with which he was still associated in the literature, I was not only grateful but impressed with his openness. I did not know at the time that his own thinking was beginning to evolve toward a two-person point of view (he had, earlier in his career, been one of the most articulate defenders of the one-person perspective), and I was struck, over the following years, how his and my thinking seemed to co-evolve, as we read each other’s work and had occasional continuing conversations about our common interests and evolving theoretical inclinations.
Over the years, I have continued to absorb, and be influenced by important thinkers in the relational tradition. These include, in a major way, your own thinking, which has been enormously stimulating to me both for its elaborations of relational theory and for its creatively integrative explorations of active interventions of a wide variety, all pursued from a sophisticated relational foundation.
KF: Thank you, Paul. So you’ve progressively expanded the model to include more approaches and also the determinative role of context, while anchoring it to the early cyclical psychodynamic approach. I understand that, but there is a point I have had trouble with in your thinking—one of very few; it is that some of your writings seem to imply an equivalence among early and later experiences. Of course, it is customary for analysts to see the early period as especially formative, and in recent years, in validating ways, we have learned from neuroscience and attachment research that the early years are a period of rapid brain growth and receptiveness to foundational implicit learning. These early family schemas are thought to be more enduring and less readily modifiable than most later learning. What are your thoughts about this?
PW: I agree, this is one of the places where my own version of psychoanalytic thought departs most from the views held by many analysts, including even some elements of the relational perspective with which I am in most ways in strong agreement. I do see early experiences as critically formative in many ways. But I diverge in two ways. The first, which you are familiar with, is more theoretical. It has to do with what I called the “woolly mammoth” model in my first book—the traditional psychoanalytic idea that repression and other kinds of defenses and splits seal off certain parts of the psyche from change, keeping them unchanging and “timeless,” “archaic,” “primitive,” “preoedipal,” what have you. This model of the unconscious as frozen in time, prevented from changing and growing up by the layers of defense under which the original “infantile” wish or fantasy is buried, reminded me of the stories of perfectly preserved woolly mammoths occasionally found buried under the Arctic ice, unaffected by everything going on the “surface.” (It was an image in part stirred in me by Freud’s comment that the repressed is not subject to the same kind of “wearing away” that consciously accessible thoughts and ideas are subject to.) This idea has been (without the mammoth per se, of course) a dominant image underlying most psychoanalytic perspectives. It was most explicitly spelled out in The Ego and the Id (again without the mammoth per se), but is evident in the full range of psychoanalytic perspectives that continues to describe functioning adults as preoedipal, as having a psychotic core, or in a range of other related concepts and metaphors with similar import. My own cyclical psychodynamic perspective does take into account the observations that have generated such ideas, but it explains those observations very differently. It sees those “infantile” or “archaic” elements not as the simple, direct, linear result of early experiences and psychological structures having been walled off from the impact of later ongoing experiences, but as the product of countless interactions throughout the life span in which expectations and skewed behavioral and emotional reactions elicit responses from others that generate still again the same expectations and skewed behavioral and emotional reactions. Put differently, the psyche develops not via a split off “primitive” part covertly influencing an only superficially adult part, but via a repeated series of vicious and virtuous circles, in which the primary consequence of our early experiences is to skew the kinds of later experiences we have. By the time the pattern replays itself (over and over) in our adult life, it is no longer simply the product of what happened early; it is the result of the entire (continually repeated) history.
Consider, as but one example, a patient (I’ll call him Edward) whose troubled mother needed constant, almost symbiotic, attention, who couldn’t let him grow up and grow apart, who felt betrayed and tended to decompensate when Edward had normal interest in spending time with friends or pursued his own interests. The tremendous guilt and inhibition (and unconscious rage) with which he lived was certainly initiated by his early developmental experiences. But over time, the primary engine of the pattern evident in his life lay not in the distant past but in the evolving present. His constant nagging sense that he was being disloyal, inattentive, neglectful, selfish (initially experienced with his mother, but also, over time, with friends and lovers) led him to experience each new relationship as a painful test of his worth as a human being that he would likely fail. He would at first try to be “everything” to the other, pushing himself to his limits and ignoring his own needs and feelings, but would still experience that the other person felt it was not enough. In part this derived from a selective perception that magnified (and often misinterpreted) even the slightest dissatisfaction with him by the other. But his perception of the other’s dissatisfaction with him generally also reflected something really going on—the other might not always be aware of or clear about much of what was happening between them, but at some level would sense Edward’s unacknowledged anger and resentment at what felt to him like an exhausting and one-way relationship and would experience Edward not as a generously attentive and responsive giver but as grudging and resentful in his giving, no matter how “much” of it there was. Indeed, often Edward’s excessive availability would elicit a negative response in its own right, feeling cloying even as Edward was feeling worn out. The relationship would, as a consequence, typically begin to feel like an arena in which Edward’s extreme sensitivity to even the slightest sign that he was being perceived as hurtful because he was not totally available and totally devoted became a source of great pain. The frequent consequence was that at some point, in order to gain some relief from that pain, he would withdraw to a rather extreme degree. This, in turn, once again stirred the old feelings (first communicated by his mother) that he was selfish, disconnected, and unable to relate to others. Then, in the next turn of the wheel (either with the same person or with a new figure in his life), he would respond to the painful feelings his withdrawal had stirred by once again being overly available and giving, and the cycle—most of whose elements were unconscious—would begin again.
This pattern, in my view, is insufficiently understood by explaining it as the product of his having “internalized” the messages of his
early childhood. To understand it sufficiently—and especially to intervene effectively—it is essential to understand how it is the product of repeated experiences throughout his life, in which each step leads to the next in a repetitive cycle in which the primary engine is not how it started but how it is maintained over and over by the new experiences that are continually being generated.
The second reason I focus much of my effort on the present rather than the earliest experiences does not reflect a view that their impact is unimportant but rather is rooted in the difficulty in genuinely recapturing those experiences. Many of them are pre-
doing in relation to others is obscured from our consciousness. But in employing that psychoanalytic sensibility, I aim to work with the unconscious processes that are currently shaping the patient’s life and to understand them in relation to the ongoing and often reciprocally interactive contexts in which they are manifested. That, it seems to me, is where our therapeutic leverage is likely to be greatest and most able to help the patient turn his life in a more satisfying direction.
KF: Thank you, Paul. That’s clarifying. So one of the ways in which you were visionary is that back in the 1970’s, you took a view, quite radical at the time, that emphasized the present over the past. That early theoretical shift affected treatment as you saw (and see) it and presaged a much later clinical trend in contemporary psychoanalysis.
Your reply leads me to wonder whether more recent theorizing about dissociation and trauma, especially “Big-T” Trauma, has impacted your thinking in any way. And, in a related vein, are there other recent developments you have not mentioned that have significantly influenced you?
verbal, and even those occurring in the years when language has just begun to develop are difficult or impossible to recall. Experiences of enactment or other transference experiences are often thought to make them accessible, but it is my belief that we largely exaggerate the degree to which those occurrences really recapture these early experiences. When addressing enactments or transference reactions is therapeutically useful, it is largely because they reflect the current tendencies that were set in motion by the earlier experiences in the way I was discussing a bit earlier, not because they unearth something that has been stored in potentially accessible form for decades.
We work most effectively on how the person is living now. That is where we can have our impact. In doing so, I remain powerfully influenced by a psychoanalytic sensibility, with a central concern with the degree to which much of what we feel, what we seek, what we think, and even what we are actually
PW: I have increasingly been interested in dissociation as a concept that illuminates, and to some degree reframes, a wide range of clinical phenomena. Freud’s turning away from the term, as a product of explicit and implicit competition with Janet over priority, was a significant misstep. It grounded psychoanalysis most of all in repression, which in turn made consciousness the key aim and criterion. Dissociation is a much broader concept (somewhat overlapping with but not reducible to the broader concept of defense in contrast to repression). Phenomena such as intellectualization and isolation—in which conscious verbal awareness, emotional experiencing of what one can talk about verbally, and the inclination to be moved to action on what is verbalized are all separated—are best understood as phenomena of dissociation, as are the different set of phenomena discussed these days in terms of multiple self-states. Freud, of course, did come to articulate this broader set of defensive efforts (without much reference to dissociation) through the path of (and as part of constructing) ego psychology. But the grounding of psychoanalysis in the concept of repression as essentially the Urdefense, largely rendered all the other kinds of defensive efforts as “additional,” as further means of bolstering repression. And this left analytic technique insufficiently active and experiential, too bound to the distinction between conscious and unconscious and to verbal awareness, and too dedicated to interpreting and uncovering. By referring to repression as the Ur defense, I don’t mean
…intellectualization and isolation—in which conscious verbal awareness, emotional experiencing of what one can talk about verbally, and the inclination to be moved to action on what is verbalized are all separated— are best understood as phenomena of dissociation
that it comes first; much psychoanalytic theorizing, both from the repression framework and from the dissociation framework, points to a developmental sequence in which other kinds of defensive efforts occur earlier, and repression comes only after a significant degree of cognitive development. Rather, I mean that the metaphors in which psychoanalytic thought are cast (including the pervasive archaeological metaphors of uncovering, digging up, bringing to light, etc.) derive from Freud’s most fundamental interest in repression, in the hiding and disguising that give the analyst the opportunity to be clever in undoing the disguise. (Freud illuminated a wide range of ways in which we can defend against a threatening experience, but among these various kinds of defenses, repression was clearly his “favorite child.”) With dissociation as the grounding metaphor for defenses, the therapeutic aim of helping the person accept and experience and reintegrate that which has fearfully been cast off becomes more obvious, and a different grounding structure for psychoanalytically inspired therapeutic work becomes apparent. I’m working on a book now that explores these issues.
With regard to trauma, I think the rediscovery of trauma has been a very important development in psychoanalytic thought, but I also think that it is part of an even broader development, represented especially by attachment theory, of going beyond the emphasis on fantasy to acknowledge the impact of reality. Fantasies, idiosyncratic meaning-making, ways in which we are not merely responding in some one-to-one way to what is going on are critical to attend to, but for many years, reality retreated too far and fantasy loomed too large. Attention to trauma was, in the last few decades, an especially important path back to reintegrating reality into psychoanalytic thought and practice. But that reintegration should not be limited just to trauma.
KF: I look forward to reading your next book articulating these thoughts further. Finally, I know that SEPI, which you co-founded, has had enormous national and international influence and that psychotherapy integration has had a huge impact on the field. Yet I’m personally disappointed that, with few exceptions like N.I.P., most psychoanalytic training programs do not educate analysts in integrative work. Do you share my impressions and feelings? How do you understand these developments?
A related “intraprofessional” question also occurs to me. When I first became inspired by psychotherapy integration during the 80’s, I felt like a professional outlier. The staunch analysts (who formed a kind of narrow-minded elite at the time, in my view)
were the card-carrying members of the profession. I felt somewhat stigmatized by my analytic colleagues when I openly proclaimed the value of Behavior Therapy, for example. Nowadays, I think I’m regarded less judgmentally and, I suspect, at least in my own circle of analysts, as being at the vanguard of an important development. What I’m getting at here is the long struggle for psychotherapy integration’s legitimacy within psychoanalysis. I wonder how you’ve experienced your own role in this regard. A sense of marginality?
KF: I think you’ve put your finger on an important issue and a major challenge. I too started out feeling marginalized by my explorations beyond the then standard boundaries of psychoanalytic thought and practice
course SEPI keeps trying to foster real collaboration, dialogue, and (most important) mutual learning across the partisan divides. And I do think that I have seen considerably more interest among analysts in the broader range of therapeutic possibilities that exists today—not just with regard to cognitivebehavioral methods (especially in more acceptance- and mindfulness-based versions of CBT such as ACT and DBT, or in versions such as schema therapy) but with a range of other ways of thinking and working, such as family systems approaches, experiential and body-centered approaches, even approaches still largely identified as psychodynamic that are in their essence integrative, such as AEDP, control mastery theory, or the work of the Boston Change Process Study Group. And I think it is a very important development that psychoanalysis is increasingly taking into account the absolutely critical role of race, class, and culture in every phenomenon that psychoanalysis has attempted to address and understand. I think the future (at least the best future) lies in putting together all of these perspectives without attempting to declare one or another as core and most essential and others as secondary or peripheral. My hope is for a genuinely integrative approach to this range of perspectives, rather than a merely additive one—that is, not just “this is important or useful too,” but a way of taking each facet so seriously that it requires us to rethink all the others. This kind of rethinking does not in any way diminish the importance of the others. It further illuminates their importance.
(recall my earlier comment about being described as a behaviorist). And I too, like you, have subsequently seen my personal acceptance thrive. But I too have noted as well still predominant limits on what might be called “the integration of integration” into our field as a whole, a failure to appreciate that for psychoanalysis to survive, it must stop circling the wagons and open itself to developments outside its original boundaries. I think here we may see still another vicious circle. As CBT advocates have taken on the same kind of hegemonic arrogance that analysts exhibited in the 1950s, ‘60s, and ‘70s, current day analysts understandably recoil from their narrow-minded refusal to see what remains of great value in the analytic point of view. The result is that each side sees only the worst side of the other, the self-justifying, blindered side, and that feeds still further self-justification and exclusionary thinking. Institutes like NIP that try to go beyond those selflimiting dynamics are of great value, and of
KF: I might just add here that there exists a two-way street—that as we learn from different kinds of psychotherapy practitioners what they can offer us, they also learn what analysis can offer them, which augers well for the uncertain future of psychoanalysis.
As I consider what we’ve covered, Paul, I can truly appreciate how fortunate you and I have been and what a dynamic time our careers have spanned in psychoanalysis. Psychoanalysis during the past 50 years has come a long way, and it’s been enormously intellectually rewarding to have shared those years and your contributions with you, including this exchange. I think we’ve managed to be quite comprehensive in our allotted space. We’ve captured the origins and evolution of your position, given you an opportunity to elucidate your fundamental beliefs, as well as describe how your views intersect with other contemporary developments. I imagine this reminiscence will provide some stimulating reading for our audience and hope it will honor you and all you have contributed and continue to offer, as you so deserve. As always, it’s been a pleasure to collaborate with you. z
Fantasies, idiosyncratic meaningmaking, ways in which we are not merely responding in some one-to-one way to what is going on are critical to attend to, but for many years, reality retreated too far and fantasy loomed too large.
Dear reader, Thank you for opening our special issue of Division/Review devoted to this enigmatic conjunction, “community psychoanalysis.” It is a home that feels appropriate: a division of an organization, a small community, and also a mark of that which divides me from you and both of us from ourselves, which we can, perhaps, review but never mend. Our measure in common.
It seems that in these days of distress—in this way, ordinary days—something has been given us in common, to which we also have to respond commonly…That something which one may call misfortune, but which one also has to leave nameless, can in a certain way, be common. Which is mysterious, maybe a delusion, maybe unutterably true. (Maurice Blanchot, letter to Georges Bataille, 1983/1988, p.xiii)
We live in the ruins of the names, find hiding places among their desiccated husks, ever waiting to be found, bracing for it. Will it yet come?
The lack of divine names—the suspension of prayer, or worship—would thus be a way for the sacred to keep itself in reserve, to withhold itself, and as a consequence, thereby to offer itself, to offer itself in reserve, both as its own reserve and as its own withdrawal. (Nancy, 1991, p.120)
I encounter you there, where the name withdraws. I am gutted, wordless. I cry out. I offer you my voice, these invocatory entrails. Is it a gift, this exposure? Is it an exposition, this potlatch? Is it a rock placed upon a pile of stones, here at the furthest edge of the known lands?
this is the region where those we’ve caught up with are resting . . .
They pay off the debt that sparked their origin, they pay it off because of a word that exists unjustly, like summer. (Celan, 1955/2001)
It is almost winter now, foreshortened days of letters never written, never sent. No storyteller stands before the hearth. There is no hearth. We live on the other side of myth.
Interruption occurs at the edge, or rather it constitutes the edge where beings touch each other, expose themselves to each other and separate from one another, thus communicating and propagating their community. On this edge, destined to this edge and called forth by its interruption, there is a passion. This is, if you will, what remains of myth, or rather it is itself the interruption of myth.
(Nancy, 1991, p.61)
One of the contributors to this issue asked me once why I do it, this whatever-it-is of community psychoanalysis, and I was brought up short, embarrassed. It felt like I was being asked to place some object in the place of hope. I think beyond the superficies of my weekly to-do lists, I have little commerce with hope.
From this edge that is the interruption of myth, the absence of hope, I write this letter to you who would still dream of community, let pass this reserve from voice to voice, from body to body.
It is, somehow, to live on, at, and for the limit of death where what counts is not what, according to the discourses that regulate our lives, is essential (that I survive, that you survive) but what is the surplus (that I, that you endured the chilling touch of death against all odds). That moment may be fragile, lethal, but it is the only genuine contact we have. (Michaeli, 2020)
I would wish to make known my gratitude to this small community—the ones we’ve caught up with and who are resting now and those who carry forth the task that has been left them. z
Blanchot, M. (1988). The unavowable community (P. Joris, Trans.). Station Hill Press. (Original work published 1983)
Celan, P. (2001). Nocturnally pursed. In J. Felstiner (Trans.), Selected poems and prose of Paul Celan (pp.68-69). Norton. (Original work published 1955)
Michaeli, L. (2020). Affording intimacy. The Philosophical Salon. https://thephilosophicalsalon. com/affording-intimacy/
Nancy, J. L. (1991). The inoperative community (P. Connor, Ed. & Trans.). University of Minnesota Press.
Matthew Oyer: I’m here today with Kirkland Vaughans and Martha Bragin, who have graciously agreed to sit down for an interview with me today. Hello, Kirkland and Martha. Thanks so much for joining me today for this interview. Is there anything you want to say right off the top, before we get into my questions?
Kirkland Vaughans: I think you should be clear that we’re talking about our work that took place in Brooklyn. I knew Martha from East New York and Brownsville. That’s where our work came together.
MO: Yes, so that’s where I was hoping to start. I’d love for you guys to tell me a bit about how you met and the work that you did together in Brooklyn.
Martha Bragin: I can give some of the background if it is helpful. The Brooklyn PINS Diversion Project began in 1987, as part of a new law that created mandatory diversion away from court-related services to all persons in New York State aged 16 or under who were brought to family court as in “need of supervision” (PINS). The youngsters had been accused of offenses ranging from truancy to armed robbery, gang violence, and violent attack. Our job at the program was to meet every child and family on the day that they came to court, and to within six weeks assess the root causes of the problems that had brought them there and provide noncarceral community-based solutions that could address the issues that we found.
We quickly learned that they were affected by three levels of violence: (1) structural violence, baked into the conditions of their lives; (2) social violence that maintains those structures; and (3) interpersonal violence in family and neighborhood relationships, in which social conditions manifest as deeply personal. In addition, the historical violence, transmitted through generations of struggle, that Kirkland writes about so eloquently, played a significant role. While the youngsters who came to our attention were labeled as the source of violence, their histories made it clear that they were in fact its survivors. Their concerned parents brought them to court as they engaged in active efforts to save their lives. We needed to connect to programs that could accept these families and provide the deep and multi-leveled understanding that they required and to keep working with them for a minimum of the 18 months or two years required by family court.
KV: We had not met at this point.
MB: I had heard about Kirkland’s work from a good friend of mine, Elsa First, who
worked with you in your doctoral program. So, when I saw the name associated with a Brownsville-East New York Agency, I thought ah ha! we’ve got a partner!
KV: Yeah, I worked with her while I was in Brooklyn. That’s right. I started the Child Program. It was an outpatient clinic in East New York, and we had another outpatient clinic in Brownsville. And our responsibility was to accept the referral or reject the referral. I don’t recall any rejections at all. It was like, why would you reject because every kid that Martha sent our way was really a kid who was desperate. It was like they wore a uniform to the rest of society, and the rest of society tended to look at the uniform and not the kid. The uniform was a civic symptomatology that would then get labeled conduct disorder, dysfunctional, high risk, those kinds of things. They didn’t see pain. They didn’t see depression. They didn’t see agony. They didn’t see confusion. And they didn’t see shame.
MB: One thing that I’m sure we succeeded in this partnership was to lift the conversation. So, we started out in 1987 being told we had a problem with “youth violence.”
By the time we had our first major conference in 1992, which was called “Beyond Conduct Disorder,” we changed the label to “children affected by violence.” It wasn’t that the kids were violent; it was that they had experienced the violence of society in their lives and in their bodies. And their parents, their grandparents, and their communities had been doing their best to support and protect them, but they too were under relentless attack, through combined economic, social, and historic injustice, and that’s why the kids were suffering. We opened the conference by stating, “Ladies and gentlemen, our children are dying of sorrow.”
MO: What you both are addressing, what Kirkland called civic symptomatology, and, Martha, when you speak about changing the discourse and the direction of causality, what kind of effects did you see? Did you see this shift in discourse moving outward into the community, outward to other agencies? I think this is where change starts to happen, but I’m not as clear on the methods by which it should be disseminated.
KV: Some changes that I saw were that different community elements began to feel supported; they no longer felt alone with these issues, and as a result, became more supportive of children who were impacted. Schools, churches, with support assume more responsibility and sensitivity. I know that as a clinic director that
OYERthat can be a scary thing, because too often we want to point the finger at someone. I remember I had a bright female clinician who was exceptionally good at working with kids and young folks who had violent experiences and who had committed violence. And she came to me and wanted to reject a patient because she was frightened that this person had all kinds of weapons at home and had acknowledged that he had committed violence. And I remember my response as the administrator was that the clinic will get in trouble, we’ll all get in trouble if anything happens with this person. And I took the patient because she was pregnant, and as I mentioned, it didn’t work therapeutically. And as it turns out, the patient and I worked together for two and a half years, but my initial response was “You gotta go,” the ship will sink, it’s all going to implode, and so I was frightened. It turned out, he and I worked very, very well together. We were able to get his weapons removed, all except one. This was the first time I experienced the patient interpreting the therapist’s fears and anxieties. This was determined by an episode in which he almost became very violent, and he said, “Dr. Vaughans wouldn’t want me to hurt you.” And he stopped in the middle of the story, and he said, “What are you sweating for? Look at your armpits.” He said, “I haven’t been violent since I’ve been here. You need to chill out.” And I said, “You’re absolutely right; I need to chill out.” [Laughs] We all grew as a result of this, through facing our shortcomings. I had a role in that; I wasn’t innocent of any of these applications myself. How do I keep my staff safe, how am I going to deal with the City Department of Health, the State, blah, blah, blah. So, facing our own vulnerabilities in this mandate that Martha described was to be really effective in our work and to work collaboratively in a real and sincere way.
MB: It was our job at the Diversion Project to create space that protected the community agencies that accepted our clients. So let me take a minute and walk you through the assessment process. We reviewed all available records, making needed referrals for any medical and educational supports that were needed. We screened for emergencies, then followed up by taking detailed histories from the child, all family members, and any community members the family wanted to include. By the final session, most families could work with us to create their own interpretation of how life, history, and adversity had created the presenting problems and were eager to move forward toward addressing them. We had a psychiatrist on staff who came from the UK and had studied with Winnicott— especially his ideas linked to deprivation and
delinquency. We also had the distinguished Rick Dudley, an African American forensic psychiatrist, who was far too senior to be on staff but did make himself available for teaching and consultation. We would do a very intensive, child-friendly, homicide/ suicide screening, and if a child was positive, they would see our psychiatrist. If he found a child determined to die, with a practical plan of how to make that happen, then they would go to Kings County Hospital, to a special unit supervised by a senior clinician there. Most children would respond by saying, “No, no, doc, I’ll come to my next appointment, everyone needs to chill”—but if they did want to die, then we could arrange a shortterm hospitalization before any community referral. We were trying to protect our partners by saying, okay, we will take this on, but that also meant being very, very strong. We knew that we were dealing with very depressed, desperately hopeless children, with families who often held down multiple jobs and worked their fingers to the bone just trying to protect them. We had a sacred obligation to get these children proper care.
A story: We have a kid who comes in, the mother is sure he has a firearm in the closet, and he’s apparently held it to someone’s head. So, he comes in, and I’ve got a young, beginning, skinny, white social worker assigned to the intake. But he had been through Dr. Dudley’s clinical training, and he knows the drill. He was very calm, and he asked what was going on. The kid starts cursing, yelling, and calling him names. He doesn’t respond, just acknowledges that the child is really distressed. He doesn’t react, just sits there patiently saying that he really does want to know what is going on. The child storms out of the room with his anxious mother trailing after him. Then, at six o’clock, he shows up in the office. “Is Mr. Ted here? I’ve got to talk to Mr. Ted.” I said, “Mr. Ted’s not here, but I’m here. What’s the problem?” He said, “You know that Mr. Ted, my social worker, he’s a weirdo. You could tell him anything.” [Laughs] So, I said, “What’s the anything?” The “anything” was that he had a firearm with him. I had to put it in a drawer and call the police to come collect it after hours. That way, I need not release any information about where the weapon came from. I asked the youngster if he was going to hurt himself or somebody else. He agreed to a short-term hospitalization.
KV: You mentioned Winnicott, and that story reminded me of a paper of his that I just love called “Delinquency as a Sign of Hope” (Winnicott, 2016). And to me, your story just put it right there.
MO: What strikes me is that in these stories, there’s a real hunger for psychoanalysis. “This guy’s crazy. You can say anything.” But
part of what Kirkland is pointing to as well is that there are all these forces that really do interfere with one’s capacity to protect a space where a kid can say anything. I wonder if you guys have insight or thoughts about how that space can be protected, how it can be held open.
KV: I think your term, protected space, is first and foremost. I think that the therapists need to feel protected. And I talk about it in very simplistic ways. It’s like if we’re in a school setting, and the principal or dean brings a kid to a therapist and says, “Here.”
The kid is on the spot; the therapist is on the spot. And there’s no way that I believe that that’s not going to undermine the efficacy of the treatment. Both are now being tested. The kid knows. He or she’s not blind to this phenomenon, they just don’t use the same vocabulary. They’re aware. So I think the idea of building, really forging them, knowing that that can happen is to be able to protect the therapist, so the therapist, in kind, can protect the patient. They protect the patient by saying, “This is a space in which we want to see what evolves here that can be helpful.” When black kids protest—black boys, but also lots of black girls—when they’re being reprimanded and they say, “You ain’t my father!” I hear that as a protest. Right? Where the hell is my father? But I hear responses like, “Well, now you’re suspended.” “You’re oppositional.” “You’re defiant.” So the space is undermined before the referral even gets made. “You are to be compliant, to be who we need you to be.” And the kid, even if they wanted to in their fantasy, they know it can’t be done. And so, it’s a mechanism of shaming and of othering right there. So I think the administrative staff need education and training about the power that rests in the school system.
Martha mentioned Winnicott, and Kenneth Clark, the black psychologist, also noted the same from the perspective of social psychology. They spoke in a very positive way: how these troubled, delinquent kids help the community so much, how they hold hope. That’s what they said, “These kids have not given up yet.” So, what Martha is describing is grabbing the strength and hope that are carried in these kids before they get killed off by our labels: “wilding” as a classical example. I remember arguments and fights that occurred at the time of the Central Park Five and after, justifications after that, “We’ve got to get tough.” We do have to get tough, but the toughness is in creating programs that can then protect and let kids know that they have a real opportunity. Not opportunity like they are going to make this amount of money or that amount of money, but that somebody really does care about them, and somebody’s going to mentor them to be the best that they can be. And I think failure is okay, failure’s
okay for everybody. It’s not whether or not you failed; it’s whether or not you made an attempt. If you haven’t had the opportunity to make an attempt, that’s when the shame dissolves who you are. It just eats away like an acid. I think they don’t get that. We have to give them an opportunity.
MB: They get shut down and pressured to lie very, very early, just as the Exonerated Five were back in the day. I just did a paper (Bragin, 2021) in your journal [Journal of Infant, Child, and Adolescent Psychotherapy (JICAP); Dr. Vaughans is the founding editor]. It’s about kids who become involved, whether it’s in gangs in the US or in other armed groups around the world, in violent extremism. But, when you interview these kids, what they show you is their hope: they’re fighting for something. When they think that you want them to comply with the existing structure, they think that you don’t want to know the truth that they know; you can’t hear it. Then, they shut down. The paradox of hope is allowing them to tell us their truth, and we adults are making psychic space for that truth so that we can find a third way forward, (in Benjamin’s terms) beyond violence and toward creative action, together.
We have a social imaginary that is controlling the narrative, and then we’ve got real humans who are not reducible to that narrative but who are caught up in it. The PINS program allowed us to listen to children and their families and their truth, and to help them to live their truth and to figure out how to mourn their losses, acknowledge their suffering, and to celebrate their resistance and resilience. To value that is powerful.
MO: This was 1987 that the program started. I want to get a sense of then and now. What were the biggest challenges implementing a program like this, bringing psychoanalytic principles into a community setting in 1987, and how have those challenges changed today, for better and for worse, I’m sure?
KV: For me, the good news back then was that we had people who were analytically trained who were invested in youth. Now, it’s also my belief that they had to be re-trained, but a lot of this cadre is now gone. The young cadre is not being trained this way: they’re being trained in behaviorism, CBT, DBT, what Dorothy Holmes has referred to as the alphabet therapies. So they don’t get a sense of looking at the person inside, only at the symptomatology. So, in that way, trying to teach psychodynamic thinking is much more difficult because the students know when they go on externship or internship, they have to talk that talk, walk that walk, and it’s CBT and DBT. So even if they’re interested, they’re intimidated. If they don’t have enough CBT and DBT stuff on their resume, they’re
out to lunch. It’s like I’m whispering to them something that’s lewd, that’s of interest when I talk psychodynamically. I’ve even had students, who are on their internship, sign up to take an additional course to come back to me to get supervision on their internship because it’s only CBT and DBT and they don’t know what to do with these patients. So I end up supervising them on their internships unofficially. So the cadre is gone. The whole sense of creating a therapeutic environment for youth after they’re hospitalized, it’s out the window.
There is a children’s psychiatric center near my home, and every time I pass, without fail, I see two police squad cars out there. Every time. Without fail. Any time of the day. Always two police squad cars. So, that suggests to me—I’ve never been inside—but it suggests to me that it’s gone back to a very legalized, monotonized, behavioral focus. So I would say it’s more difficult today. I know that Martha caught hell, I caught hell, and more than that, the kids caught hell, but I could find people like Martha back then, whereas now I feel like I would be hard put because people have gotten tired, they’ve gotten worn out. You have to know how to play in the mud. The professors may say, “I don’t want to play in the mud anymore,” but that’s where you’ve got to stay. My wife and I were at a party a few months ago, and there was a young white woman with an eight-month-old daughter in her arms and about a four-year-old son. And they’re walking towards us, and my wife and I started laughing because there was a puddle between us, and the mother stepped a little bit faster, and I said, “It’s too late.” That kid headed straight for that puddle and enjoyed himself. We just laughed. The mother looked like it was a catastrophe, but it’s no catastrophe. No kid is going to walk past a puddle. It’s not going to happen. It’s still a requirement for this work to play in the puddle, even more so, I would say. And that’s more difficult these days. The environment has changed, the culture has changed to wipe out this way of looking at kids. Fix them and be gone.
MB: I’m going to speak again to the external side of what’s going on here. So, first of all, PINS Diversion was a great place to train people in doing a psychodynamic assessment, working with families to understand their experience, what a child’s acting out behavior represented, and how to address it, with families and children affected by violence. We kept strict records of our assessments, referrals, and results, that included circling back to families for their views of our effectiveness. We tweaked referrals and practices based on community reports, in a process that today is called “monitoring, evaluation, accountability, and learning” (MEAL).
However, in recent years, this program and others like it fell victim to a controversy regarding the nature of evidence in clinical practice. As we all know, the gold standard for evidence in medicine, particularly in the prevention or treatment of disease, is a randomized controlled trial, which ensures that every aspect of sample and care is standardized except for the presence or absence of a very specific intervention. This is, of course, really important for the creation of vaccines or the treatment of disease.
However, children’s development is interactive from birth. Brains and bodies develop as a product of unique interactions between the new human being and its caregivers, influenced by culture and community and affected by myriad protective factors as well as risks created by adversity. Biopsychosocial interventions must therefore also be complex—too complex to lend itself to an intervention addressing one symptom only. A recent policy paper by the Alliance for Child Protection in Humanitarian Action therefore recommends MEAL processes as a better standard to use to judge the effectiveness of biopsychosocial programs for children. However, in the US, complex interventions that have not undergone a clinical trial are considered to be without evidence and discarded in favor of manualized interventions designed to address specific behaviors (regardless of how small the effect size, or whether the evidence for effectiveness was actually gathered with the population that we are working with in mind, and not another one).
Right now, the PINS program runs based on a series of short-term and limited interventions, rather than the complex ones that were engaged in those early days in the 1980s, 1990s, and early 2000s. I am hopeful that the discussion of the nature of evidence for effective practice is just beginning.
What I do is a combination of lending my voice to discussions like these in the international community, and, here in the US, running a small program out of Silberman School of Social Work at Hunter College, where I try to teach the ways of working that my research tells me are developmentally sound and culturally relevant, as well as the value of learning from, and accountability to, the communities and the humans within them with whom we are working.
I should shut up now and let Kirkland talk.
KV: Well, no, you shouldn’t shut up. I like what you do, Martha. I deeply respect the work you’ve done. Your articles in JICAP have brought so much to light. It gave credence not just to the work, but to the population that this work impacts, that we can work with this population. For me, up until the point when you began to write,
there were a few other folks out there, but there was a quiet dismissal. It wasn’t loud. Nobody was saying, “Screw these kids. These kids are no good.” It was a quiet dismissal. It was more like, “Why would one go there?” There was a woman, Barbara Lerner. She wrote Therapy in the Ghetto (Lerner, 1972) about psychotherapy in the slums in Chicago, and she showed how effective psychodynamic therapy was with poor black people in the Chicago slums. Rarely do I see her referenced. There’s a giant book, Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, it comes out every few years, and it says whether or not your research is good. They reviewed her work and found that it was quite outstanding. And yet her work has been ignored. I see Martha’s work in the same way, except it’s beginning to be read and to impact other areas.
MO: Some of what you both have spoken about are these external pressures— from government, from funding sources for research, and from the scientific paradigms themselves—that exert themselves on psychoanalysis and on clinics that want to support psychoanalytic practice, but I think Kirkland was starting to point to before some of psychoanalysis’s internal problems, in terms of how it has made itself available, the ways it has theorized or not on race, socioeconomic issues, gender, and sexuality. Anecdotally, I meet lots of social workers who are interested in psychoanalysis and pursue psychoanalytic training, but it’s often accompanied by a turning away from what is so special about social work, which is the broad, social, community orientation. They go into psychoanalytic training, they open private practices—I have a private practice, I’m not disparaging the decision—but there’s a shift away from attention to the collective into this very individual thing that has always been there with psychoanalysis.
KV: Most of my career has been community-based mental health, but I also have a private practice. When I went to NYU [New York University], Bernie Kalinkowitz, who was the founder of NYU Postdoc, turned to me and asked me if I was still involved in community-based mental health, and I defensively responded, “Yes, I am.” And Bernie said, “Oh great, great, I’m glad.” And I was surprised to hear a psychoanalyst really be supportive of community-based mental health, and I appreciated it. Honestly, I cannot understand how the psychic and the social can be disconnected. If I were to believe that, I would believe you can separate heads or tails on a coin; there’s just one side or the other. I don’t want it to sound arrogant, but to me, this is just a reality.
MB: I so appreciate your saying that. Going back to an earlier point of yours, Kirkland, about what we needed to do to create our own ability to work effectively with these youngsters. Work with families affected by such high levels of violence can be especially challenging when practitioners and clients are living within the same systems of structural and institutional violence that the families are. We had to learn about this from Chilean psychoanalysts Janine Puget and Elizabeth Lira. We are all incubated in this system whether as survivors, witnesses, or accomplices. Even as the straight, white, cisgender, “ablebodied” among us were particularly affected by blindness and denial, all of us were affected by being part of a society that denied the reality of structural and social violence embedded in everyday life. We are all blinded by the violence that renders history, culture, and class invisible along with the scholarship illuminating strengths and protective mechanisms inherent in BIPOC cultures’ capacity to survive.
It happened that during the same period that I was developing the Diversion program, I was invited by MADRE, a women’s organization, to work in countries in conflict in Central America, Eastern and Southern Africa, Southeast Asia, and the Middle East. MADRE’s capacity exchange program recruited US-based women of many ethnicities to learn from successful organizers in countries in conflict, while sharing our own expertise. I began to bring the learning from these experiences back to our program to help us gain perspective. In that process, I became aware that Freud’s greatest gift was taking ideas he obtained from around the globe, through his interest in anthropology and his correspondence with Indian philosophers and incorporating them into his thinking. The ideas that he tests in 1896 were already available. Remember that in 1492, the “known/ civilized world” was centered in the global south. The idea of an unconscious mind was ubiquitous, as were such concepts as conflicting passions, with both sexuality and aggression part of the psyche of all humans. So psychoanalysis actually brought to Europe and the European mind some knowledge that is more universal and not particularly white. And if we keep that in our mind, then we can start thinking differently about psychoanalysis. The idea that the past lives in the present, that the parents and their parents before them are remembered in some way in all that we experience, and that if we encounter violence in the world or are forced to break society’s boundaries, we must find societal methods to symbolize the unsymbolizable in order to be able to join the peaceable community again. These are all part of the knowledge that was brought to psychoanalysis in its early days and are part of the international psychoanalysis so often ignored in the US. A vibrant Indian
psychoanalysis provides global leadership in understanding the importance of caste, class, and cultures; a popular psychoanalysis in the South American continent takes the lead on issues of politics, economics, and social justice. Newly emerging Southern African and Central American psychoanalytic thinkers are exploring their “Atlantic” cultural practices and communal methods. All of these ideas are part of our psychoanalytic worldview and heritage. We need to reclaim and rejoin our heritage, our present and our future. The good news for me is that my diverse band of graduate students, and others like them, are eager to interrogate their own histories and traditions and make psychoanalysis their own. Every day that I teach, I learn from them. These kids are smart, insightful, and ready to forge a new world. But yes, in earlier times, these aspects of psychoanalytic thinking, as embedded in culture, class, and history, were often “whited out” in the US—obscured from view.
KV: You’re right. What I came up under is what Martha’s describing. And it impacted me in that I was dismissive of a lot of the teachings; it just didn’t make sense, it didn’t apply. And I recognized that even in our psychology programs, it was the same. And it seemed to me that students of color were missing out on significant parts of their education, while white students were being miseducated because you couldn’t have conversations back then about this. It was dismissed as, “That’s cultural,” as if that has nothing to do with how the mind operates. We saw culture in a very simplistic way: how an East Indian or a Native American might dress, a black with jazz or hip hop, not as a part of the person and a way the mind is structured. To me, it’s who we are, it’s a part of our makeup; our identity is very profound.
Recently, I gave a talk about my treatment with a ten-year-old black boy, and he’s attending an all-white school district, and he’s the only black person there. So, he’s a very, very smart kid, and all of the sudden, he’s being written up, suspended, threatened with expulsion in this private school. And the one teacher, a Jewish woman, that had talked with him about this the prior year had left, and he felt so abandoned. So I talked to his mom, and I said, “Listen, this is not a battle that we should fight.” And he moved to a public school district that has diversity and to a black church, and he’s performing there, and the preacher knows him. It’s not like this kid is mentally disturbed, but to get him back on his developmental track, he needed to use his cohorts and be able to identify with them, not be put in a position of “something is wrong with you, you’re here by yourself.” And the kid said to me after about twelve weeks, “Listen, my mind doesn’t hurt anymore.”
That’s what he said to me. “I’d like to see you again, but I’m not so sure about that.” And I said, “Let’s talk. We call that ambivalence. Part of you feels this way, part of you feels like that.” And he said, “Well, I’m in trouble or I’m in pain if I accept to see you, and I don’t want that trouble and pain anymore, but I would like to see you.” So I said, “Well, we can do other things. We have what we call check-ins, just, ‘How you doing?’, and we have talks that way.” Mom agrees we can have check-ins whenever he wants, wouldn’t have to be in pain, wouldn’t have to be in trouble. And with that, the kid dismissed me. He’s doing well. He doesn’t need me there every week. He’s doing very well on his own. He told me about the preacher and the programs there. He’s participating actively. He’s not being singled out. In effect, that’s what I said to him, “I won’t be singling you out.” So I felt like the termination was a good one, our work together was good. He turned me onto a book where he’s reading about the other, a kid going to a school where he doesn’t belong. I’m so interested in Martha’s work with narrative. Helping the patient to tell his story. To me, that is analytic: helping the kid tell his story. It’s just that it’s not recognized without all the analytic terminology. Martha said, “Tell your story. I want to hear it. I’m interested in hearing your story.” And the more this person can tell their story, they begin to hear themselves. Whereas before, it was forbidden. Nobody wanted to hear it. There was an article written in volume one of Psychoanalytic Psychology entitled “The Conspiracy of Silence” (Danieli, 1984). It’s about how Jewish people who survived the Holocaust were treated even by people in our field. “We don’t want to hear it. You fix that.” Judith Herman in her book talks about how it takes a political movement to understand trauma. And I think she’s right. Psychoanalysis needs to look at social justice and its role in either supporting it or undermining it. There are no bystanders here.
MO: That sounds like a good place for us to stop. Thank you both so much for sitting for this interview and for the remarkable bodies of work you both have generated, envisioning and elaborating the space for a community psychoanalysis. z
Bragin, M. (2021). The paradox of hope: A psychodynamic approach to understanding the motivations of young people engaged in violent extremism. Journal of Infant, Child, and Adolescent Psychotherapy, 20, 1-14. https://doi.org/10.1080/1 5289168.2021.2007685
Danieli, Y. (1984). Psychotherapist’s participation in the conspiracy of silence about the Holocaust. Psychoanalytic Psychology, 1(1), 23–42. https://doi.org/10.1037/07369735.1.1.23
Lerner, B. (1972). Therapy in the ghetto: Political impotence and personal disintegration. The Johns Hopkins University Press.
Winnicott, D. (2016). Delinquency as a sign of hope. In The collected works of D. W. Winnicott (pp.91-98). Oxford University Press.
In September 1918, Anna Freud was in the audience at the Hungarian Academy of Science, in Budapest, on the day when Sigmund Freud offered to “review the position of our therapeutic procedure” (S. Freud, 1919/1955). This “review” would lead Freud to repudiate his earlier and far better-known writings from 1913 on fees and the psychoanalyst/ physician as a medical entrepreneur. With the end of the war, he said, “the conscience of society will awake,” and the new psychoanalytic perspective would advance a platform of modernist beliefs in achievable progress, secular society, and the social responsibility of psychoanalysis. Nearly four months later, when the Social Democratic Party won Austria’s first post-Monarchy election, the government would use its firm majority to promote a highly innovative program of community policies and to redesign virtually every municipal resource. Psychoanalysis fit in perfectly.
Yet even then, Freud worried that psychoanalysis was at risk of isolation partly because “our therapeutic activities are not very far-reaching.” Why? Because therapy was only one side of the psychoanalytic coin. Engagement with social democracy demanded the kind of activism that would mitigate social stigma and place mental health care on a par with physical health care. Poor people, Sigmund Freud (1919/1955) said, have “just as much right to assistance for the mind as they now have to life-saving help offered by surgery. This treatment will be free.” This goal—psychoanalytic treatment provided for all in the context of a free clinic—would shift the provision of mental health care from the paternalism of individual charity to a broad social welfare paradigm, the welfare of society as a whole.
In the historiography of the psychoanalytic movement, descriptions of the clinics tend to frame them as mere adjuncts to their respective training institutes, essentially laboratories where candidates would find patients on whom they could exercise new skills and theories. Fortunately, we now have excellent primary source data that portray a more accurate picture—namely, that the clinics were started several years before the training institutes and functioned as community-based treatment centers. In Berlin, for example, the psychoanalytic Poliklinik opened in 1920 as an independent clinic at least three years before the advent of a training institute. In mid-July 1919, Max Eitingon, the clinic’s co-director, wrote to Freud:
Last Saturday, our association decided to open a psychoanalytic policlinic in Berlin next winter. We will
Elizabeth Ann DANTOtherefore start our “psychotherapy for the people” without waiting for the state, itself rebuilding, nor for the generous impulses of an individual, to give us the means to pursue this goal . .
. As a first step, most of the daily treatment will be provided by a number of experienced colleagues from our association, depending on the time available to them. (Eitingon, 1919/2009a)
In November, Eitingon (1919/2009b) announced: “Our Poliklinik is en marche.” Though it started with the treatment of adults, within two years of operation, the Poliklinik was accepting referrals from Berlin’s Child Welfare administration and treating children and adolescents.
Since the Social Democrats’ election in 1919, the party’s health and welfare department in Vienna had specified that the creation of a healthy nation called for healthy children. More than any other European Social Democratic Party, the Austrians emphasized youth and educational organizations (Rabinbach, 1978). These community services, said the psychoanalyst Josef Friedjung (1937), would combine health and mental health care to “immunize the soul of the child against the hardships of life.” Friedjung’s colleagues were ready. “Back in Vienna then, we were all so excited—full of energy,” Anna Freud told Robert Coles. “It was as if a whole new continent was being explored. We were the explorers, and we now had the chance to change things” (Coles, 1991). Their free clinic on Pelikangasse, the Ambulatorium, opened a Child Guidance Center. The analysts pushed for sex education. They were in the courts, in the hospitals, in journalism, and in the schools.
Traditionally, troubled children and adolescents who had difficulty reaching prescribed educational goals had been singled out or, worse, simply expelled from school. But under the de-stigmatizing rubric of “educational counseling,” and with August Aichhorn at the helm, they were offered accessible psychoanalytic treatment. A core organizer of the city’s childcare institutions, Aichhorn had already set up the local educational counseling offices in Vienna’s fourteen district youth offices. From the truant (and sometimes homeless) youths in his residential facilities, to the families treated at the Ambulatorium’s Child Guidance Center, to the indigent toddlers at the Jackson Nursery, Aichhorn and other analysts insisted that psychoanalysis would be made available to all. Aichhorn’s transformative perceptions of the inner lives of disturbed or delinquent adolescents were gained at the public clinics and remain influential today.
From 1922, the year it opened, until the 1938 Nazi Anschluss of Austria, hundreds of “office workers, shopkeepers and government officials—found help and an indispensable sense of well-being at the Ambulatorium for the destitute” (Hitschmann, 1927). Like the clients of their sometime rival Alfred Adler, the analysts’ target populations lived toward the western edge of the city; in contrast to the bourgeois dwellings inside Vienna’s “Ring” boulevard, the Ottakring district housed, physically and metaphorically, outsider groups of workers, immigrants, gangs, bohemians, and servants (Maderthaner & Musner, 2003). These were precisely the population clusters which would be denied access to psychoanalytic treatment were it not offered in the context of what Freud called a “social right.”
Whether by intent or historical circumstance, community clinics, child analysis, and progressive early childhood education all came on the scene in the early 1920s. Partly in response to the open lectures offered by Anna Freud, Alfred Adler, and Josef Friedjung, interest in child analysis surged among public school teachers at all levels. Anna Freud, for example, supervised a group of teachers engaged in a working collaboration between Montessorian and psychoanalytic pedagogies at the Volksschule Grünentorgasse, a primary school in Vienna’s ninth district. She applied her research based on hands-on practice to the three child-centered areas of education. Psychoanalysis, she said, would be used effectively to “1) critique existing methods; 2) extend the teacher’s knowledge of human beings; and 3) endeavor to repair [childhood] injuries” (A. Freud, 1930/1974a). She also led seminars with Aichhorn, organized the “Vienna Course for Educators” with Willi Hoffer, and welcomed Heinrich Meng1 into the editorial circle of their new publication, the Journal of Psychoanalytic Pedagogy (Zeitschrift für Psychoanalytische Pädagogik). The journal’s mission, its editors announced, was to prevent the incidence and consequences of childhood neurosis and to lay the foundation for psychoanalytically-informed education. This ideal “child-appropriate education” (kindgemässe Erziehung) would parallel the unique developmental needs and capacities of the child.2
With the city’s public school teachers and social workers increasingly attracted to the new methodology, and with the capacity at the Vienna Psychoanalytic Society’s Child Guidance Center reaching its limits, the child analysts decided to expand the scope of their services. Club leaders, teachers, social
1. Heinrich Meng, a Berlin psychoanalyst, was co-founder of the Association of Socialist Physicians with Ernst Simmel.
2. Anna Freud and her life companion Dorothy Tiffany Burlingham made a practice of this theory at their Hietzing School in Vienna, 1927 through 1932.
workers, and school-based doctors were now referring children “from all strata of the necessitous classes” to the Ambulatorium. With child welfare now integrated as a standard feature of Vienna’s education and human service system, the psychoanalysts confronted a wave of previously unacknowledged distress. In response, Anna Freud, August Aichhorn, Siegfried Bernfeld, and Willi Hoffer (who had been meeting privately to discuss psychoanalytic pedagogy) agreed that the time had come to offer counseling and guidance in the community. They started with schoolbased advisory services.
These educational and youth counseling resources, or Beratungstelle (short for Erziehungs und Jugendtlichenberatungstelle), were modeled in part on Aichhorn’s public outreach programs and in part on Anna Freud’s guidelines for child analysis. The core team— Anna Freud, Aichhorn, Hoffer, and Editha Sterba—offered on-site treatment to local children (with or without family present) and adolescents as well as parents and grandparents. The Beratungstelle opened to the public in workers’ education and community centers, large apartment complexes, clubs, and, of course, public schools. “This had the advantage,” commented Hoffer (1932), “of dispelling a number of obstacles to treatment of neglected, neurotic or difficult-to-educate children and those who lived with them.” Medically trained analysts could assist with psychiatric evaluations or referrals if necessary. The psychoanalysts sustained these Beratungstelle around the city through 1935.
Like the Ambulatorium on Pelikangasse, the Beratungstelle were well supported by the local press; in published notices as small as three lines and as long as a half page, the consultations were announced widely. At least 75 meeting notices were printed in 15 local newspapers through 1934. In the February 16, 1932 issue of Kleine Volks-Zeitung, a liberal daily paper, a typical announcement reads: “Education and Youth Counseling Center of the Vienna Psychoanalytic Society. Guidance by A. Aichhorn, Anna Freud, Doctor E. Sterba, Doctor W. Hoffer, Thursday from 6 to 8 o’clock in the Federal high school, Vienna Ninth District, No. 10 Wasagasse (cost-free counseling).”3 The notices appear to be thoughtfully arranged by the newspaper’s typesetter: one is positioned just under the death announcement of a young man and his son, perhaps by suicide, while another adjoins an article about maternal care. While over 140 daily and weekly newspapers were circulated in the 1920s and early 30s (Barnett & Woywode, 2004), those which published Beratungstelle announcements were of the 3. Erziehungs und Jugendtlichenberatungstelle der Wiener Psychoanaltischen Vereinigung. Leitung: A. Aichhorn, Anna Freud, Dottor E. Sterba, Dottor W. Hoffer, Donnerstag von 6 bis 8 Uhr im Bundesgymnasium, Wien 9 Bez, Wasagasse 10 (kostenlose Beratung)
left. These same left-of-center publications reviewed new psychoanalytic books and lectures, announced related events like Sigmund Freud’s Goethe Prize, and publicized Anna Freud’s lectures throughout the city.
These advertisements for the Beratungstelle meetings offered all readers an initial snapshot of Anna Freud’s work team. At the same time, interested teachers and analysts could read about cases in greater depth, as clinical illustrations of theory or technique, in the Journal of Psychoanalytic Pedagogy: a depressed grandmother is supporting the child whom her son fathered extramaritally; the eight-and-a-half-year-old Minna is referred because “no one could cope with her strange personality”—she lied, stole, and masturbated openly in the classroom. In an article titled “The Love I Have for Fear” (Sterba, 1933), a young boy describes his psychotic experience: “It is like when a cloth is thrown over my head, like when robbers overcome me. I can‘t get out of there. It can drive you crazy. Now I‘m not sick, but there is a feeling in me that I don‘t think any other person understands.” Perhaps Josef Friedjung did. The pediatric psychoanalyst had identified how urban children thrive when they are free from fear. He repeated this theme in the City Council chambers, in the offices of municipal district leaders, and in local programs developed to educate parents about the equal impact of psychological and physical safety. Friedjung had started this campaign with an essay, “The Education of Parents” (“Die Erziehung der Eltern”), during World War I in 1916. For his psychoanalytic peers, he framed the message in a 1924 essay, “A Dream of a Child of Six.” The point was not to blame parents but rather to show that parents shared with the state an obligation to protect children from trauma.
Interestingly, social conscience is never far behind the intrapsychic material discussed in the Zeitschrift articles. In the Social Democratic city, the analysts included the effects of social class in their case studies: Aichhorn’s grandmother is from a “petit bourgeois family,” while Sterba’s Minna, born to a poor family, was moved through a sequence of foster homes. This case would have come to the attention of Vienna’s child welfare administration at City Hall, which, Anna Freud (1924/2006) said, “knows psychoanalysis well and holds it in high regard.” Freud was sensitive to the needs of marginalized children and families: she welcomed the newly professionalized field of social work, and she saw that “all individual development, whether on social or dissocial lines, [is] the result of interaction between innate and environmental factors” (A. Freud, 1951).
The Beratungstelle analysts offered, in addition to personal counseling, information on psychology, addiction, child development, and marital and family relationships for par-
ents and caretakers. Editha Sterba (1941) would later observe, “In active child guidance work, advice and help cannot be limited to the child. The environment of the child and the members of the child’s family need to be included.” Thus, when social workers and district welfare workers visited homes of families in need or at risk, parents who may have consulted a Beratungstelle analyst seemed open to child treatment. Where the old monarchist Austria had asserted the supremacy of parental authority, social welfare in progressive Vienna now upheld the state’s right to protect the child from abuse.
In her barely veiled criticism of Alfred Adler’s character-building practitioners, for whom “child analysis might [be] some special form of educational guidance,” Anna Freud (1945/1966) outlined how adult anxiety could, in fact, deprive the child of help. Conversely, “analytic education can count among its success greater openness between parents and children…[But] it will be a long time before theory and practice are complete,” she said (A. Freud, 1968/1974b). The argument between Freud’s and Adlerian approaches to child guidance, as well as Siegfried Bernfeld’s and Wilhelm Reich’s, were so well known that even the local newspaper Die Stunde (1928) satirized their alleged competition for progressive credentials: “The Individual-psychologists under Alfred Adler’s leadership tried to persuade us that their soul-searching could fit into Social-democratic theory like a new bed of grass in a large, somewhat overgrown lawn. Well,” continued the metaphor-mixing columnist, “now Dr. Bernfeld proposes that Freudian theory is the genuine mediator between psychology and social progress.” As each of these theorists saw in their own Beratungsstelle cases4, society’s repression of childhood self-regulation could interfere with the adult’s compassion for the child. But like Friedjung and Aichhorn, Anna Freud’s ideas for handling disturbances in childhood concentrated specifically on the child’s autonomous point of view, separate to the extent possible from parents and the state. Many years later, she would apply a similar logic to aspects of family law. “We had to address the tension between the fear of encouraging the state to violate a family’s integrity before intervention is justified, and the fear of inhibiting the state until it may be too late to protect the child whose well-being is threatened” (Goldstein et al., 1980). In other words, government intervention in the lives of at-risk families should be minimal. But if intervention is necessary, the child’s interests should be paramount.
Thus, as their city embraced the pursuit of a just society between the two world wars, 4. Each “camp” ran one or more community-based child guidance centers, though Anna Freud’s and Alfred Adler’s dominated the scene. Wilhelm Reich’s focused more specifically on sexuality and sexual health.
so too many of the psychoanalysts affiliated with the Vienna Psychoanalytic Society’s Child Guidance Center pursued the idea of equitable treatment by extending their practice into the community. Anna Freud, August Aichhorn, Siegfried Bernfeld, and Willi Hoffer were among the second generation of Viennese psychoanalysts, all affiliated with the Social Democratic Party and each an activist in their own way, who took to heart Freud’s 1918 demand for mental health care as a social right. They offered cost-free psychoanalysis in the schools, in the large communities of public housing, and in Vienna’s networks of health advisory centers. At the same time, alliances between health reformers, educators, and psychoanalysts fostered a system that would enhance the autonomous human voice from childhood to society. They believed that early childhood services would remedy traditional authoritarian repression and allow for the emergence of “a free and self-reliant human being” (A. Freud, 1930/1974a). With a methodology grounded in social rights and infused
with the energy of interwar social democracy, psychoanalytic practice was, at least until 1938, significantly more public than conventional narratives would have us believe. z
Barnett, W. P., & Woywode, M. (2004). From red Vienna to the Anschluss: Ideological competition among Viennese newspapers during the rise of National Socialism. The American Journal of Sociology, 109(6), 1452-1499.
Coles, R. (1991). Anna Freud: The dream of psychoanalysis Addison Wesley.
Die Stunde. (September 16, 1928). In Folder “Psychoanalysis & Socialism, 1926-29-1937”, Container 7, papers of Siegfried Bernfeld, Collections of the Manuscript Division, U.S. Library of Congress.
Eitingon, M. (2009a). [Letter No. 142 E of 25 November 1919 from Max Eitingon to Sigmund Freud]. In Michael Schröter (Ed.) and Olivier Mannoni (Trans.), Correspondance (1906-1939) (p. 195). Hachette Littératures.
Eitingon, M. (2009b). [Letter No. 152 E of 25 November 1919 from Max Eitingon to Sigmund Freud]. In Michael Schröter (Ed.) and Olivier Mannoni (Trans.), Correspondance (1906-1939) (p. 141). Hachette Littératures.
Freud, A. (1951). August Aichhorn: July 27, 1878-October 17, 1949. International Journal of Psychoanalysis, 32, 53. Freud, A. (1966). Indications for child analysis. In The Writings of Anna Freud, Vol. 4 (p. 5) International Universities Press. (Original work published 1945)
Freud, A. (1974a). Four lectures on psychoanalysis for teachers and parents. In The writings of Anna Freud, Vol. 1 (p. 127). International Universities Press. (Original work published 1930)
Freud, A. (1974b). Normality and pathology in childhood. In The Writings of Anna Freud, Vol. 6 (p. 127). International Universities Press. (Original work published 1968)
Freud, A. (2006). [Letter # 152-A of January 25, 1924 to Lou Andreas-Salomé]. À l’ombre du père – Correspondance 1919-1937 (p. 234). Hachette Littératures.
Freud, S. (1955). Lines of advance in psychoanalytic psychotherapy. In J. Strachey (Ed. And Trans.), Standard edition (Vol. 17, pp. 157-168). Hogarth Press. (Original work published 1919)
Friedjung, J. K. (1924). A dream of a child of six. International Journal of Psychoanalysis, 5, 362-363.
Friedjung, J. K. (1937). Report on the First International Congress of Child Psychiatry, Paris, France, July 24 to Aug. 1, 1937. Archives of Neurology and Psychiatry, 37(5), 1171.
Goldstein, J., Freud, A., & Solnit, A. (1980). Before the best interests of the child. Burnett Books.
Hitschmann, E. (January 1927). [Document dated January 1927 from the Archiv des Psychoanalytischen Ambulatoriums Wien]. Archives of the Freud Museum.
Hoffer, W. (1932). Der ärztliche Berater. Zeitschrift für Psychoanalytische Pädagogik, VI, 496-504.
Maderthaner, W., & Musner, L. (2003). Outcast Vienna: The politics of transgression. International Labor and Working Class History, 64, 25-37.
Rabinbach, A. (1978). Politics and pedagogy: The Austrian social democratic youth movement 1931-32. Journal of Contemporary History, 13(2), 337–356. https://doi. org/10.1177/002200947801300209
Sterba, E. (1933). Die Angst habe ich liebe. Zeitschrift für Psychoanalytische Pädagogik, 7(2), 45-82.
Sterba, E. (1941). The school and child guidance. Psychoanalytic Quarterly, 10, 445-467.
Franco Basaglia (1924-1980) is definitely the Italian psychiatrist—of those no longer alive—who is best known to the Italians; he is one of the Italian psychiatrists best known in the world, together with Cesare Lombroso, Bruno Tanzi, Ugo Cerletti and Ugo Bini.1 Everyone—or almost everyone—in Italy knows that Basaglia inspired the “180 law,” approved in 1978, the law that abolished the lunatic asylums. In fact, the law is known as the “Basaglia law.” In Italy, he enjoys the same mythic status that Philippe Pinel still does in France: the enlightened doctor who freed the mentally ill from their shackles. When he was alive, however, his notoriety went way beyond the borders of Italy. In Spain and Latin American countries, he became the point of reference for anti-institutional psychiatry.
Despite this notoriety, however, his thoughts and the meaning of his practical actions—and those of his followers, still active and organized in the society Psichiatria Democratica (Democratic Psychiatry)—are usually widely misunderstood, even in Italy.
I was regularly in Franco Basaglia’s company over a couple of months as a student of
1. Tanzi is famous above all for his analysis of paranoia. Cerletti and Bini invented electroshock treatment in 1938.
psychology at University VII Paris in 1971, during my psychiatric internship at the Psychiatric Hospital of Trieste, of which he was already the director.
That year, I knew that Basaglia had come to Paris to hold a lecture, and I hastened to invite him to speak at the Italian Home at the Cité Universitaire, where I was in charge of the cultural programs. He came, and many people were there to listen to him. It was clear that Basaglia was well known in France; the French translation of his book L’istituzione negata (The Negated Institution) had made quite an impression in that country. The translator was somewhat embarrassed because Basaglia didn’t avoid the language of obscenity when he wanted to explain what he meant, even when he was quoting Nietzsche and Artaud.
At that time, I knew the Clinique de la Borde, near Blois, for psychotic patients. La Borde, directed by Jean Oury and enlivened by the work of Félix Guattari, was the sanctuary of “institutional psychotherapy”; everyone in France knew it as the paradigm of a different sort of psychiatry. I found La Borde an enchanting place, despite the human suffering that was lodged there. A castle enshrouded in the most beautiful wood, where horses bounded about. For Basaglia, however, La Borde
needed to be destroyed, precisely because it was an institution. His project was conceived as an absolutely anti-institutional one.
I took advantage of the occasion to ask Basaglia whether he could accept me for an internship at the psychiatric hospital in Trieste, of which he was the director for a short while. He introduced to me Michele Zanetti, President of the Province of Trieste. Zanetti had given him carte blanche in Trieste: he had the power to change the psychiatric system of the Trieste county completely. Without Zanetti, a right-leaning Christian Democrat, Basaglia couldn’t have been Basaglia. And it is a paradox that the “destruction”—as he put it—of the hospital in Trieste should have been possible thanks to the far-sightedness of a Christian Democrat politician. Zanetti agreed that I could come to Trieste.
I remained for a couple of months, in the spring of 1971, at the San Giovanni Hospital of Trieste (closed years later by Basaglia’s successor, Franco Rotelli). I participated intensely in the life of an institution that was still a traditional lunatic asylum, of the kind that no longer exists in Italy (I hope). Some wards were upsetting: the patients wandered around
like ghosts or larvae in their rough asylum uniforms, and, like zombies, they pounced, ravenous with curiosity and even with libidinousness, on those who, like me, came from Outside. The women in the wards for the most extreme cases had shaved heads or extremely short hair, as in the Nazi concentration camps. I was struck by a woman who was unable to speak, but seemed an agitated little animal, twirling around me to touch me: the head of ward told me that she was in this condition because a psychiatrist had had her lobotomized when she was four!
Although I too was dazzled by Basaglia’s growing fame, I already, at that time, did not attach myself to his school of thought. I had said to him clearly and bluntly that I was a supporter of psychoanalysis, and that I appreciated the institutional psychotherapy of La Borde. In his view, on the other hand, there was no sense in replacing psychiatric institutions with better institutions—more open, more democratic, less repressive: a curative institution was for him a contradiction in terms. And yet, even though I was not on his wavelength, I was impressed by the man. In particular, I appreciated his ability to enter into contact with the patients directly and competently. It was evident that he had excellent training in classic psychiatry: when ambiguous patients were admitted, in whose cases there was a doubt as to whether they were even, in fact, psychotics, it was usually Basaglia who gave the diagnosis, which would then be shown to be correct.
His director’s office was always open, and I took advantage of this to speak with him often. He had me participate in meetings in private houses, reserved for “conspirators”: that is, for those psychiatrists whom he had brought to Trieste precisely to dismantle the hospital. He spoke with scorn and irritation of some old psychiatrists at the hospital who tried to jump on the new bandwagon. He and his team lived for the hospital even when they weren’t physically there; they dined talking about the hospital, they went to the cinema thinking about the hospital…The day was punctuated by continuous meetings and consultations: with the patients, with the nurses, among the psychiatrists from specific wards, among the psychiatrists from the whole hospital. These assemblies were not so much in order to take decisions, I should say that they were decision. The work of those involved was massive because all or almost all felt themselves protagonists of a historic event, of an epochal transformation.
The first day, he said to me, “You will feel ill at ease here! Because here we don’t function in psychoanalytic mode.” Did I in fact feel bad or good? Let’s say that I was too busy experiencing and learning to realize that I felt ill at ease. In this way, I understood what Basaglians were aiming at.
Their intention, fundamentally ethico-political, took as its starting point a sort of basic philosophical assumption: to contest Technique in psychiatry. Even if they admitted that psychiatry had to have recourse to skills and techniques. This demonization of Technique, behind which was sketched a diffidence in confronting science in general, was derived from Basaglia’s exquisitely phenomenological culture. Husserl, Binswanger, Medard Boss, Minkowski, Szilasi, etc. were the horizon within which he thought of mental illness. Psychoanalysis too was excluded inasmuch as it was a technique. As a Basaglian proclaimed coram populo: “We reject all the technical system of psychiatry: from the miserable patient who rots away in the most fetid asylum to the beautiful, rich, blonde, blue-eyed young man who goes to a psychoanalyst three times a week.” Psychoanalysis is, for Basaglia and his followers, a practice for the well-off, but objectively it’s still a
…a true need of the patients was to have lavatory paper, not coated or pink lavatory paper; these would be “ideological needs,” not true needs. The desire for refined lavatory paper could indeed lead to intestinal disorders, he said: “even a diarrhoea can be ideological.”
technique. And yet, certain psychiatric techniques were used at Trieste. From which the dynamic contradiction of Basaglia’s doctrine follows: how can psychiatrists, people of technique, cure in a manner beyond Technique? One day, Basaglia said to me, “I am convinced that electroshock treatment works in many cases; for example, in serious melancholy. But we don’t use it here because of its violent and repressive connotations.” He took a dim view of the fact that even at La Borde, they used electroshock treatment. It was not the efficacy of electroconvulsive therapy that was in question, however, but its aura of violence. And yet, at Trieste they used many psychopharmaceutical drugs, which at the time were in their early stages of development, and so I cheekily asked him, “You are against all technique? But not against pharmaceutical technique.” He replied that psychopharmaceuticals were a help in overcoming the segregation of patients in asylums. And I riposted, “But perhaps psychotherapeutic techniques, including psychoanalysis, can help to overcome segregation in asylums.” I don’t remember what he replied. Today, I believe that
Basaglia accepted the use of pharmacological techniques (unlike the American psychiatrist Loren Mosher, who cured psychotics without any drugs) because they seemed to him mere tools, objects, whilst other “techniques,” such as psychoanalysis, were surrounded by “ideological” haloes, as he would have said. Psychoanalysis seemed to him to be incompatible with his work precisely because psychoanalysis wasn’t simply “a technique.” At Trieste, I realized how much the progressive elimination of psychiatric hospitals—and not only in Italy—owed something to the invention of psychopharmaceutical drugs that worked to some extent. Psychiatrists could avoid putting patients in straitjackets, or imprisoning them in padded cells, because a pill “restrains” the patients so much better than a straitjacket or a padded cell. The histories of psychopharmacology and of the deinstitutionalization of mental patients are indissolubly linked. The chemical asylum has replaced the physical asylum.
Some of the Basaglians at Trieste were charming and noteworthy people, and I became their friend. But some of them were Marxists of a rather priggish kind. During the years after 1968, a certain revolutionary schematism was de rigueur. One thing, however, was clear to them: theirs was not anti-psychiatry. Nor was there on their part any intention of inventing a “new psychiatry,” a new science; their action was purely anti-institutional in its aims. Often at Trieste, there arrived as visitors shoals of militants of the Revolution whose leitmotiv was ‘”Down with the old psychiatry! Here at Trieste is practiced the true science, the new psychiatry!” These were at once disowned and often openly derided by the Trieste team. Over the following years, I have been able to ascertain the extent to which Basaglia’s project, despite his great popularity even after his death, has been little understood, above all by so many of those who claim to admire him. For example, many believe that Basaglia was the promoter of a sociogenetic theory of mental illness, according to which, one might say, we emerge as mad because the society in which we live is sick. Basaglia never uttered these banalities; he knew that the mad had always existed, in every society and social class.
His fundamental idea is that we should respond to the true needs of the patients. But what were these true needs? At the time, French intellectuals on the left spoke always of desire—liberating desire, Deleuzian desiring machines. Italian intellectuals on the left, on the other hand, spoke always of needs, which seemed less ethereal than desires. Basaglia said to me once that a true need of the patients was to have lavatory paper, not coated or pink lavatory paper; these would be “ideological needs,” not true needs. The desire for refined lavatory paper could indeed lead
to intestinal disorders, he said: “even a diarrhoea can be ideological.” This affair of ideological diarrhea made quite an impression on me. After all, any neurotic symptom, for a Marxist phenomenologist such as he was, expresses an ideological need. But why should the need for basic lavatory paper be a true need? Why not use water, renouncing even lavatory paper? For Taoists and for the Greek Cynic philosophers, the need for any object would be inessential, “ideological.” Apart from the bowl, the only thing that they might use—but Diogenes the Cynic discarded even that. In short, from what moment onwards do manufactured goods satisfy a real need or create desires, that is, ideological needs? The dividing line between need, on the one hand—as a desire that it is legitimate to satisfy—and desires, on the other hand, is always, historically, in a state of flux. Today, high-tech comfort—mobile phones, cars, computer, internet, etc.—is the bowl that we can’t throw away. I am struck by the fact that today the youngest people around ask themselves how older people, even ten or twenty years ago, could stand to pass the summer without air conditioning. For them, air conditioning has become almost a primary need. (I do have to confess that it has always been that for me, too, even when I was young.)
Basaglia seemed a man devoured by the need to act, and he was certainly an irritable person. Even with me, he once became utterly furious because I had posed some objection or other to his strategy of deinstitutionalization of mental patients. His very ocular tics expressed his impatience, his haste. But at bottom, Basaglia was above all an extremely cultured intellectual, passionate about art, who had forced himself to become a great reformer. Paraphrasing Marx, it is as though one might say, “Until now the great phenomenological psychiatrists have described madness, the point today is to change it.”
The Basaglia law was the Italian trajectory of a process of freeing mental patients from the asylums, which set its mark upon the whole of the West from the seventies onwards. Backing community care, cures in the community. And every culture has had its vociferous advocates of this policy: Thomas Szasz in America, Ronald Laing and David Cooper in Great Britain, Félix Guattari in France…We have had Basaglia, one of the best.
I have always been a friend of Sergio Piro, a Neapolitan like me, known as the “Basaglia of the South” because he was Director of the Democratic Psychiatric Association in the Italian Mezzogiorno. Piro didn’t have certain ideological asperities—and asperities of personality—like Basaglia had. He was an elegant intellectual, passionate above all about linguistics, and he didn’t cast an anathema over psychoanalysis; psychoanalysts of
important standing came out of his school. His most important book is Il linguaggio schizofrenico (The Language of Schizophrenia) (Piro, 1967). I found him an extraordinary man. A short while before he died, in 2009, he told me that in his view the 180 reform had failed. It had been applied to the letter but had been profoundly betrayed in spirit. It was only in one place in Italy that the sense of the 180 had been passed on, he said, in a local health service at Pordenone directed by a Lacanian psychiatrist, Francesco Stoppa.
Paradoxically, Basaglia is famous for a reform that appears extremely simple: eliminating long-term psychiatric care, curing mental patients “in the territory” (“nel territorio”), as it was termed at the time. And yet the result of his action was the development of a highly sophisticated system of thought, which was hard to understand, not only for lots of psychiatrists, but also for lots of those who call themselves Basaglians. As I’ve said, his approach was in substance a critique of Technique in the name of what phenomenological philosophers call Lebenswelt, world-of-life.
The element in technique that horrifies the revolutionary phenomenologist—and in science, to the extent that it is a technique of knowledge—is its power of separation. Technique, essentially, is separation: in general, separation of the agent from the product of her or his action. Today, this denunciation of technique goes back at least to Plato; Socrates hates the idea of leaving books behind him precisely because the book survives its author, it is an inert, artificial product of a living subject. If one poses a question to a book, it doesn’t respond, Socrates said. What has been predicted, from Plato to Edmund Husserl and right up to certain post-modern authors (such as Gilles Deleuze), is seeing the advent of productions that don’t separate themselves from their producer or author. If today the world-of-life is thought of phenomenologically as tension, movement, dynamics, then technique becomes, on the contrary, the operation that divides, encapsulates in a stasis, and isolates an alienated product. Against poiesis, the production of things or institutions, phenomenologists exalt praxis, pure action as an end in itself, expressing the agent. In this way, the asylum is thought of by Basaglia either as the product of technique or as a machine (hence a technique) for separating. This separation is consumed at various levels: the asylum doesn’t just separate the patient from the living, integral social community, but also separates the inmates among themselves. It sharply separates the psychiatric doctor from the patients; within itself, the world of healers is hierarchically organized, and hierarchy is a form of separation.
The wards, moreover, are separated from each other. Basaglia interpreted the world of the hospital in a radical manner as the application of the form of technocratic life to that from which, insofar as we are vital and eccentric, we flee.
The practice of Basaglia’s team, however, was based on the promotion of a form of liberating agitation: “creating movement.” The wards were made to communicate amongst each other, and as part of this same project, the doors of the hospital were opened and a growing osmosis between hospital, surrounding area and city was encouraged. Spaces were opened: not only physical spaces, but also spaces of social initiative and of animation. Later, vociferous artists and theater people came to collaborate at Trieste, attracted by the popularity of the experiment. There followed from this the famous epoch of Marco Cavallo (Marco Horse), a walking statue, who symbolized liberation from the asylum. “Get people to circulate.” In short, the free circulation of the world-of-life as temporality and fluidity was set in opposition to the hospital of old. In fact, Basaglia denied that the institution of the hospital—or any institution—could have a history. The psychiatric hospital, as a product of psychiatry understood as science-technique, is estranging and expropriating—without a history. At the time, all the clocks of the San Giovanni hospital were stopped; not a single one was working. It was as though the institution was closing down astronomical time. It was a fixed feature of almost all the clocks in asylums at the time: they were stopped. For Basaglia, therefore, the psychiatric hospital was an institution that exemplified the technical universe: the patients, human flotsam, were the throng that society had separated from itself, set outside of itself, in a long repression of its own vital being and visual prospect (in Italian, it is vi(s)ta: life and view). The asylum was a product which that technical society refused to recognize as its own: a shameful by-product of a technoscientific society. But wasn’t this a way of getting that sociogenetic theory of madness that seemed to have been thrown out of the door to come back in by the window? Not really, because at bottom, Basaglia thought that the cause of madness was, precisely, Technique as separation from the world-of-life, and so a technique could not in its turn be a cure.
On the one hand, Basaglia denounced the psychiatric hospital and the old psychiatry as “non-curative.” At the time, he convinced the Italians that a patient in the asylums would definitely not get cured, but only deposited, kept under surveillance, and incarcerated (a claim that was substantially true). Today, most people interpret this
denunciation as meaning that Basaglia was proposing a real cure. But, as we have seen, on the other hand, he contested the various cures available, from shock therapy to interpersonal psychotherapy, as more or less camouflaged figures of Technique. And yet Basaglia thought that mental patients should be truly cured. Cured in the sense of care or of cure? If every cure is revealed as a technocratic Alienation, what care can be offered to those who are suffering? How can this contradiction be escaped?
Basaglia seemed to count on the fact that curing patients from the asylum—destroying in this way not only the asylum, but any institution that might have taken its place—would also be a cure for psychosis. But this certainly didn’t imply an absurd theory along the lines of “mental patients are made into mental patients by the asylum.” Basaglia obviously knew that people mainly become mad outside the asylum. But he thought that, precisely to the extent that he was renouncing every technique of cure (apart from psychopharmaceuticals), he would be able to arrive at the kernel of cure, that is, to cure the subject of that separation in which, at least in part, the illness consists. He thought, in short, that mental illnesses are double; on the one hand, there is the true illness—the origin and nature of which he was wary of articulating—and on the other hand, there is the “double” of this. The theme of the Double certainly came to him from Antonin Artaud, the psychotic poet. Basaglia, then, saw mental illness as, on the one hand, a product of the technical division of subjectivity, and on the other, the double that technique has made of madness itself. The madness that he was confronting was the double that technocratic society has made of it, segregating it not only physically in some hospital or other, but also scientifically—in some DSM, for example, today—separating it conceptually from the stream of life. For him, the priority was the cure of the double of the illness, before that of the illness itself.
We have said that plurality and fragmentation were for Basaglia the double. The double of that which for a revolutionary phenomenologist was lived reality, the experience of life as Erlebnis. The technocratic, duplicative separation of life from itself—which deprives of sense both life and the suffering that is part of life—produces something that we can only live as shit
Scatological metaphors proliferated in Basaglia’s discourse. For example, the inmates of the psychiatric hospital were referred to as social rubbish or excrement; his insult of preference was “shit.” In fact, technocratic knowledge-power, to the extent that it creates fragmented forms, inevitably excludes, rejects, and segregates something that therefore descends into an excremental real. Technoscience is continually summoned to manage that which
it has repressed, and so for that very reason produced, such as the psychiatric hospital.
But the point is: doesn’t every de-separating and de-technicalizing act in its turn, to the extent that it is “realized,” itself produce rejection effects? Doesn’t it tend to relapse into a state where it is itself double, an inert form? To rejoin full meaning—the flow of undivided life—is in fact always a prospect that is at best asymptotic: every act tends to halt at the threshold of real life. The Revolution is always somewhere beyond, afterwards, still to come, in other words, eschatological. In the present, at bottom, we have always and only to do with that shit of the double. We could say that outside the social scatology, there is only eschatology. This is the worm that gnaws at every phenomenological philosophy of life (even that of psychoanalysts seduced by phenomenology); you want to destroy the institutions, and they always reconstitute them-
the norm which ruled in China for a while, where the doctor was paid according to how healthy the people were; for every sick person, the salary was reduced. In short, real psychiatric work should have been preventative: a sort of ecological remediation to prevent madness.
selves spontaneously, as if life itself had an intrinsic predisposition to alienating itself, to fragmenting itself in separations, in depriving itself of vitality. And this is the case even if we are concerned with asylums: these tend diabolically to reconstitute themselves as soon as the enthusiasm and the libertarian fever of the liberators collapse. As we have seen in Italy in the last few decades, psychiatric clinics, for the most part private but affiliated to public institutions, are just swarming about, like sculptural solidifications of lava when it cools and no longer flows.
Basaglia and his followers hated the very idea of private psychiatry. All the private psychiatry clinics, above all those with a vast clientele and fat profits, were objects of total disdain; they called this “the madness industry.” But why was this profound ethical rejection not seen as valid for medical practice in general? Isn’t even a surgeon who performs eye operations on thousands of patients also an “industrialist of the cataract?” Every doctor really lives thanks to the ailments that beset people. Every therapist, even a humanitarian one, must live off the afflictions that
beset people. Every therapist, even a humanitarian one, must secretly hope in some way that many people will be ill, because otherwise how could he or she live? Basaglia and the Basaglians had taken this contradiction very seriously: for them, private medicine is implicitly immoral.
But then, how is it possible to prevent even the psychiatrist paid out of the public purse from becoming a person who lives off the suffering of others? Basaglia cited the norm which ruled in China for a while, where the doctor was paid according to how healthy the people were; for every sick person, the salary was reduced. In short, real psychiatric work should have been preventative: a sort of ecological remediation to prevent madness. But with what tools, what techniques? Basaglia really didn’t have a precise idea about his. His heirs, then, tried to find practical solutions.
In conclusion, can we say that Basaglianism is a feat of the past? That it was too much an expression of that epoch that we call ‘68, and that really lasted until the end of the 1970s and therefore included the 180 law? Must we interpret the Basaglian spirit with the same reservations with which we now interpret what I would call the 1968 way of thinking?
And yet, despite all the reservations that I haven’t tried to hide in this essay, I believe that Basaglia isn’t only a relic of our years of roaring activism, full of dreams and illusions. In fact, his challenge to the primacy of technique has a particular timeliness today: much more than in Basaglia’s epoch, psychiatric technique is now really triumphant. The consumption of psychopharmaceuticals has become a mass practice; psychiatric techniques are much more pervasive in contemporary life than they were at the time. Psychiatry has flowed into multiple capillaries, and almost all of us are “mentally disordered people.” The psychiatry of the DSM (Diagnostic and Statistical Manual of Mental Disorders) puts itself forward as a rigorous science of human ill-being, and the new neuroscientific techniques promise a technical solution to spiritual problems. Even if Basaglia’s rejection of science and technique is certainly not the reply, nonetheless, without doubt, there bubbles up, even if in other forms, a refusal, at the same time ethical and philosophical, to tolerate the growing pretensions of science to resolve our spiritual problems and sufferings through technical means. There is once more a need to reconsider—in ethical terms, before we think about it in scientific and technical terms—our relation to the suffering of our minds. z
Basaglia, F. (1968). L’istituzione negata [The Negated Institution]. Einaudi.
Piro, S. (1967). Il linguaggio schizofrenico [The language of schizophrenia]. Feltrinelli.
From the series 365 Days: A Catalogue of Tears, 2011 February 9, 2010
© Laurel Nakadate, Courtesy Leslie Tonkonow Artworks + Projects
Laurel Nakadate
From the series 365 Days: A Catalogue of Tears, 2011 January 1, 2010
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From the series 365 Days: A Catalogue of Tears, 2011 April 17, 2010
© Laurel Nakadate, Courtesy Leslie Tonkonow Artworks + Projects
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From the series 365 Days: A Catalogue of Tears, 2011 March 2, 2010
© Laurel Nakadate, Courtesy Leslie Tonkonow Artworks + Projects
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A Catalogue of Tears, 2011 May 11, 2010
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From the series 365 Days: A Catalogue of Tears, 2011 July 18, 2010
© Laurel Nakadate, Courtesy Leslie Tonkonow Artworks + Projects
Laurel Nakadate
From the series 365 Days: A Catalogue of Tears, 2011 June 14, 2010
© Laurel Nakadate, Courtesy Leslie Tonkonow Artworks + Projects
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Laurel Nakadate
From the series 365 Days: A Catalogue of Tears, 2011 August 27, 2010
© Laurel Nakadate, Courtesy Leslie Tonkonow Artworks + Projects
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From the series 365 Days: A Catalogue of Tears, 2011 September 23, 2010
© Laurel Nakadate, Courtesy Leslie Tonkonow Artworks + Projects
From the series 365 Days: A Catalogue of Tears, 2011 October 17, 2010
© Laurel Nakadate, Courtesy Leslie Tonkonow Artworks + Projects
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Carl Sandburg’s “Chicago” (1914) still sings, “so proud to be alive and coarse and strong and cunning,” but when it comes to care for the emotional well-being of its chorus, Chicago has historically turned its brawny back on those who carry the “terrible burden of destiny” on theirs. This neglect is not new, but has accelerated greatly over the past decades. Further, attention to disparities in the quantity of available treatment—for instance, the fact that Chicago’s former mayor, Rahm Emanuel, closed half of the city’s remaining community mental health centers with the sweep of a pen in 2012, or that the ratio of therapists to residents in wealthy neighborhoods is more than twenty times higher than that in low-income ones (Quinn, 2018)—has been accompanied by, and has often obscured, an interlocking issue regarding the quality of the therapeutic resources provided. Yet disparities in the quality of treatment should be equally obvious; those without means more often encounter longer wait times for—and little to no choice in—therapist assignment, intermittent sessions, frequent therapist turnover, and short-term, symptom-focused interventions provided by overworked, poorly-paid staff. In Chicago, psychotherapy is least available to those who need it most and least substantive, and although the same can likely be said of community services in all US cities, “in Chicago there’s been an intentional [emphasis added] disregard for investment in these areas” (Carrillo, 2018, as cited in Quinn, 2018).
Enter the game-changing Illinois Community Expanded Mental Health Services Act (https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=3300&ChapterID=34), which went into effect in Illinois in 2012, just as existing mental health centers were being shuttered. Essentially, the Act takes mental health funding out of the hands of city and state budgeteers and places it directly into those of each affected community itself, represented by an appointed panel of Commissioners that includes neighborhood residents and individuals with lived experience. No pen-sweeps, no closures, unless the residents themselves hold the pen. It authorizes areas of Chicago to vote by referendum to delineate and tax themselves at a rate of .4% of yearly property tax, amounting to an average of $16 per household annually, for purposes of creating services that reflect their needs, cultures, and values. Support for these referenda and the centers they underwrite, now four in all (with several others in the wings), has not been equivocal. In economic hard times, these referenda have demonstrated enthusiasm rarely seen regarding other issues; in the most recent, covering the Logan Square/Avondale/Hermosa areas of Chicago’s northwest side, “[a]bout
86 percent of voters in the three neighborhoods voted in favor of opening the clinic— and nearly 80 percent voted to raise property taxes to fund it” (Bloom, 2018). (Any concern that the clinics will erode justification for or a sense of urgency around maintaining and expanding existing public clinic systems has been misplaced; there is still a desperate need for more, and the mandate of the centers created under the Act allows for the treatment of those who wouldn’t necessarily be eligible to access services at other community mental health centers for lack of a diagnosis of what is often termed “serious mental illness.”)
The implications of the Act are many, potentially affecting not only the accessibility of mental health treatment, but the nature and quality of that treatment; look no further than the first of the centers to be approved and opened, the Kedzie Center, to appreciate the transformations in mental health service delivery that the Act makes possible. It likely came as a shock to some that a small group of psychoanalytically oriented private practitioners with shared roots in community mental health, Expanded Mental Health Services of Chicago, NFP (EMHS-NFP), was chosen by the first Governing Commission to run the inaugural center. EMHS-NFP viewed itself as David to an army of Goliaths that included established hospital and other mental health systems looking to expand existing services on the basis of a stable revenue stream of approximately half a million dollars a year. What made EMHSNFP stand apart was its immersion in the life of the community and an integrated vision of healing that extends fractally from individual to family to culture and community and back. If Frieda Fromm Reichman famously stated, “to heal one person is to heal the world,” EMHSNFP added a vice versa to create a full circle of potential intervention. This vision, we are excited to announce, recently gained EMHSNFP the stewardship of another of the Actauthorized clinics, the fourth in the city, name TBA, which will open its doors in August in an area adjacent to Kedzie’s.
While many still regard community psychoanalysis as an oxymoron and view intensive psychodynamic treatment as either too costly or—even more concerning—simply inappropriate for those who struggle with material needs and significant trauma histories, EMHSNFP embraces both in-depth treatment and the modifications that make it possible to implement in the most diverse and challenged communities. These modifications do not erode the integrity of psychodynamic intervention, but rather enhance it by appreciating the nexus of internal and social cultures, both articulated and unconscious, in a way that values both and positions each as an essential interpreter of the
other.1 Even further, they enable us to play a therapeutic role in fostering the well-being not only of the individual clients we treat, but of our community itself, as a hub for communal healing processes and active partnerships with schools, community centers and arts organizations. Our psychodynamic seminars and consultation for staff, efforts to address community problems through a psychoanalytic lens, and depth-oriented treatment provision “for as long as it takes” have been welcomed by all of our organizational partners, who value Kedzie precisely because of its distinctive perspective. In short, we concur with others who have found that psychoanalysis is not so fragile and rarified a method that its life-giving poetry cannot survive translation into the languages of communities in need.
Kedzie’s roots are as deep in community as they are in individual, family, and group psyches. Its offerings are hyper-local, the product of the sort of immersion that many clinicians experience in their analytic practices as they find their feet within the dream landscapes of their patients’ inner lives. The proposal for the centers was itself the product of an intermeshing of our clinical vision with prior efforts by two adjacent community organizing agencies, one of which, the Coalition to Save Our Mental Health Centers, had been exploring models for community ownership of treatment resources since its formation in 1991, fully half of 40 years spent wandering in a desert of failed attempts and broken promises until it finally gained the political traction that culminated in the passage of the Act in 2011. Along with the Coalition and the Saul Alinsky-inspired Institute for Community Empowerment, we were able to knock on a thousand doors and speak in some depth to hundreds of community members, coming to understand what need looks like from inside the bubbles of block and neighborhood as we worked to formulate our first proposal. Faith leaders, social service workers, teachers, elders, custodians, parents, principals, and physicians all had input that has, since Kedzie’s establishment, been further cultivated into an ongoing partnership.2
While Kedzie is referred to as a clinic, conjuring an image of a discrete building in physical space, its brick walls are remarkably
1. In this, we take inspiration from the landscapes and legacies of other articulations of psychoanalytic practice in community settings, including not only the innovations offered first by the Berlin Poliklinik and Vienna Ambulatorium, by SaintAlban and La Borde, but also the current iterations offered by 388 in Quebec, Greene Clinic, the Harlem Family Institute, and the New York Community Center for Psychoanalysis in New York, and a wealth of Bay Area treatment centers such as RAMS Inc. Access Institute, the West Coast Children’s Center, and Partnerships for Trauma Recovery.
2. The same efforts went into the development of our second proposal, for the about-to-be-opened clinic to serve the Logan Square/Avondale/Hermosa Chicago neighborhoods but was somewhat less immersive due to the restrictions against door-todoor interviews and on-site conversations during the pandemic.
elastic. During non-plague times, treatment can be as likely to take place off-site, where the trust is (and often where the trouble is) as it is to take place in our home base on Kedzie Avenue.3 We offer ongoing psychotherapy process groups for students in their schools, including one designated for DACA and undocumented students, who have felt particularly vulnerable given increasingly pervasive anti-immigration rhetoric as well as public charge concerns that in general have made service access for the undocumented and tenuously documented exponentially more frightening. Therapeutic services for parents often begin in more familiar and accessible school spaces as well, which can function as a bridge to clinic-based interventions, while older adults, who may have limited mobility and an even more acute sense of vulnerability, participate in their senior living facilities. Relationships are developed sometimes quite literally on the streets—at festivals, community events, and our annual holiday giveaway of 100 kids’ bikes, as well as at events that we 3. Sadly, some number of groups were disrupted during the height of the pandemic, and the emphasis turned temporarily to individual contact by phone and Zoom, some community and group Zoom services and events, support for out-of-school students and parents, and more intensive wellness-oriented interventions, including some financial support as well as more liaisons with other community agencies. Needless to say, our families were often hit harder than others in more affluent neighborhoods in the city and state, and our staff struggled to tolerate the reverberations of trauma on trauma.
host for the general public aimed at addressing threats to our neighborhoods. Our Acute Trauma Outreach Program extends our hand even further in an effort to facilitate respect and healing to families affected by gun violence, sexual trauma, and losses due to Covid. We recognize that it can sometimes take years before victims of violence, for instance, feel ready to access or re-access the parts of themselves that were shattered, but we work to adjust our tempo to theirs, meeting each person when and where we can, knowing we’re all in it for the long haul. Integral to a psychotherapeutic process that facilitates saying the unsayable, we feel an imperative to reach the unreachable, those at the margins, who may not ever in their lives have had the opportunity to explore their distress as a form of expression worthy of respect, or to audition alternative symptoms that might more effectively facilitate connection and growth.
We celebrate the first decade of the Expanded Mental Health Services Act and believe that it has the potential to facilitate transformation in the lives of thousands by making quality treatment possible. Yet we know that not every center authorized by the Act will opt to contract with depth therapy-oriented organizations or even community-oriented ones, despite the community support needed simply to get a referendum on
the ballot. And, of course, we walk the same delicate line that individual psychoanalytically oriented practitioners do, committed to constant self-examination lest our belief in a perspective that holds listening and a sensitivity to the particularities of internal and cultural meaning at its core itself become a universalist, prescriptive orthodoxy. What we can say at this point is that we at EMHS-NFP have had the privilege of witnessing the coming into being of a clinic that strives towards life and are the better for it. Further, we have seen the power of a psychodynamic vision to reach communities and individuals whose roots are seemingly far from those of psychoanalysis, and to watch how that distance is bridged through stories of pain and grief, healing and hope. We await Kedzie’s “sibling” with optimism and anticipation, eager to participate in the transformations of a second community “under [whose] wrist is the pulse, and under [whose] ribs the heart of the people” (Sandburg, 1914). z
Bloom, M. (2018, November 7). NW side is getting a community-funded mental health clinic thanks to overwhelming support of voters. Block Club Chicago. https://blockclubchicago.org/2018/11/07/nw-side-is-getting-a-community-funded-mental-health-clinic-thanks-to-overwhelmingsupport-of-voters/
Quinn, M. (2018, September 27). This is what happens when a city shuts down mental health clinics. Governing. https://www.governing.com/archive/gov-chicago-mental-health.html
Sandburg, C. (1914). Chicago. Poetry, 3(6).
ECHEGOYÉNIn analytic practice, we are taught and trained to maintain a therapeutic frame and analytic identity, both of which can impede and interfere with engagement in community settings. This paper will explore ways in which we can adjust our analytic stance on a collective level in the service of community. In community psychoanalysis, the ability to be flexible, humble, and adaptive to the community environment is a call to action to shift the frame.
“Community psychoanalysis” is psychoanalysis outside the consultation room providing interventions to a group, agency, school, or organization. It is also a “way of working” that opens possibilities for connection and sustaining care for the most vulnerable populations, specifically the impoverished, the elderly, children, marginalized groups, and the mentally ill. In addition to that, it is a mode of intervention that is applied to the community at large, for example with police, hospitals, schools, or an intervention to a traumatic incident in a community.
What does it take to shift the paradigm to work beyond the consultation room? I have tried to explain this concept to many of my colleagues, and they are still befuddled by what exactly community psychoanalysis is and who
exactly it serves. Is it psychoanalysis in marginalized communities? Yes. Is it at community mental health clinics? Yes. Is it interventions for hard-to-reach populations? Yes, it is all of these scenarios, but it is also the community at large—for example, providing a community intervention at a macro level to train police.
We can turn to Stuart Twemlow, who has written extensively on this subject and is known for his work with anti-bullying at a school: “A community analyst is required to exercise flexibility in technique and personal humility when embracing an analytic identity derived from a mode of action” (Twemlow, 2013). I discovered Dr. Mark Borg (2005), who uses an interpersonal perspective focused on transference/countertransference at an institutional level in his work with gang violence in Los Angeles. There are many more examples of analysts who contribute to scholarship and practice in the public sector. I encourage you to check out contributions by Ghislaine Boulanger, Patricia Gherovici, Ruth Lijtmaer, Ricardo Ainslie, George Bermúdez, and Judith Alpert. There are so many more to mention, but these analysts stand out as models of shifting our positionality.
I will be referring to “community” often and want to clarify that this is not just about working at a clinic in a low-income neighborhood. When I refer to community, I’m referring to any group of people that are part of a vulnerable group. My assertion is that community refers to populations that are hard to reach or are at risk of falling victim to gaps in care.
What is it that I mean by a frame? As we all come to practice, we adapt to different “frames” that are useful as containers (among other utilities) in a therapeutic dyad. As analysts, we shape our own frame that fits our theoretical persuasion, comfort level, countertransference/transference considerations, and practical considerations in the effort to hold and contain the treatment. In their co-edited book, Isaac Tylim and Adrienne Harris skillfully curated varied perspectives in Reconsidering the Moveable Frame in Psychoanalysis (2018), which is a compilation of theoretical orientations, explorations of the impact of social forces on the frame, challenges of flexibility of the frame, and varied experiences of creative uses of the frame in analytic treatment.
The frame acts as a boundary to hold patients who require mastery of a developmental task and are working through attachment
issues and other psychological concerns. As we all know, components of the frame include payments for sessions, frequency, vacation, the setting, the contract or agreement to provide care to our patients, and external elements of the setting. In this past year, we have all adjusted our frame due to Covid.
As we all know and experience in our training, the frame is aligned with our analytic stance, whatever that might be. An example: A patient frequently misses their session. Depending on your orientation or analytic stance, you may or may not reschedule the patient. You may or may not charge them the fee, schedule a make-up session, etc. Whatever your alliance, a boundaried analytic stance will not translate well in a community setting. Collective interventions require spontaneity and flexibility that do not work in tandem with the fixed “analytic frame” that we often incorporate into our private practices.
When the concept of the frame is utilized in a systems model, such as a social service agency, mental health clinic, or school, the frame is challenged by the competing forces of Medicaid regulations imposed on the institution of the clinic and the needs of the client.
In my experience in community mental health settings, we were often challenged by frame issues such as patients arriving late to their sessions and missing their sessions at a high frequency, which led to discharging their cases preemptively before we could analyze what was transpiring clinically with them.
In a community setting, patients’ lives are mired by multiple socio-political, socio-cultural, and socio-economic factors that set them up for failure when it comes to a rigid frame. Oftentimes, at the clinics where I’ve worked, I had patients on my caseload who would be pathologized as “chaotic” patients due to their poor attendance and the pathologization of their life circumstances. This can manifest in the therapist being withholding, which can be interpreted by the patient as the therapist being dismissive, and therefore the patient is unseen, unheard, and invalidated.
When we are working with hard-to-reach populations, this mode of therapeutic action of holding the frame perpetuates whiteness in a clinic or community setting. By whiteness, I am specifically referring to white supremacist ideologies that subjugate the most vulnerable to remain in power. By whiteness, I’m speaking to the rigidity of clinicians who are unable to adapt to a person’s suffering due to maintaining a position of power in the clinical situation. The burden of systems shutting them out of society (their Medicaid case was closed; they were getting evicted from public housing; they do not have bus fare to get to the clinic) would spill into the treatment room. These are all examples of whiteness and white supremacy.
On a macro level, more specifically at an institutional level, there was an understanding and explicit statements made by the directors of
the clinic that we were dependent on government contracts, and any misstep could close our doors. Thus, community mental health clinics that rely on government funding via Medicaid/ Medicare contracts and program-specific grants are subjugated to systemic oppression that limits how the clinic can deliver services. These contracts come with stipulations and regulations that limit what we can and cannot do for our patients in need. We are confronted constantly with the threat of our clinic closing its doors if we do not “follow the rules.” I recall feeling anxious when the buzz circulated through the clinic that the auditors were here. Many of us at the clinic would scurry back to our offices to make sure our documentation was compliant. While I understand this might not be any different than being in private practice and following the rules of billing services for insurance reimbursement, the hovering threat of being audited at a moment’s notice colored and informed some of the ways we would manage patients who had difficulty keeping appointments.
The clinic where I worked in East Harlem staffed close to 30 clinicians. The patients we served were predominantly long-time residents in East Harlem, most of whom lived in one of the twenty-four public housing buildings in the area. The individuals and families we served were caught in a cycle of intergenerational trauma perpetuated by social and economic oppression. I admired many of my patients who could really stretch a dollar and navigated systems to keep their families fed, clothed, and schooled.
While our clinical approach was psychoanalytic, it was incumbent on us to follow the rules, and we were subjected to frequent audits that threatened our existence as a clinic. I was trained at the clinic to be curious and to understand a patient’s inability to keep their appointments consistently. We were taught to be curious about what might be transpiring analytically. However, this stance started to change under the pressure of New York state restructuring their Medicaid regulations in 2010, when the frame became even more rigid. At the time, I was in analytic training and adopting an interpersonal stance informed by Ferenzci—he coined the phrase “elasticity of technique,” noting that the analyst, “like an elastic band, must yield to the patient’s pull, but without ceasing to pull in his own direction, so long as one position or the other has not been conclusively demonstrated to be untenable” (Ferenczi, 1928, p.95, as cited in Bokanowski, 2018, p.49).
Tony Bass expands this idea in his paper “When the Frame Does Not Fit the Picture”: So while the concept of a frame signifies something that is, by its very nature limiting structure, the work of analysis requires that the structuring function of the frame be capable of constant recalibration in response to the needs of the clinical process. The function
of the frame thus appears paradoxical: it delimits and proscribes what can and should happen in the clinical situation, while at the same time facilitating disruption and change in the organization of psychical life. (Bass, 2018)
At the clinic, most if not all of us were seeing patients who were coming twice a week to treatment for several years. One of the changes in the restructuring is that the more you saw the patient, the less Medicaid would pay the clinic per visit over time, yielding a lower reimbursement rate. Thus, as a clinic, all of the clinicians were tasked with restructuring our treatments by reducing frequency with patients who had been seeing us for some time. The shift in this regard influenced our frame even further due to the pressures of a larger system of Medicaid regulations.
All of this said, I’d like to share two vignettes of how I shifted the frame at a community mental health clinic.
An elderly patient of mine was having difficulty keeping her appointments with the psychiatrist. She was being threatened with her case being closed. This patient had difficulty with ambulation and walked with a walker for five long blocks from her home to the clinic. Due to her multiple health ailments and difficulty with appointments, I was able to visit her in the home. Unfortunately, our psychiatrist did not have this flexibility, as his schedule was booked by 15-minute increments throughout the day. One day, she was going to miss her appointment with the psychiatrist. Any time there was a no-show to a psychiatric appointment, it threatened the livelihood of the clinic; we were constantly reminded of this. I ended up sending a car to pick her up to ensure she could keep her appointment.
Another patient who suffered from severe agoraphobia and panic attacks would miss her appointments regularly due to her symptoms and lack of childcare. Due to the institutional pressure of generating revenue, maintaining a caseload of people who showed up regularly was a challenge, specifically with patients with debilitating symptoms. Clinical staff were charged with making sure most of our patients kept their appointments. For those of us who work analytically, the frame often induces heightened symptoms, anxiety, acting out, and enactments. She canceled often and sometimes no-showed; thus, her case was under threat of
closure. While it might have been helpful to analyze “resistance”—assuming that is what was operating—it seemed more urgent to me to meet her where she was at.
We all expect that our patients will experience some discomfort with the frame (our office, the time, the fee, etc.). In community work, we can also zoom out and consider the real-life circumstances and symptoms that don’t match well with specific interventions. With the frame, my patient could barely make it to sessions. She was not getting any better, and her case was about to be closed. Forcing her to come felt sadistic, unempathic, and imposed a specific way of working that did not consider her unique situation. I knew that I had to think outside the box. Initially, we tried to understand what might be happening unconsciously, and while that might have been interesting, lack of childcare and debilitating symptoms were prioritized to engage her in treatment. Over time, her mother was able to babysit. However, my patient’s agoraphobia became worse, and she started to miss her appointments again. If we can think of the frame as mutable, we are not exactly abandoning the analytic frame. Rather, we are adjusting it to fit the needs of the patient. Given that we think of the frame in a very particular way, perhaps the symptoms would not get any better because the analyst cannot adjust the frame to meet the patient. Perhaps the analyst does not want to leave the office. The analyst does not want to adopt creative ways to meet the patient wherever they are emotionally and/or physically. This is extremely important in doing community work, where flexibility is key.
When this patient could not leave her apartment, I considered ways in which she had been coming regularly and was motivated to change. I also considered how difficult it is to treat a patient with agoraphobia—regardless of a clinician’s theoretical orientation, patients are expected to show up at the clinic. I imagined myself in her shoes, not being able to get help because I could not leave the house. We started to have phone calls to practice grounding techniques—she had longstanding anxiety since she was a child, and daily panic attacks at the thought of leaving home. After receiving approval from the clinic director, we agreed on a plan: I would pick her up at her apartment and walk her to the clinic, where we would have our session. Her mother would pick her up at the clinic when her session was over. The success story in this is that she ended up going back to school by starting remote classes. She was able to identify alternative ways to live a productive life.
In my view, our analytic frame needs to be adjusted and or altered to meet the patient where they are. This concept is drilled into us in graduate school: meet your clients where they are. Yet in practice, we do not always do that, as we associate the analytic frame to
physical locations, the time, institutions, clinics, etc. Dr. Bass offers:
For the most part, frame recalibrations take place pre-consciously, or sub-symbolically, at the level of micro-adjustments in the analyst’s psycho-physical presence and active technique. Active technique (or what I will describe as the inductive dimension of technique) is the part of our technique that is performative rather than receptive or interpretive: it is the aspect of our clinical activity that is embodied in the actuality of our presence (in contrast to what we may represent in the transference, the dream, in a phantasy, and so on). These elements of the analyst’s actuality and presence—the way we speak, move, react—have a formative role in the ongoing configuration of the frame, become part of the living body of the frame, before our presence is captured in the web of representation and transferential objectification. Bass, 2018, p.105)
While many community mental health clinics aim to serve those who are marginalized, are on public health insurance, and have lives mired by chaos, navigating oppressive systems of care, the institutional nature of a clinic coupled with the inflexibility of a clinical stance can only exacerbate systemic racism and oppression.
As Twemlow and others in this discourse of community psychoanalysis all emphasize, humility and flexibility are key, whether we are working in a community mental health setting or with a hospital to respond to health care worker fatigue. The circumstances in community work are largely unpredictable and require our flexibility to shift and pivot to meet the needs of those we are serving.
If you are to embark on meeting the need for community psychoanalysis, my call to you is a call to action: the frame is not simply an extension of your theoretical orientation; rather, you are the frame. As Dr. Bass and others suggest, the frame is moveable and adjustable, as the frame is established as a “particular kind of contact at the level of shared experience” (Bass, 2018, p.104). In essence, the clinician, analyst, social worker, psychologist is the frame as a dynamic participant who recalibrates the frame to meet the needs of the patient.
The challenge for us today, as enthusiasm for community psychoanalysis grows: how do we, as analysts who are wedded to our analytic stance, pivot? The answer is to pause, look at ourselves, and interrogate our own positionality and intention to provide clinical work in communities.
In sharing my experience, I’m challenging community psychoanalysis to abandon the traditional frame in service of our communities.
What does this look like? Some of you in private practice probably already make modifications to your frame to hold your patients. In “Catch Them Before They Fall,” Christopher Bollas (2013) describes how his frame is expanded in response to his patients on the verge of decompensation. Without charging more, he increases the frequency of visits and coordinates care via their primary care physician and referrals to psychiatrists. We are the frame that holds an analytic lens and abandons the frames that are systemically perpetuating oppression with the communities that we aim to serve.
As I continue to explore the discourse on frame issues and how our analytic identities inform our work, more questions come to the surface for me: How can we be more intentional in the clinic and take into consideration socio-cultural, socio-political, and socio-economic factors? What cultural and language considerations should we pursue in order to address stigmatization amongst Latinos seeking therapy? How can we be creative and really meet patients and communities where they are in an authentic way that validates their existence?
I hope this paper will motivate us to shift our alliance with our analytic frame (whatever that is for you), which is informed by Euro-centric/white supremacist ideals that foreclose opportunities to engage authentically with people.
If you and your institute, agency, or organization are planning to embark on this endeavor in community psychoanalysis, stretch the frame. Unpack your analytic identity. Abandon the traditional frame in the service of community and move it around instead to meet their needs. Be creative and collaborate with the communities you aim to serve. Use your imagination, exercise collaboration, model mutuality, welcome recognition, embrace humility, and be flexible. Above all else, be much more human than otherwise. z
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Bermúdez, G. (2019). Community psychoanalysis: A contribution to an emerging paradigm. Psychoanalytic Inquiry, 39(5), 297-304.
Bokanowski, T. (2018). The modernity of Sandor Ferenczi: His historical and contemporary importance to psychoanalysis. Routledge.
Bollas, C. (2013). Catch them before they fall: The psychoanalysis of breakdown. Routledge.
Borg, M. B., Jr. (2005). Community analysis: A case study examining transference and countertransference in community intervention. International Forum of Psychoanalysis, 14(1), 5-15.
Christian, C., & Gherovici, P. (Eds.). (2018). Psychoanalysis in the barrios: Race, class and the unconscious. Routledge.
Ferenczi, S. (1928). The elasticity of psychoanalytic technique. In Final contributions to the problems and methods of psychoanalysis (pp.77-86). Hogarth Press.
Twemlow, S. W. (2013). Broadening the vision: A case for community-based psychoanalysis in the context of usual practice. Journal of the American Psychoanalytic Association, 61(4), 663-690.
Tylim, I., & Harris, A. (Eds.). (2018). Reconsidering the moveable frame in psychoanalysis: Its function and structure in contemporary psychoanalytic theory. Routledge.
[D]emocratic work requires the creation and activation of potential spaces in which inclusive, dialogic encounters across entrenched lines of difference might take place. The inclusiveness of these processes not only fulfills democratic norms of respect but is a psychological necessity. …interaction and cooperation across lines of discord are less occasions for social unity or political consensus and more opportunities for individuals and groups to mirror viable otherness and solicit a viable rearrangement of spaces that have caused and continue to perpetuate patterns of misrecognition.
(McIvor, 2016, p.121)
If at first the idea is not absurd, then there is no hope for it.
Albert EinsteinMy core thesis, threading through several publications (Bermúdez, 2018, 2019; Bermúdez & Kramer, 2016) is that if contemporary psychoanalysis aspires to contribute to addressing our socio-political and ecological challenges, we must develop an enlarged repertoire of theory and practice. My project aligns with the distinguished Harvard Law School Professor, Lawrence Lessig (Lessig, 2019), who has eloquently and creatively argued that repairing our dysfunctional democratic project is the “first problem” that must be fixed if there is to be any hope in effectively addressing all the other problems. I’ve developed the conviction that unless we co-create democratic processes and structures that authentically facilitate a citizenship that is engaged, informed, imaginatively deliberating together about the existential challenges we face, and having a meaningful impact on political decision-making, we will remain stuck in systemic dysfunction. However, I do believe that psychoanalysis has, over the course of its long history and multiple streams, generated both theory and practice that hold great promise for a socio-political contribution (Danto, 2005). In the next sections, I will outline some pieces of an emergent socio-centric psychoanalysis and suggest an emergent path forward.
In the words of psychoanalyst Francisco Gonzalez (2016), who advocates as I do for a new, more expansive and inclusive paradigm, a “community psychoanalysis”: “The established order has been wracked by tectonic forces—globalization, convulsive
capitalism, climate change, unprecedented migrations, technological accelerations.” In a keynote speech (2019, Division of Psychoanalysis Conference, American Psychological Association), Dr. Gonzalez expanded his vision and articulated a call, in response to our global crises (moral, socio-political, and environmental), for social justice, advocacy, and community building, which would mean a radically transformative socio-centric turn and application of psychoanalytic principles.
The community psychoanalysis paradigm proposes a path toward the dismantling of disciplinary and communal walls. Can it be the future of psychoanalysis, as Twemlow and Parens (2006) rhetorically inquired in their seminal article? I suggest that the paradigm may be the integrative path forward with which psychoanalysis can contribute robustly to multidisciplinary strategies to addressing the multivalent “wicked problems” (Kreuter et al., 2004), which are challenging our regional, national, and global communities.
Wicked problems have no definitive formulation: these are problems that, in a seemingly infinite regress, are symptoms of other problems; problems that involve multiple stakeholders, who like the proverbial blind men and the elephant have divergent and often incommensurable perceptions of the problem and its causes; problems that generate attempted solutions, which in turn generate unintended consequences and new problems; problems with no objective right or wrong, requiring reliance on human judgment, subjectivity, and collective wisdom.
I propose in this paper something—a conceptualization and a potential practice— that seems to me both obvious and radical; it seems obvious to my sensibility as a community psychoanalyst but radical as an American citizen who remains psychologically influenced by the normative “psycho-phobia” (Bollas, 2018) and cynicism of our culture. I’m afraid that these ideas may be judged too idealistic, naïve, and even preposterous. Like a novelist who discovers that his or her characters have taken on a life of their own, with the narrative evolving in unimagined and incomprehensible directions, I have discovered that my theoretical and practice interests are emerging, converging, and concretizing in previously unimagined directions.
I suggest a path that borrows from and integrates several disciplinary streams. Integrating elements from the social dreaming matrix (Lawrence, 2000, 2003; Manley, 2014) and its application to “reflective
George BERMÚDEZcitizenship” (Mojovic, 2020); from community psychoanalysis (Gonzalez & Peltz, 2021; Twemlow et al., 2005; Twemlow & Parens, 2006); from “whole systems change interventions” (Bermúdez, 2019; Owen, 1997; Weisbord & Janoff, 1995); and, finally, the political science literature and experiments with “deliberative democracy” (Dryzek, 2010; Fishkin, 2018; Fishkin et al., 2021; Mansbridge & Parkinson, 2012). I believe that the social dreaming matrix, which provides access to the “social unconscious” (Hopper, 1996; Weinberg & Hopper, 2011) and “unconscious citizenship” (Fromm, 2017), as well as potential containment (Bermúdez, 2018; Bion, 1961) and healing of culturally imposed trauma (Holmes, 2016), should be at the heart of our search for solutions to our multi-valent wicked problems, which include our climate crisis. However, as Lessig (2019) avers, restoring democratic processes is the first problem— because it is the foundation for solving all of our multi-valent problems. I believe social dreaming and community psychoanalysis have enormous potential to contribute to the development of deliberative democracy, a process of civic engagement that promotes authentic democracy, facilitates generative and inclusive solutions, and reduces socio-political polarization (Fishkin et al., 2021).
Although not a cure-all for the multiplicity of challenges inherent in democratic governance, many political theorists argue that developing deliberative principles and practices can revitalize our democracy by engaging and informing citizens. Despite the often-heard cynical, anti-political attitudes, citizens yearn for more influence. In the words of one distinguished political scientist:
Everyone I meet believes in the need for some kind of political system, but they have grown frustrated or despondent with the existing model. They are, therefore, not “anti-political” but actually “pro-a-differentform-of-politics”. They want to “do” politics differently. deliberative processes will not deliver eas y or painfree solutions to complex social or political challenges for the simple reason that easy or pain-free solutions do not exist. And yet injecting the people’s
verdict through planned and adequately resourced deliberative mechanisms will undoubtedly strengthen the decision-making process in terms of legitimacy and may produce fresh and innovative ideas. (Flinders, as cited in Chwalisz, 2017, p.xi).
Focus on deliberative democracy surfaced in the 1980s among political scientists and political philosophers (Bessette, 1980; Dahl, 1982, 1989; Mansbridge, 1980). From those early beginnings, deliberative democracy developed in three stages (Mansbridge & Parkinson, 2012): at first, the ideal principles of deliberative democracy were outlined; this was followed by extensive experimentation in a variety of settings and countries (Chwalisz, 2017); finally, a third stage focused on addressing the challenges of self-interest and power in national and international politics (Barvosa, 2018; Dryzek & Stevenson, 2011; Mansbridge & Parkinson, 2012). Although there are a variety of models, the prototypical deliberative democracy process involves the following steps:
1. A large, randomly selected representative sample (300-400) of the population is invited to deliberate on a specific issue. The group will include all demographic identities and political affiliations to represent a broad spectrum of perspectives. The goal is to have a truly representative microcosm of all social viewpoints on an issue.
2.Participants are provided balanced background information and the pros and cons on an issue.
3.The large group is sub-divided into smaller groups of 15. These small group deliberations are facilitated with an eye toward balanced participation, with no domination allowed based on gender, educational, or economic status. The process of deliberation occurs over a substantial period of months, sometimes years.
4.There are plenary sessions in which the mini-assembly addresses questions (written and spoken) to a balanced panel of competing experts.
5.The final decisions (the “considered judgments”) provided by the participants are recorded in a “confidential” questionnaire.
Deliberative democracy has been facilitated in 27 countries, including China,
Bulgaria, Mongolia, Hungary, Britain, the United States, and the entire European Union. The most recent example facilitated in the United States with a large representative sample of Americans (“America in One Room”; Fishkin et al., 2021) demonstrated that the deliberative democracy process reduces political polarization! There are a variety of deliberation approaches; some offer advisement to legislators, some provide binding decisions for legislatures, and other models place more emphasis on the consensual development and execution of collaborative action (Nabatchi et al., 2012). I will discuss later in the paper a widely used and effective example of the last collaborative action approach, “Future Search” (Weisbord & Janoff, 1995).
I am suggesting that the principles and practices of deliberative citizenship and democracy, in dialogue with the social unconscious (Hopper, 1996; Weinberg & Hopper, 2011), seem to have great promise in addressing our core first problem (Lessig, 2019)— the co-creation of authentic democracy.
A potential partner in the construction of a psychoanalytically informed deliberative democracy process is the emergence in American psychoanalysis of community psychoanalysis, which proposes to partner with other disciplines and communities to promote ethical, engaged citizenship; integral leadership; and communal deliberation. In an article in the journal Psychoanalytic Inquiry (Bermúdez, 2019), I summarized the work of Stuart Twemlow (2018) and his collaborators (Rudden & Twemlow, 2013; Twemlow & Parens, 2006), who originated the contemporary community psychoanalysis paradigm, and I go on to suggest the expansion of that paradigm by the integration of three potentially generative models for communal psychoanalytic practice: the social dreaming matrix, open space dialogues, and Future Search/Discovery. The article also outlines implications for psychoanalytic institutes’ organizational structure, dynamics, and the democratic co-creation of future psychoanalytic training. In this last regard, I’m inspired by Kohut’s concepts of the “group self” and his suggestion (Kohut, 1976) that psychoanalysts could contribute to understanding and resolution of larger social and political challenges by studying the group and socio-political dynamics of psychoanalysis itself.
Introduction to Social Dreaming: A brief History and Description [D]ream-life matters—it matters both for the individual and for our shared political lives. These uncanny mental events are vehicles for
otherwise unthinkable thoughts and a wellspring for the freedom of speech. Dreaming is an indispensable species of psychological work that can help transfigure the force of a harsh reality. disclosing these events can become a political exercise that carries great force. In our own dark times, attending to this alternative form of thinking may just help us live through, resist, and ultimately transfigure our shared social and political landscapes …(Sliwinski, 2017)
Gordon Lawrence (Lawrence & Daniel, 1982), unhappy with the intrapsychic approach of Kleinian psychoanalysis, devised a dream group process composed of a group of participants who shared dreams and associations to those dreams, relying on the working hypothesis that the shared dreams reflected an unconscious cultural product, a social unconscious (Hopper, 1996; Hopper & Weinberg, 2017) comprised of dissociated social, political, and cultural experiences. In developing the radical paradigm of social dreaming and the social dreaming matrix (SDM), Lawrence (2003) was deeply influenced by Charlotte Beradt’s (1968) The Third Reich of Dreams In her book, Beradt, a German journalist, recounts the dreams of ordinary German citizens she had collected during the period from 1933 to 1939—dreams reflecting their intuitive, dissociated, unconscious knowledge and foreknowledge of the Nazi regime’s intentions and the early unconscious traumatizing of the German psyche (Manley, 2014)].
There are several principles that guide the SDM:
l the dreams generated in the intersubjective field of the SDM are metaphors for unconscious, disavowed, dissociated cultural and community experience—the unconscious of the group self, a concept proposed by Kohut (1976);
l the dreams in SDM are the shared property of the dreaming community; focus must be on the dream, not the dreamer, which facilitates development of a safe mental space;
l ascertaining dream meaning collectively should be approached with the attitude of developing working hypotheses about the unfolding social unconscious being expressed in the matrix through dreams and associations;
l the social dreaming matrix and reflection engages with the “generative unconscious” (Lawrence, 2007; Newirth, 2003), promoting new ideas and thinking at individual, organizational, and community levels.
Social Dreaming as a Path to an Enhanced and Proactive Social and Moral Imagination Freud (1930/1961), in his essay “Civilization and its Discontents,” seems to be expressing a sense of futility at being able to respond therapeutically to “culturally imposed trauma” (Holmes, 2016):
No matter how much we may shrink with horror from certain situations…of a victim of the Holy Inquisition, of a Jew awaiting a pogrom—it is nevertheless impossible for us to feel our way into such people … Moreover, in the most extreme possibility of suffering, special mental protective devices are brought into operation. It seems to me unprofitable to pursue this aspect of the problem any further. (Freud, 1930/1961, p.89)
I suggest social dreaming may provide the requisite collective response to social trauma. It serves a collective witnessing and sense-making function that is a group version of Bion’s “alpha function” and containment. In a previous publication (Bermúdez, 2018), I articulated the following:
[S]ocial dreaming is an emancipatory practice, representing a socially engaged group approach. Its practice is a form of social and “moral witnessing” (Boulanger, 2012; Margalit, 2002; Ullman, 2006, 2011), urging all dreamers and SDM participants to provide testimony to collectively and collusively dissociated human suffering and inviting participants to an “active commitment to social justice and human rights” (Boulanger, 2012). Stern (2012) has suggested that an internal witness is necessary for the mind to distinguish between past trauma and present reality; my view, influenced by Bion (1961), is that more than one mind is needed as witness to process “culturally imposed trauma” (Holmes, 2016). (Bermúdez, 2018)
Furthermore, I have proposed that social dreaming can be and should be included in the repertoire of community psychoanalysis (Bermúdez, 2019), applied to processing our eco-anxiety and discovering collective solutions to our climate crisis (Bermúdez, 2021), and becoming a generative contributor to the process of democratic deliberation. There is a tradition of political scientists applying insights from psychoanalysis into political theory and practice (McAfee, 2019; McIvor, 2016). For example, Glad (1969), in a review of Charlotte Beradt’s The Third Reich of Dreams (1968), suggested that “.…
the work provides some very significant data for the political scientist. …further insight may be developed into the very central and too often ignored unconscious processes which tie rulers to rules in a variety of political circumstances” (p.546).
Social dreaming may serve in a national mourning process, as outlined by political scientist David McIvor (2016), who applies Klein’s developmental theory to our politics. McIvor suggests that the nation remains mired in a paranoid-schizoid position— unable to proceed to the depressive position. McIvor’s conception of a nation in need of mourning inspired me to propose a social dreaming matrix focused on “Revolutionary Mourning,” which may provide a pathway to collective mourning. Many of our contemporary political conflicts can be viewed as social groups contending for recognition of their historical traumas and losses, which have not been fully mourned.
The inclusion of reflection and dialogue in relationship to the social unconscious may provide access to the range of unconscious emotions organizing conscious reactions to the issues as well as generating new ideas and empathic understanding, as suggested by Hannon (2019).
Toward Deliberative Democracy: Social Dreaming and Reflective Citizenship
Dr. Marina Mojovic, a Serbian psychiatrist and group analyst, has pioneered a large group dialogue focused on unconscious citizenship (Fromm, 2017; Mojovic, 2020). The social dreaming matrix plays a central role in these extraordinary events. Entitled the International Reflective Citizens Community (IRC), it typically brings together over 100 participants representing 25 countries. The organizing principle is that the social dreaming matrix and dialogue/reflection will generate manifest and latent themes related to unconscious citizenship (Fromm, 2017). In addition, there is an “application” segment in which participants reflect and share how they imagine applying the emergent insights from the social unconscious (Hopper, 1996) to their specific home city, region, or country. One example of realized application is the use of the Reflective Citizens model to address the specific regional challenges regarding public health in Serbian villages (Mojovic, 2020). Another example of application has been the creation of a monthly “Reflective Citizens Group: A Conversation on Race” by The Group Analytic Practice of Dallas.
Inspired by the IRC approach to making conscious the impact of citizenship (the dilemmas, the wounds, the traumas, the strains—the despair and the joy), I’ve begun to experiment with integrating an SDM with a whole systems change process, “Open Space Technology” (Owen, 1997).
I designed and facilitated virtual workshops at two professional conferences, the (2021) annual symposium of the American Group Psychotherapy Association (AGPA), “Social Dreaming: A Generative Pathway to Reflective Citizenship” and the 2022 Annual Meeting of the International Society for the Psychoanalytic Study of Organizations (ISPSO). The Zoom video conference platform has a “breakout room” function that allows self-organizing small discussion groups to deepen reflection and linkage between the discerned dream themes. This simple technique generates an interactive process that replicates the hyper-connectivity of the dreaming mind and the inter-subjectively linked dreams of the SDM. The permeability and cross-fertilization foster a synergistic emergence of new associations, insights, and applications—what I’ve termed the “forward edge of the group self’s development” (Bermúdez, 2018) and what Gordon Lawrence called “new thoughts” (Lawrence, 2003; Manley, 2014).
Encouraged by the online Social Dreaming-Open Space integration, I am now imagining a process which links up more rigorously with the deliberative democracy framework—more actively promoting wide-spectrum citizen deliberation to foster communal decision-making and collaborative projects. This is where I believe integrating elements from Open Space, Future Search (FS), and deliberative democracy (DD) will be extremely productive. From both FS and DD, we borrow the process of curating representation so the “whole system is in the room,” thus populating a space with the spectrum of perspectives and social roles.
The ideal “whole deliberative system in the room” will have representation from a wide spectrum of perspectives and social roles. Ackerman and Fishkin (2004) have proposed a “Deliberation Day” for citizens (“DDay”, declared an official holiday with citizens paid for participating), during which the technique of “deliberative polling” would be used (Fishkin, 2018). Initially, their concept involved the assembling of citizens at multiple community “DDay” sites, but Fishkin has more recently proposed online deliberative polling (Fishkin, 2020)—which would create the possibility of a “deliberative society,” widening the impact of deliberation from a microcosm of mini-publics to a fully participatory macrocosm of deliberative democracy.
Influenced by the progressive and research-based proposal for a Deliberation Day (Ackerman & Fishkin, 2004), I’ve proposed (Bermúdez, 2019, 2021) a deliberative process organized on the principles of Future Search (Weisbord & Janoff, 1995), a widely used model for deliberation (Nabatchi et al., 2012) that facilitates the co-creation of common ground among citizens.
Future Search (Weisbord & Janoff, 1995), which I’ve described more fully in a previous publication (Bermúdez, 2019), allows for the orchestrated inclusion of representative stakeholders, the insertion of social dreaming matrices at several points in the overarching process, and facilitated large and small group dialogues. It is a “whole system” deliberation process that features all the core principles and processes of deliberative democracy:
l a focus on a topic that requires community decision-making;
l a representative group of stakeholders is assembled to deliberate;
l the process includes both large and small group deliberation;
l the deliberation process facilitates a dialogue with experts;
l skillful facilitation so that all voices are heard;
l concrete and specific outcomes.
However, FS has a unique deliberation process that fosters collaborative action. Future Search has the uncovering of common ground as its primary task, so the system develops concrete and specific action steps in the service of an imagined and co-created communal future. Future Search has five stages, an unfolding process over several days similar to the psychoanalytic goals of establishing continuity with the past, grasping how it influences present and future, and linking past and present. Also, most importantly, creatively and proactively constructing the newly imagined productive future.
The five phases of the Future Search deliberation are:
1. Discovery of the Past. Small and large group discussions focus on the pasts of the individual and communal self. Participants respond to the question, “Who were we 10, 20, 30 years ago?” at three levels (individual, community, and global contexts), developing a shared community narrative, which includes historic traumatogenic events needing to be metabolized.
2. Discovery of the Present. Small and large group discussions focus on co-constructing a collective “mind map” of the contemporary “external world’—events, trends, and potentially traumatogenic shocks—and self-reflectively assessing how they are coping with that world.
3. Discovery of the Future. Small and large group discussions focus on imagining a future for the community and creatively presenting that imagined future to the whole system, using visual, action, or symbolic/narrative means.
4. Discovery of Common Ground. The whole system dialogues and collaboratively discerns the “common ground” that has emerged from the community’s unformulated social unconscious.
5. Discovery of Future Action. Participants self-organize into small groups who commit to developing concrete and specific action steps based on the “common ground” future.
Social dreaming matrices (45-60 minutes) could be hosted at the beginning of each phase or selectively at transitional phases 2 (“Discovery of the Present”) and 3 (“Discovery of the Future”), for example.
In summary, I am imagining the equivalent of a psychoanalytic “moonshot”—a socio-centric systems psychoanalysis that contributes to the evolution of an authentic deliberative democracy—a syncretic synthesis of social dreaming, community psychoanalysis, and reflective citizenship that cultivates a deliberative democracy with reflective and engaged citizens. z
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I approach the task of writing a piece on community psychoanalysis with more wonderings than conclusions. As someone who is new to psychoanalytic theory and practice, I struggle with insecurity about my ability to both leverage and challenge the field.
Kalen WHEELERmight or might not translate to a community setting, at what point of disruption does psychoanalysis become unrecognizable to itself?
What I have to offer in the conversation about community psychoanalysis is my background in a different framework: transformative justice.1 A movement originally developed2 in opposition to the carceral state’s punitive and inequitable response to lawbreaking, transformative justice aims to (re) imagine how we might bring justice in ways that lead to healing and societal change or “justice that transforms the root cause of injustice” (Brown, 2017, p.133). Transformative justice values the transparency, radical honesty, and accountability that disrupt hierarchies and power differentials that are often designated through roles, especially in institutional settings. As such, throughout this essay, I attempt to write vulnerably and in a way that is unworked, to enact what I wonder transformative justice might offer community psychoanalysis, wherein we all become analyst and analysand.
From School Counselor to Psychotherapist
small interactions” (p.2). Brown (2017) uses the scientific concept of fractals, which are “infinitely complex patterns that are selfsimilar across different scales’’ (p.51) to argue that only if we adopt a transformative justice paradigm on the interpersonal, institutional, and community level will those patterns eventually come to fruition on the macrostructural level. This involves a commitment to radical honesty, transparency, interdependence, reparation, and political action, as well as a disruption of roles and hierarchy. In my position as a school counselor, this paradigm was by no means easy to actualize, but
However, if we believe Freud’s assertion that we approach every psychoanalytic encounter with novelty, perhaps it is exactly this discomfort, uncertainty, and skepticism that primes me to write about community psychoanalysis—a term that is buzzing through our spaces but lacking in shared definition.
What is community psychoanalysis? Do those of us who claim to want to figure it out have a shared interest in radical structural transformation on a societal level, as we do on the psychic level? If so, what is our theory of societal change and where do we expect psychoanalysis to fit into that? What does psychoanalysis have to offer? How might psychoanalysis, as we know it, need to be disrupted? If we interrogate how some of the core elements that qualify psychoanalysis
Before beginning my clinical mental health counseling internship year at a psychoanalytically oriented practice, I was a school counselor. Although the core academic requirements for an MSEd in School Counseling and one in Mental Health Counseling are identical, the nature of the role is entirely different, especially in the environments I chose to practice each. My first job as a school counselor was in the Bronx, New York. At that time, I was involved in a citywide political group that organized to dismantle the school-to-prison pipeline, mostly by supporting schools to engage with transformative justice theory and practice. In schools, transformative justice aims to create (and, ideally, to constantly interrogate and reiterate) systems to build strong community foundations, as well as to respond to harm in ways that emphasize repair over punishment.
Relatedly, the theory of change that I adopted, not only for disrupting racist, capitalist, sexist, queerphobic, and ableist oppressive systems, but also for imagining and actualizing alternatives is based on what Adrienne Marie Brown (2017) calls an emergent strategy “for building complex patterns and systems of change through relatively 1. The term transformative justice is often used interchangeably with restorative justice. The critique of the latter is that it assumes there is something worth restoring, so I choose to use transformative justice.
2. Although the term to describe the movement developed in the 1970s, the practices used in transformative justice have long standing histories in many indigenous cultures (BoyesWatson & Pranis, 2015).
it was in alignment with what I understood the frame of a school counselor to be. My students saw me in a variety of roles—in my office, in the classroom, out at recess, at political actions, at the corner store, at their prom, etc. Moreover, they saw me in circles, a core practice of transformative justice, where we all shared stories, memories, feelings, and conflicts in a way that disrupted typical power dynamics between adults and young people in a school building (Boyes-Watson & Pranis, 2015). Through transformative justice and emergent strategy, I aspired to be a part of a fractal that might be a microcosm for something greater.
Out of frustration with the operationalization of transformative justice, I moved to clinical psychotherapy, based on the
I am progressively more protective of a frame that keeps me private from my patients to make use of their fantasies of me…In fact, many of my patients have expressed to me—explicitly and implicitly—their desire to keep their fantasy of me…
…only if we adopt a transformative justice paradigm on the interpersonal, institutional, and community level will those patterns eventually come to fruition on the macro-structural level. This involves a commitment to radical honesty transparency, interdependence, reparation, and political action…
observation that without tremendous healing on an individual level, besides the institutional level, a more robust societal change felt unattainable.3 However, when I began my clinical internship as a psychotherapist at an analytically oriented group practice, I was immediately struck by a feeling of disorientation. Suddenly, my overarching theory of societal change felt at odds with my role and the frame of psychoanalysis. How would the core values of transformative justice and emergent strategy translate to a frame that protects transference, often, though not always, at the expense of a certain kind of shared vulnerability and interdependence that I practiced as a school counselor? However, over time, through learning more about psychoanalysis in my training and supervision, I have come to believe in psychoanalysis’ liberational qualities over most other theories, and believe psychoanalysis has important elements to offer transformative justice.
I must admit that since practicing as a psychotherapist, I am progressively more protective of a frame that keeps me private from my patients to make use of their fantasies of me, in other words, of protecting the transference. In fact, many of my patients have expressed to me—explicitly and implicitly—their desire to keep their fantasy of me, so as to not bring in “the real” to the unique, analytic space where we can play with fantasy. In my own analytically oriented therapy, I too make use of knowing very little about my therapist, which allows us to explore the assumptions I make about him and our relationship in a way that feels significantly less complicated than if I interacted with him outside of our biweekly sessions. If my patients were to see me in the same variety of roles my students did, this sacred, symbolic “make-believe aspect of the psychoanalytic situation” (Loewald, 1980, as cited in Padrón, 2019) could be jeopardized.
In his discussion of Hans Loewald’s essay “On the Therapeutic Action of Psychoanalysis,” Carlos Padrón (2019) writes that the freedom of fantasy “is not only a freedom from life’s constraints and exigencies. It is also freedom to see and experience oneself and one’s world in life-enhancing ways that enrich meaning,” which he argues is the political potentiality of psychoanalysis (p.196). This suggests that the maintenance of fantasy is necessary for change, at least within the individual psychoanalytic framework. This beckons me to ask: how can psychoanalysis access and make use of fantasy within a community setting that is more dynamically constituted by collective, interactive forces and 3. I recognize that in this essay I am simultaneously arguing for a departure from an individualistic psychic focus, while also admitting that I found a need for this while working in institutional settings. This question of the relationship between individual healing and collective healing is an unresolved throughline in my mind and this essay, and perhaps community psychoanalysis offers a bridge.
less protected from actuality than an individual treatment?4 Or is this impossible, and is community psychoanalysis therefore just a matter of making this individual treatment accessible to more folks, while other frameworks are used for community organizing?
Looking back, I used to hold strong, but shallow and misinformed, views of psychoanalysis as an inherently oppressive theory and methodology. This was mostly due to the reputation Freud holds in the postcolonialist, feminist, anti-racist, and leftist spaces I was a part of, which viewed him as a perverse, misogynistic, anti-Black, non-scientific theorist and clinician, who hid behind concepts like neutrality to, as Daniel Gaztambide (2020) suggests, disavow his own complicated subjectivity. Although I still believe Freud must be interrogated within a contextualized understanding of his positionality at that his-
Europe. Because of psychoanalytic theory’s intention to act from a position that “assumes no point of normalcy” (Padrón, 2019), it invites us to interrogate and dissect everything, orienting us “toward uncommon sense,” and therefore rethinking that which we have passively come to accept as normal, including societal structures of inequity (Jacoby, 1975).
Russell Jacoby writes:
If Freud was “conservative” in his immediate disregard of society, his concepts are radical in their pursuit of society where it allegedly does not exist: in the privacy of the individual. Freud undid the primal bourgeois distinction between private and public, the individual and society; he unearthed the objective roots of the private subject—its social content. (Jacoby, 1975)
torically specific time (Gaztambide, 2020), I have also come to deeply appreciate Freud’s understanding of the unconscious as the access point for liberation, which is perhaps why so many politically left thinkers and writers, such as Frantz Fanon and Paulo Freire, were historically attracted to psychoanalysis (Gaztambide, 2020). As Carlos Padrón (2019) writes, from its inception, psychoanalysis was “a scene of radical otherness within the entrails of the normal—call this consciousness, status quo, ideology” in that Freud was writing from the marginalized position of a Jewish man in anti-Semitic
4. George Bermúdez’s (2018) “social dreaming” initiative might act as an example of how this can be done.
In arguing that social structures are objective, Jacoby offers how they become subjective through what is understood as “common sense” or “second nature,” an “accumulated and sedimented history so long unliberated—history so long monotonously oppressive—that it congeals” (1975). States of being that theories like Existentialism might consider inherently “human” are uncovered as symptoms or manifestations of a repressive society (Jacoby, 1975). Relatedly, while simultaneously uplifting and problematizing Carl Jung’s collective unconscious, Fanon (1952) writes that the collective unconscious is not made up of inherited cerebral matter born through the nuclear family, but instead acts as “the repository of prejudices, myths, and collective attitudes of a particular group,” transmitted intergenerationally outside of individual consciousness (p.161). However, as I said previously, if the unconscious is also the site of “uncommon sense” (Jacoby, 1975) or what I call an access point for liberation, then it carries potentiality, which “can interrupt, problematize, and re-work the political narratives that are at the base of the status quo, consciousness, and ideology” (Padrón, 2019). Perhaps we might think of the unconscious as a constant site of struggle between repression and subversion. Herein lies the liberational potential of psychoanalysis, as I understand it.
But then what is community psychoanalysis? How do we make the collective unconscious conscious? How do we leverage the political potentiality of the unconscious in a community setting? As I asked previously, is it simply a quantitative change that makes the consultation room accessible to more
…
the reputation Freud holds in the postcolonialist, feminist, antiracist, and leftist spaces I was a part of, which viewed him as a perverse, misogynistic, anti-Black, nonscientific theorist and clinician
folks? Or does it involve a serious qualitative disruption of the frame that allows us, or perhaps more accurately forces us, to relinquish control as the analytic therapist and engage in the collaborative dissection of the status quo, including that of psychoanalysis itself and the roles of analyst and analysand? Moreover, if we expand from the consultation room to the institution, community, society as the container for the psychoanalytic encounter, and we consider the possibility of how transference operates within this expanded container, at what point might the symbolic element of the transference threaten to obscure the structural and material reality that constitutes the encounter and perpetuates inequality?
One historical reference point for this question of transference and the roles of therapist and patient is within the institutional psychotherapy movement. Led by Francois Tosquelles, it began in Saint Alban Psychiatric Hospital in post-war France, in response to the inhumane treatment of institutionalized patients with serious mental illness (Robcis, 2016). The guiding claim behind institutional psychotherapy was that the institution itself was sick and had to heal before it could be of service to the patients who inhabited it (Robcis, 2016). To this end, Saint Alban adopted a unique model that involved multi-stakeholder, democratic structures for decision-making, programming, beautification, and other communitybased efforts that were populated by patients, psychiatrists, psychologists, nurses, facilities, and other staff alike (Robcis, 2016). This disrupted the typical dynamics of power and patient-practitioner boundaries in a way that expanded notions of transference from the interpersonal to the institutional level (Robcis, 2016). At another psychiatric hospital, La Borde, also known for its endeavors in institutional psychotherapy, Félix Guattari challenged the notion of transference altogether, developing a theory of transversality in its place (Goffey, 2016). Guattari believed that transference was an inherently oppressive construct that the institutional setting exposed for its reliance on a hierarchy that perpetuated inequality (Goffey, 2016). Unlike transference, which, within the frame of the analyst and analysand in the consultation room, often assigns one person as analyzer and the other as analyzable, transversality relied on everyone in the institution being “susceptible to an openness to alterity” (Goffey, 2016). Guattari wrote:
A fixed transference, a rigid mechanism, like the relationship of nurses and patients with the doctor, an obligatory, predetermined, ‘territorialised’ transference onto a particular role or stereotype, is worse than
a resistance to analysis: it is a way of interiorizing bourgeois repression by the repetitive, archaic, and artificial re-emergence of the phenomena of caste, with all the spell-binding and reactionary group phantasies they bring in their train. (Guattari, 1972, as cited in Goffey, 2016)
By radically disrupting the hierarchical modes of interaction common within institutional settings (and reflective of hierarchical structures beyond the institution), transversality aimed to shift the subjective and relational experiences of the institution in a way that would “facilitate precisely the kind of movement vis-à-vis the unconscious that the transference is thought to accomplish” (Goffey, 2016). In changing the “modeling clay” of analysis from the stuff of the oneto-one encounter in the consultation room towards the “institutional matter that is generated through the entangling of workshops, meetings, everyday life in the dining rooms, cultural life, sports, games,” transversality
on the part of the white analyst seems especially relevant, as it is impossible to disentangle the power held by the position of analyst from the power held by the position of white settler, colonizer, and gentrifier.5 In her writing on cross-racial analysis, Lara Sheehi (2020) discusses the ideological misattunements of psychoanalysis, brought about by a white innocence that hides in the symbolic. When the colonizer occupies the position of analyst and the colonized occupies the position of patient, enactments are not ghosts of the past, but current realities, “catapulting the white analyst into the real” (L. Sheehi, 2020). Writing in the context of occupied Palestine, Stephen Sheehi (2018) discusses the harm (re)produced by nonviolent dialogue initiatives between Palestinians and Israelis that “aim to naturalize ‘coexistence’ without genuine restorative justice” that alters the material reality of the occupation (p.356). Although there is a uniqueness to the Palestinian context that I do not want to conflate with American racial dynamics in an oversimplified way, I believe in the US context, it is also only alongside genuine transformative justice, wherein systems of oppression are disrupted and material reparations actualized, that a community psychoanalysis can act in integrity. For without it, does community psychoanalysis not become another form of normalization, the antithesis of the core of psychoanalysis?
“generates possibilities of affective opening” for the collective (Goffey, 2016). Although one might argue that contemporary psychoanalysis has evolved from the fixed, rigid transference Guattari describes to one that is more dynamic, it seems to me that transference often continues to be discussed and practiced in a way that obfuscates the actuality of the power differentials that may exist between therapist and patient, based in the structural and material realm, and hides behind notions of fantasy, based in the symbolic realm.
When I think about community psychoanalysis within the sociopolitical context of the community where I, a white woman, currently practice in Brooklyn— once Lenapehoking, or the Land of the Lenape, then a historically Black, working class neighborhood—the need for an “openness to alterity” and relinquishment of role
It seems that the framework of transformative justice, not only as a dialogic practice but as a political practice that aims to redress systems of oppression and dispossession, might have something to offer the concept of community psychoanalysis. Similar to Guattari’s transversality, transformative justice frameworks rely on non-hierarchical approaches to personal, institutional, and societal change as the means and the end. In the same way that the transformational power of a patient’s transference to their therapist occurs when the patient experiences a relational dynamic that does not perfectly map onto their repetition compulsion, but is something anew, might transformative justice act on an institutional level so that a person or group of people might experience the institution anew, in a way transformed? And could this lead to psychic, institutional, and eventually societal restructuring?
Maria Hantzopoulos (2015) writes about the New York City high school Humanities Prep’s Fairness Committee, which 5. As I write this, I am aware that by suggesting these questions have to be interrogated to define and discern community psychoanalysis, it perhaps demonstrates the ways I continue to carry the white fantasy that structural power dynamics are somehow less palpable in the consultation room than “out in the community.” As if the consultation room exists outside of the community.
The guiding claim behind institutional psychotherapy was that the institution itself was sick and had to heal before it could be of service to the patients who inhabited it …
is a structure to which any member of the community can bring any other member of the community to discuss a concern about how the former acted in a way that was misaligned with the collaboratively iterated and reiterated values of the school (e.g., mutual respect, cooperation, empathy) and to repair the rupture. This means that a student can bring their principal to the Fairness Committee, a concept that challenges long-held power structures of the institution. The Fairness Committee is tasked with entering the space without a preconceived outcome in mind, asking lots of open-ended questions, and listening deeply to every person involved (Hantzopoulos, 2015), which are also values of psychoanalysis. Eventually, the Committee works to arrive at a consensus about what needs to take place in order to “restore” what was broken. An important point to mention here is that members of the Fairness Committee can equally be brought to the Fairness Committee, so there is no fixed role, and again, everyone is susceptible to the process. I believe Guattari might argue that the experience for all stakeholders involved in this encounter would indeed “generate possibilities of affective opening” by virtue of its radical difference in terms of non-hierarchical, dynamic roles and its departure from traditionally punitive responses to community harm.
Although I never worked at a school with a Fairness Committee, I did start a Peer Mediation Club—another transformative justice practice—in the middle school I worked at in the Bronx. Every semester, I would train a group of students in deep listening, information-gathering, facilitation, and conflict resolution skills. When a conflict would arise within the school community, I would supervise these students as they helped their peers repair their relationships after rupture. There were multiple levels through which peer mediation disrupted the hierarchical norms of the institution. Similar to Humanities Prep’s Fairness Committee model, the idea was that anyone in our school community could bring anyone else to a mediation. Mediations between students and teachers6 were amazing to witness, as the newness of the disrupted hierarchy caused both student and teacher to listen and respond to one another in ways that impacted them as individuals, in relation to one another, and in relation to the institution. Another way peer mediation disrupted the hierarchical norms and expectations was through the allowing of students who were labeled “at-risk,” “disturbed,” “defiant,” to become mediators. Unsurprisingly, these students were generally the best mediators on
6. Mediation is dependent on all parties agreeing to the process. Therefore, in actuality, only a handful of teachers were open to participation. Adult resistance to these processes is beyond the scope of this essay but is unsurprising and likely related to the analyst’s grip on the current frame.
the team. I believe the trust and faith placed on them through the institutional structure of Peer Mediation Club gave them permission to access deep wisdom, empathy, and tenderness that the labels they usually carried overshadowed and repressed. Moreover, for the students in the conflict, there was something transformative about being helped by students normally labeled “helpless.” I like to believe the ripple effects of these practices continue to affect those who participated. A fractal, perhaps.
an ongoing admission of imperfection and not-knowing, as without this, transformative justice practices can become another congealed perpetuator of the status quo. However, given that there is some frustration at the lack of tangible practices that have operationalized the ideas of institutional psychotherapy, I hope these vignettes illustrate the potential of how transformative justice could be used by community psychoanalysis as part of an emergent strategy towards structural and material change.
I keep coming back to this idea that in a community psychoanalysis, we are all the analyst and analysand, navigating transferences that are informed by both fantasy and actuality. However, without the frame of the consultation room, I continue to grapple with what is lost if fantasy is conquered by actuality and no one is responsible for protecting the liberational aspects of it. When is actuality so pervasive and oppressive that we cannot collectively use the “freedom of fantasy” to imagine and manifest an alternative, if that is indeed the goal of community psychoanalysis? Again, maybe the goal is instead to make “the cure” of a more traditional analysis accessible to more folks, while other frameworks are used for institutional, community, and societal healing, justice, and reparation. But I am more excited by the possibility of how community psychoanalysis, perhaps with the help of transformative justice, can become a fractal for the large-scale redistribution of power and justice. z
Bermúdez, G. (2018). The social dreaming matrix as a container for the processing of implicit racial bias and collective racial trauma. International Journal of Group Psychotherapy, 68(4), 538–560.
Within the past decade, transformative justice practices have been co-opted by the state, non-governmental organizations, community-based organizations, and even corporate consultants to a concerning degree. As mentioned above, there is a way in which these practices—such as community-building, teaching tolerance, and mediation—can have an insidious effect; when they are bewedded to mainstream liberal politics and divorced from a commitment to real material and structural change, they can actually help to maintain the status quo and to deflate radical social movements. This needs to be consistently monitored and interrogated. Part of what I believe psychoanalysis can offer transformative justice models, as I have seen them practiced, is the release of the idolized expectation that individuals and institutions can ever be fully transparent or integrous, as that assumes full consciousness (Padrón, 2019) and will lead to disillusionment when unachieved. For the institution to be open to alterity requires
Boyes-Watson, C., & Pranis, K. (2015). Circle forward: Building a restorative school community. Living Justice Press.
Brown, A. M. (2017). Emergent strategy: Shaping change, changing worlds. AK Press.
Fanon, F. (1952). Black skin, white masks. Grove Press.
Gaztambide, D. (2020). From Freud to Fanon to Freire: Psychoanalysis as liberation method. In Lillian Comas-Díaz and Edil Torres Rivera (Eds.), Liberation psychology: Theory, method, practice, and social justice. American Psychological Association.
Goffey, A. (2016). Guattari and transversality: Institutions, analysis and experimentation. Radical Philosophy, 195, 38-47.
Hantzopoulos, M. (2015). Sites of liberation or sites of despair?: The challenges and possibilities of democratic education in an urban public school in New York City. Anthropology & Education Quarterly, 46(4), 345-362.
Jacoby, R. (1975). Social amnesia. Beacon Press.
Loewald, H. (1980). Psychoanalysis as an art and the fantasy character of the psychoanalytic situation. In Essays on psychoanalysis (pp.352-171). Yale University Press.
Padrón, C. (2019). The political potentiality of the psychoanalytic process. In Psychoanalysis in the Barrios: Race, class, and the unconscious (pp.189-202). Routledge.
Robcis, C. (2016). François Tosquelles and the psychiatric revolution in postwar France. Constellations, 23(2), 212-222.
Sheehi, L. (2020). The reality principle: Fanonian undoing, unlearning, and decentering: A discussion of “Fanon’s vision of embodied racism for psychoanalytic theory and practice”. Psychoanalytic Dialogues, 30(3), 325-330.
Sheehi, S. (2018). Psychoanalysis under occupation: Nonviolence and dialogue initiatives as a psychic extension of the closure system. Psychoanalysis and History, 20(3), 353–369.
…peer mediation disrupted the hierarchical norms and expectations
through the allowing of students who were labeled “at-risk,” “disturbed,” “defiant,” to become mediators. Unsurprisingly, these students were generally the best mediators
Universality is inherently dialectical. It lets us see what particular identity hides—connection in the midst of division. Universality allows for a response to a catastrophe like climate change that is equal to the magnitude of the event. Our particular identity, in contrast, leaves us with only a series of responses that can never add up to being adequate to the problem. The stake of the struggle between particular identity and universality is now existence itself. (McGowan, 2020, p.205)
The impetus for this essay is a growing set of concerns regarding transformations in the social field and their effects on how we think about and conduct our clinical work, particularly in relation to “community psychoanalysis.” By way of introduction, we want to provide some context for the experiences that led us to formulate the questions we bring forth in this essay. In addition to our work as psychoanalysts, we draw extensively from attempts to carve out a space for psychoanalysis in the university via our teaching and the clinical training of graduate students at the California Institute of Integral Studies (CIIS). The central conduit of this transmission has been the Community Mental Health program, a Master’s level course of study designed for the express purpose of social justice-oriented clinical training1—this primary objective has been accomplished by placing emphasis on maintaining a polyphony of voices within a diverse student body in conjunction with upholding a curriculum grounded in liberation and community psychology. Closely connected to this academic program is the clinical training site called The Clinic Without Walls (TCWOW).
From its inception in 2009, TCWOW aimed to address major gaps in the treatment of marginalized populations within the San Francisco Bay Area and to provide clinical training specifically in relation to community-oriented praxis. To this end, TCWOW has followed in the genealogy of Freud’s free clinics (Danto, 2007) and has operated without institutional constraints regarding the frequency of sessions and duration of treatments. Over the course of the last 13 years, both of us have served as clinical directors of TCWOW and have also provided clinical supervision and didactic seminars to 1. CIIS is one of the largest graduate-level clinical training institutions in the United States.
the psychotherapists in training. During this time, we have introduced many students to psychoanalysis and collaborated closely with them throughout their clinical formation. It is on this basis of an ongoing engagement involving the practice and transmission of psychoanalysis that we have come to formulate what follows.
As will become obvious, many of our reflections in this article revolve around questions, issues, and problematics regarding reductionistic politics centered around identity and a methodological individualism rooted in neoliberal capitalist discourse. We understand identity politics as describing “how marginalized people embrace previously stigmatized identities, create communities on the basis of shared attributes and interests (which are typically held to be essential and unchanging), and rally either for autonomy or for rights and recognitions.” (Lancaster, 2017). We are well aware that any foray on our part into this vexed and thorny terrain will inevitably summon forth critiques, energetic arguments for and against, and even heated exchanges. We welcome these and look forward to engaging with them. In the same breath, we respectfully ask that our arguments, as abbreviated as they must be in an essay of this length, be understood in their knotty complexity and subtlety. Just as we endeavor to do, we ask the reader to give us the benefit of the doubt when confronted with something not fully explained or seemingly confusing, and to reach out to us with any questions or concerns they may have. Our objective is to advance an argument that is of benefit to clinical work, broadly speaking.
What “Community” Are We Speaking of? “Community” psychoanalysis is a kind of quick shorthand, signifying a kind of practice that is oriented to the public at large, even if the work occurs with individuals, as opposed to “private practice,” which is the main modality of treatment conjured up when psychoanalysis is mentioned in the United States. Both terms, “private” and “community,” speak immediately to issues of social stratification, how these are understood, and how treatment in either modality operates within, against, or in collusion with the various forces operating in any given social field. So, we ask, to what community are we attending in this essay? Following from the above, and in a more granular fashion, what social field is being addressed here, and how have transformations in this social field
impacted and perhaps limited the possibilities for analytic work, particularly when it comes to community psychoanalysis?
In the case of TCWOW, we immediately realize that there are two different aspects of the social field we are attending to, but interestingly enough, they have significant overlap. While all possible folks that may qualify for services at TCWOW (the homeless, unemployed, uninsured, underinsured, non-English speakers, poor, working poor, immigrants, and their families) would seem to make up the principal aspect of the social field we are concerned with, we should quickly note that the trainees of the clinic make up another facet of the field that is of vital importance for our considerations. And we say this not just out of a sense of fairness, but because these therapists-in-training, themselves part of the larger discursive and structural weave of the university itself, play an outsized role in how the work is understood, what is imaginable, and what the aims of the work are assumed to be.
TCWOW trainees often describe the patients2 or clients they work with using various terms in a limited set, including “disadvantaged,” “oppressed,” “traditionally marginalized,” “poor,” under-resourced,” and “traumatized.” In all cases, the words used denote patients that are certainly not part of the elite, the well-to-do, or the ruling classes, and most often not part of the middle class or even the working class. What’s interesting, however, is that no matter what term is used, and regardless of the fact that these terms often found their genesis in a discourse that explicitly had class as its starting point, the above terms are now often entangled with other lines of social stratification, namely race, ethnicity, gender, and sexuality. The use of these terms, in this fashion, immediately signals the hollowing out of a previously well-established social class discourse, and its replacement with one that often obfuscates the always thorny yet fundamental role of class struggle. And we mean something quite specific when referring to social class. To quote Paul Heideman:
[R]ather than just the education or money someone has, class refers to an entire structure that imposes very specific logics of action on people in society. And because of the power the
2. Students and trainees often struggle with the term “patient,” associating it with the dreaded “medical model” they are encouraged to avoid. In reality, this difficulty reveals a misconception. We need only recall the Latin origins of the term “patient” to understand its suitability. Patiens means one who suffers.
capitalist class holds in society, any significant redistribution of power requires confronting that class. These arguments have massive implications for thinking about politics in general and undoing the structures of racial and gender oppression in particular.
…While the liberal view of class is like a ladder, with a potentially infinite number of rungs depending on how narrowly one wants to define the groups, the socialist view is famously polarized, with overwhelming emphasis on two classes: capitalists and workers. Those structural positions, in turn, impose two things on members of a given class: common logics of action and common interests. … For socialists, then, class is less about common status and more about interests and actions. (2019)
Not surprisingly, these same measures of social division (race, ethnicity, gender, and sexuality) are the ones often, but not always, employed by TCWOW trainees to describe themselves. While this fact may strike many a reader as nothing novel, let alone momentous, it is of crucial importance for how the work is understood or articulated in a community clinic such as TCWOW. This is all the more so when we consider that TCWOW operates under the aegis of the university and is therefore structurally entwined with the larger discursive weave of identity politics that has taken almost all North American academia by storm. With this in mind, we now turn our attention to specific aspects of psychoanalytic practice and the discourse of capitalism.
In the years following May 1968, Jacques Lacan elaborated his theory of the discourses, in a sense responding to the momentous social upheaval of the time by formalizing the structures of the social bond. For our purposes, Lacan’s theorization of the Discourse of Capitalism serves to examine the consequences of the dissolution of the social link in contemporary political economies. Without rehashing an explanation of Lacanian algebra (readily available elsewhere), we will consider how the theory and practice of community psychoanalysis is pressured and compromised by the ideological confines of neoliberalism.
Lacan’s comments on the Discourse of Capitalism provide a way of thinking through how neoliberal discursivity functions as a backdrop for contemporary psychoanalytic practice. Here, it is worth quoting Daniel Koren on this basic logic:
The ruse of liberal reason rests on the illusion of autonomy:
illusion that each one can be, have and become “whatever s/he wants”. The Capitalist’s Discourse, under the guise of the market’s discourse, invades all spaces (political, economic, social, artistic, etc.). It transforms subjects into permanent consumers of objects, which has direct effects on the production machine, but leans for this on what is the foundation of subjects themselves: the lack. (2017)
Bearing in mind this concise summary, we can begin to think of how the clinic is shaped by a machinic apparatus that produces a very particular type of illusion. Two things immediately come to mind. First, that capitalism serves as a petri dish for the fantasies of the consumer (it’s no coincidence that broadly speaking within the mental health field, “consumer” is now used widely and interchangeably with the term “client.”). Second, that subjects within the Discourse of Capitalism attempt to circumvent the lack through demands articulated to and from the market. Our aim is to interrogate how psychoanalysis is con-scripted by capitalism, and as such, how the clinic ends up reproducing the very trappings in which it is caught.
Not only does the Discourse of Capitalism effectively supplant the Discourse of the Analyst, it also operates decidedly against the division of the subject by promising wholesale jouissance (Braunstein, 2012). In contrast to the ways in which subjects are compelled by the @ Ilures of capitalism, the function of the analyst is that of cutting discourse in a manner counter to unabated jouissance, and in doing so, it destabilizes the phantasm of the analysand and the analyst. If the symbolic cut is obviated, either because the analysand refuses to work through incisions or because the analyst simply fails to punctuate subjective division in the first place, then what remains is unbridled jouissance.
In our era of responsibilization
(Pyysiäinen et al., 2017), we must ask ourselves how self-referentiality and claims to autonomy play out in the clinic. Insofar as the analyst is tasked with supporting the imaginary indexes of the analysand, the puncturing of the narcissistic image becomes nearly impossible. This is a vexed issue given that many contemporary political movements aim precisely to establish recognition via identifications, advancing this as a necessary means by which to bring justice to the marginalized. This project is especially appealing within the context of community-based work because it purports to respond to the urgent struggles of those who historically have been discriminated against. But it may be that the attempt to introduce dignity in this manner is in actuality driven by the satisfaction of conforming to the demand of the social field; these exigencies are all the more difficult to scrutinize, let alone resist, precisely because they constitute that which is assumed to rectify the injustices faced by the oppressed. But this is in fact only a semblance of care. Like other aspects of our contemporary moment, the noblesse oblige becomes yet another emblem of individual virtue (Rose, 1999), and the ingratiation of hollow modes of recognition ends up placing psychoanalysis in the same shopping aisle as many forms of contemporary psychotherapy. The logics of the marketplace dictates what it means to provide or undergo psychoanalytic treatment when psychoanalysis is ciphered through neoliberal ideologies. For this reason, psychoanalysis is at risk of a total merger with what Parker and Pavón-Cuéllar (2021) call the psy-complex (psychotherapy, psychology, and psychiatry). This essay is therefore in part an effort to carve out a space for community-oriented practice and, to this end, to disambiguate psychoanalysis from the so-called mental health professions. Only in such a clearing can the rarefied work of, and with the unconscious continue.
A brief conceptual interlude is warranted here, as it will allow consideration of the problems at hand in a more technical manner and refine how we might listen. Identity is, in a very basic structural sense, constructed in and through language. For Lacan, a signifier in isolation is empty, in itself devoid of meaning. The signifier appears meaning-full only in its articulation with other signifiers, thereby producing signification. Because no single term can be interpreted in isolation and therefore cannot be essentialized, then any point of identification is necessarily linked to other signifiers. For example, two people born in the United States share the signifier of that place, but the articulation of what “American” represents is unique in each case. By extension, we can conclude that the sharing of an identificatory category cannot establish the ground of sameness. The moment any term is brought into relation with other terms, it is no longer a signifier in isolation—it is instead one element within a network of other signifiers. Thus, one person’s relation to an identity category will be necessarily different from all other persons’ relation to the same category. This is because for each subject, all terms occupy a distinctive place within the particular structure of their discourse. As useful and
compelling as they may be in some relative sense, identity categories are inherently empty placeholders.
The analyst’s intervention on the signifier is the cutting of discourse to establish the unconscious structure of the signifying chain. To carry out this procedure, it is necessary to determine the place of the imaginary and its structural tie to the symbolic and real. As clinicians, it is vital that we attend closely to points of identification, not because they are valuable in their own right, but because they are the basis for the subject’s alienation in language. In the clinic, the extent to which self-representations are privileged is the degree to which the subject remains ensnared by the veils of the ego. It is therefore crucial to attend closely to these points of identification not to reify the image, but to determine precisely where the subject of the unconscious is caught or hides. In doing so, the analyst performs the cuts necessary to bypass the ego, consequently making possible the nascence of the subject of the unconscious. To pierce the narrow veil of identity is to open up to desire, the universal truth of the lack-in-being.
A cursory glance at economic statistics is enough to grasp the stark disparities that
exist in the United States and throughout the globe. With respect to class struggle, psychoanalysis is impotent since it cannot effect change at the level of the polity. Consequently, psychoanalysis as a clinical practice cannot in any real way produce “social justice” (as is sometimes misleadingly presumed) precisely because it cannot resolve material problems. If it isn’t already clear, our position is not a call for a resurrection of the patriarchy or a return to traditional values. No, quite the contrary. If there is a way through all of this, it will be via a profoundly radical reorientation of how we define and therefore how we might work toward social justice. As just one example of how the issue of identity might be dealt with differently, we quote Lancaster again:
Under the rubric of liberation, activists embraced identity in order to abolish it. Marxist ideas about class struggle — which similarly culminate with the abolition of social classes — influenced their ideas. They rallied around demands for adequate income, housing, medical care, ecological well-being, and meaningful employment. Their liberation struggle was ultimately a revolutionary call to action with a universalist view of freedom. (2017)
As can be readily observed, this formulation is radically different from an embrace of identity for its own sake, or as an end in itself.
Beyond the fact that identity politics fail to adequately take account of the material roots of oppression, paradoxically, such thinking instantiates the promises of a capitalist political economy (Michaels, 2006; McGowan, 2020) and therefore lead to further exploitation. And though patients may ask for it, and though we may be encouraged by our institutions to conform to it, no amount of politically correct language will resolve the very real inequities suffered by the poor, the marginalized, and the exploited. The atomized notion of individual liberation represented by the metonymy of 1+1+1+… is homologous to the depoliticization of American society writ large. Our general failure to cohere sustained, large-scale social movements is consistent with the predominance of highly individualistic, almost solipsistic discourses. What else then, might make possible a different kind of social bond? As Beshara points out:
Comradeship is a form of horizontal affiliation, which is not based on Imaginary identification, but Symbolic alignment of desire and Real enjoyment. Put differently, we are not comrades because we are the same, but because, despite our differences, we may share common interests. (2021, p.159)
It cannot be overstated just how different such a view is in contrast to current movements predicated on the pretext of social justice we’ve outlined above. Having said that, we also recognize the existence of many possible conceptions of struggle and comradeship issuing from a panoply of forms of racialized, sexualized and gendered hierarchies. These too function as symbolic, as well as imaginary and real, orders allowing for varied forms of solidarity and their own “universality thrust” (McGowan, 2020, p.26). Which is a way of saying that it’s important to recognize all forms of oppression. To quote Heideman again:
Movements fighting race and gender hierarchies have reshaped American society at different points, winning massive redistributions of power. Even when such movements are dormant, these forms of oppression shape the distribution of power in society and the degree of material oppression in ways large and small. These forms of oppression have an existence every bit as brutal and concrete as class exploitation. (2019)
We draw a straight line from neoliberalism, understood in political-economic terms and as hegemonic discourse, to identity politics. These are mutually co-arising phenomena that not only reinforce each other but are also predicated on the same epistemic misconceptions. To put it bluntly, both the politics of recognition and neoliberalism rely “on a methodological individualism that assumes macro-level social phenomena have micro-level causes and solutions. This fixation on individual choice and personal attitudes reproduces the epistemological fallacies of neoclassical economics and most of right-leaning social sciences” (Parenti, 2021, p.1). Perhaps the best way of proceeding is to ask what kind of strictures on community psychoanalysis and its praxis arise from a neo-liberalized social field? As well, what new demands are articulated to the clinic, and how might these complicate and potentially detract from the work of and with the unconscious?
We note that the demand, by both patients and trainees alike, and formulated in a variety of ways, is that the clinic join in the larger project of achieving and cohering stable identities, understood to be both authentic and outside of the strictures of mainstream morality and white-heteronormative supremacy. Attempts to go beyond this immediate project can easily be misunderstood and are often deemed oppressive or anti-liberatory. Hence, any work with the unconscious that puts into question the whole category of fixed identities, as explained above, can easily fall prey to being labeled antiquated, in opposition to liberatory politics or even in line with the “medical model”. It is only through the steady, careful, and persistent efforts of the clinic’s supervisors, trainers, and directors that a clear path beyond the politics of reductionism can be achieved. It should also be noted that once exposed to a coherent line of argumentation that delineates why it is important to interrogate the premises of identity, TCWOW students are often eager to know more and to practice in different ways.
Any attempt at a community psychoanalysis must necessarily deal with the always-looming specter of cognitive-behavioral therapy or CBT. If neo-liberalism and identity politics constitute two pieces of a triptych, then CBT most certainly functions as the third. Sharing the same epistemic bases as identity-centered politics, which sees oppression as a kind of “misinformation” and social construct (Parenti, 2021, p.3), CBT understands clinical issues as arising from incorrect cognition, faulty and incomplete information processing, or deficient knowledge bases and prior conditioning. In other words, the CBT cure, like that advanced by identity-politics adherents, is fundamentally about achieving correct thinking, based on inclusive data, framed and languaged in the approved manner.
This way of approaching clinical work is incredibly alluring, as any survey of graduate clinical training programs will immediately show. CBT has become the almost unquestioned gold standard of clinical training and practice. And part of its charm is that it matches so well with neo-liberal discourse. They are all of a piece and form an antipode to community psychoanalysis.
As well, CBT, like some aspects of identity-politics discourse, would seem to feed an extreme narcissism and individualism that we have noticed among many folks in the larger field. They sense that grand-scale social change can be enacted on a distributed, individual level (the metonymy of 1+1+1+…). And this makes sense if you believe that the important stuff is happening mostly at the level of the psyche and social forces are ignored or not fully recognized for the enormous role they play in the total equation. In this model, personal and social liberation (often and implicitly understood as being the same thing) are the result of a successful struggle against internalized oppression, a kind of unlearning or de-conditioning. By adopting correct language and thinking, appropriate attitudinal dispositions, practices, and gestures, a psycho-social cure can ostensibly be achieved.
Not wanting to reproduce the same epistemic fallacies noted above, we are quick to note that we are not blaming individual clinicians in training, let alone patients, for arriving at the doors of community psychoanalysis with the aforementioned stance. If anything, this set of positions is the result of decades-long and abiding patterns of political economy and discourse. In other words, they are a flowering or outgrowth of something much deeper. And it is something that the psychoanalytic clinic, be it of the community variant or otherwise, must necessarily deal with. z
Beshara, R. K. (2021). Freud and Said: Contrapuntal psychoanalysis as liberation praxis. Palgrave Macmillan.
Braunstein, N. A. (2012). El inconsciente, la técnica y el discurso capitalista. Siglo XXI Editores. Danto, E. A. (2007). Freud’s free clinics: Psychoanalysis and social justice, 1918-1938 Columbia University Press.
Heideman, P. (2019, May 3). Class rules everything around me. Jacobin https://jacobin.com/2019/05/ working-class-structure-oppression-capitalist-identity Koren, D. (2017). On an apocalyptic tone adopted today in psychoanalysis. European Journal of Psychoanalysis https://www.journal-psychoanalysis.eu/ on-an-apocalyptic-tone-adopted-today-in-psychoanalysis/ Lancaster, R. (2017, August 3). Identity politics can only get us so far. Jacobin https://jacobin.com/2017/08/ identity-politics-gay-rights-neoliberalism-stonewall feminism-race
McGowan, T. (2020). Universality and identity politics. Columbia Press.
Michaels, W. B. (2006). The trouble with diversity: How we learned to love identity and ignore inequality. Metropolitan Books.
Parenti, M. (2021). The first privilege walk. Nonsite.org: https://nonsite.org/the-first-privilegewalk/
Parker, I. & Pavón-Cuéllar, D. (2021). Psychoanalysis and revolution: Critical psychology for liberation movements. 1968 Press.
Pyysiäinen, J., Halpin, D., & Guilfoyle, A. (2017). Neoliberal governance and ‘responsibilization’ of agents: Reassessing the mechanisms of responsibility-shift in neoliberal discursive environments. Distinktion: Journal of Social Theory, 18(2), 215-235. https://www.tandfonline.com/doi/ ref/10.1080/1600910X.2017.1331858?scroll=top
Rose, N. (1999). Governing the soul: The shaping of the private self. Free Association Books.
Over the past three years, I have conducted ethnographic research on contemporary psychoanalysis with a focus on how the discipline, as practiced in New York City (where I live) and beyond, shifted over the course of the pandemic. These past three years, however, have not been “normal” for most anyone, anywhere, or at least that is how it appears from afar, to Us, whoever us is. It is clear, however, that We believe that never in history have we had a global event (as portrayed in the current cultural imaginary) as capable of instigating, or perhaps as representing of, universal upheaval in mind and body. It is not surprising, then, that a Western science premised on the idea that the individual human finds oneself bound, psychically and somatically, to the civilization(s) in which they are born and made, would react. An emergent movement in community psychoanalysis constitutes one such reaction. As a director at a psychoanalytic institute remarked to me, “We have always worked in the community.” Yet it appears to this ethnographer that when people use the word community now, it indexes something quite different—something that refers to psychoanalysis not only across classes and cultures, but within the civilizational globalization (mondialisation) that the pandemic foregrounds.
Psychoanalysts, amongst others, have characterized these past years of the pandemic as presenting dual crises: the effects of the pandemic itself as social isolation, economic and other forms of precarity, and exposure to death; and the revelation (for some, or in some ways) and amplification of inequity in this nation. These dual crises, perhaps in an overdetermined way, provoke the eruption of a reckoning with the racist underpinnings of nationalism across the United States and elsewhere, while also solidifying political divisions. During this time, we have witnessed what appears to be an increasingly polarized state, which seems to represent values between groups of people that are incommensurable. Vaccines or no vaccines, masks or no masks, the recent events over Roe v. Wade and gun regulation, all provide examples of how in this place, “America,” the value of life itself can be determined at the total exclusion of life sanctified by another value system.
The contention of this piece is that the emergence of what could be called a “movement” of community psychoanalysis provides a place to experiment with the idea that what is at stake in a political system is not the value of human life as physical object— what seems to be at stake in these disputes over life itself, or what is sometimes referred to as biopolitical life (Agamben, 1998)—but
the ability of everyone and anyone to think and live. Perhaps this has become more possible now because the pandemic, inasmuch as it has affected almost every person’s ability to think and live, brings something global to psychoanalysis too. Perhaps the “global” is a new object dropped into the field of experimentation in psychoanalysis, which changes psychoanalysts’ understanding of what is at stake in their work. l l l
Recently, I said to a black psychoanalyst, a good friend of my advisor in anthropology at UCLA, who is also a psychoanalyst, that I thought the pandemic had brought us more closely into proximity with the abject. I draw upon Kristeva’s notion of horror (Kristeva, 1982) when I use that word, calling up images of my own early pandemic experience and what I could observe of those around me. In those early days, it was as if something I
Marisa BERWALDgood or bad, or if good or bad is the right way to think about it, or what the notion of right means, and so on
Yet there’s still the beauty of a farmer’s market in a gentrified neighborhood in Greenpoint, Brooklyn, for example, where I live. There’s still the Mr. T-like man giving boxing lessons in McCarren Park, who describes to me the way in which he threatened a man from a nearby Art Deco apartment building, complaining about the noise of old school hip-hop interrupting his virtual workday, back into his apartment; how he wakes up at 4 AM to start studying and training; how he will always be there for me at 7 AM; and his vision for opening boxing studios internationally. To me, he looks strangely like my father. It’s their build. They both look like you could punch them in the ribs, and they would not feel it—even thicker than big—XXL. So, I found a replacement father, one who could teach me how to fight. These respites were all available during even the worst of the pandemic (or the almost worst, though we still masked outside), and they showed our realization of our lack of fitness for enduring the situations we were in.
always knew was true was finally exposed, and there was a sense of relief at seeing the fragility not of human life exactly, but of psychic integrity, held loosely together by a roll of toilet paper. I had always known how frail life secretly was, of course. I suspect if we were able to rewind a tape of our clinical work at this time, which we are not, the record of which is likely to be flushed in the anality of history, that our patients also would have been telling us one way or another what they had always known: the world does not make sense, death is random and inappropriate, and I’m trying my hardest to make it happen to me.
We all know that it is just a hop, skip, a syringe, and a swab away until we add that, it, and thing to our pronouns list, and we are not sure what that means, and in what ways it is
Nonetheless, we were all exposed to the abject. What we may have failed to see at the time, and what my advisor’s black psychoanalyst friend told me, is that we were not all exposed to the abject equally. Not that you could measure it, but some of us were more exposed than others before, were exponentially more exposed during, and will continue to be after, and this was certainly true on a global scale. In this history, the one I am trying to portray in this short illustration of events in my own life, the historical unspoken in American society looms (Throop, 2022) in ways not easy to comprehend. And I think that in the pandemic, we feel it looming more. I cannot prove this. That’s because more is difficult to quantify, and because it is difficult to measure a feeling, the affective and atmospheric (Aciksoz, 2016) problem of the United States, of the entirety of Western civilization, of the earth mother we may have already smothered, looming large.
The psychoanalytic concept of aprèscoup, after the event, presumes that there is an after. Yet, as argued by the anthropologist Robert Desjarlais (2011), an embodied sense of before, during, and after comes from a Westernized notion of linear time located in a particular historical moment and place, and access to this sort of time is distributed as a product of power, in the Foucaultian sense. Depending on what kind of life one lives on the American frontier (and, indeed, the frontier of the earth, and even, perhaps, of the universe), this time accumulates
In those early days, it was as if something I always knew was true was finally exposed, and there was a sense of relief at seeing the fragility not of human life exactly, but of psychic integrity, held loosely together by a roll of toilet paper.
differently. We, (again, whoever We are) rely on a certain kind of narrative time, which has a before, during, and after, organized around the denouement of death.
Yet does it? The pandemic calls this narrative time and its relative desirability and sustainability into question. A refrain I have heard from many psychoanalysts with whom I have spoken, or listened to, is that the après-coup of the pandemic has not occurred, and so we cannot think about it yet—and this has often been suggested as an impediment to my ethnographic work, in which I ask psychoanalysts to reflect on what is happening to our collective psyche-somas via the experience of their work during this time. So many times, I heard people sigh relief at their physical safety, and even more so, to be able to work comfortably from home, to take their shoes off, so to speak, to save money on the overhead expenses that are so high in New York City, especially for the younger middle-aged generation of workers like myself and my friends/colleagues. But that was a huge surprise to me. I expected it would be natural to them, and that they would appreciate the opportunity to speak about the challenge of confronting the pain and suffering of the psyche-soma that endures isolation, uncertainty, and precarity in the pandemic, day after day—their own, their patients, and that of all those around them, whether connected physically, virtually, or via media representation.
I expected that because that was a pain I was feeling as a human and clinician during this time, and I wanted to share it with others, carry it with them, so to speak. So many psychoanalysts did not and do not want to come back from this homely state, despite its obvious challenges to the narrative time of a day, a year, a career, a life. But I wanted to go back. I went back to the office as soon as I could, even when I still saw patients virtually, even if it risked my biological life. This longing—a refrain that appeared in my own analysis—causes me to ask, what happens if we stop thinking in a time that goes forever and never becomes après? As a participant in an ethno-psychoanalytic group started at the psychoanalytic practice where I work said, somewhere mid-pandemic, “How do we know we are going back? When do we know it is after?” This person is Asian, and it was a moment of racism against Asian people in America spurred by the pandemic and exacerbated by the hate language coming from the Trump administration. I do not know if her experience in the civilization she comes from has anything to do with why she said what she said, but I did notice that, and it made me wonder if the psychoanalytic notion of the historical subject in this way, whitened, assimilated, and premised on the après-coup, is becoming outdated—and we all know it
At the same time, psychoanalysts
describe psychoanalysis as bringing into being another sense of time, that of the unconscious, which it is commonly said has no time. Perhaps because psychoanalysis presents this other, beyond-Western and not civilizationally based sense of time, that even as a Western-based discipline, it provides a place to look for answers to dilemmas that emerge across rather than within time. l
In the introduction to Psychoanalysis in the Barrios: Race, Class, and the Unconscious (2018), Patricia Gherovici challenges the notion that psychoanalysis cannot treat “the poor” because the poor do not have enough resources to reflect. This view echoes something that has been said in psychoanalytic forums since the beginning of the pandemic: that psychoanalysis has become, over its many decades implanted in American life, a practice for the upper middle class. Community
so to speak, where life is unregulated, where the difference between the id, ego, and superego, between races, ethnicities, classes, and geographies, are no longer so distinguishable, and this threatens the stability of the values on which people’s lives are based.
In her 2022 keynote address delivered to the Spring meeting of Division 39, Gherovici describes a different address, that of Preciado, to a conference of Lacanian psychoanalysts in Paris. She describes Preciado as confronting what Gherovici calls the “sad tradition” in psychoanalysis of pathologizing non-normative expressions of gender and sexuality. Preciado calls for a “change in epistemology” and a “mutant psychoanalysis.” Gherovici links Preciado’s argument for a “mutant psychoanalysis” (which she is careful to state is not exactly her own) to a need for psychoanalysis to shift its orientation to address the structural inequities and violence that cause trauma. This leaves one wondering: how are the ways in which psychoanalysis addresses sexuality and the “external” pressures of structural violence and inequity linked? Gherovici implies they link in the discipline’s construction of “normal” and “pathological.”
psychoanalysts challenge these notions by arguing that psychoanalysis is for everyone, whether that be “the poor,” “the mad,” or “people of color”—those groups of people of whom it has been said, in the historical time of America, do not “reflect.”
Yet to become relevant to a changing world, where the psyche increasingly becomes the subject of what the psychoanalyst Willy Apollon refers to as mondialisation, or cultural globalization (cf: Jeffrey Librett, 2019), psychoanalysis needs to address not only the human condition of diverse peoples, but the human condition in the age of virtual intelligence, in which the ideals, values, and norms of different civilizational contexts mix. It no longer makes sense for psychoanalysis to primarily address an American “white middle class,” even if, as we know, it often does so in a radical way. Americans at large (and in their largesse) increasingly live in a “Wild West,”
In these “unnormative” times, are psychoanalysts more receptive to hearing about mutant psychoanalysis than they were in 2019? If so, is it because they now cannot avoid seeing the necessity of introducing more of, or perhaps a different kind of, alien, other, and mutant into psychoanalysis, because of a new global sense of things? Is this other sense more a necessity now because we can no longer “unsee” (González, 2020) the knotting between the inequities of this world and the psyche/soma? If this were the case, then the field of psychoanalysis widens, not beyond the scope of its original practice per se, but in practice today. It doesn’t become a new discipline; rather, it shifts within the scope of the discipline already in existence, but not already occupied. One might make a new mantra: “occupy psychoanalysis,” and wonder: is this even a radical suggestion? l l l
Over the course of the pandemic, psychoanalysts referred to the scene in analytic history where Winnicott famously asked a room of psychoanalysts in London if they are aware of the bombs dropping outside and received admonishment from Melanie Klein that all that matters was what was inside that room in which they had all convened. Psychoanalysts call upon this story like a screen memory, but what is it meant to describe? Psychoanalysts could not describe themselves as frontline workers during the worst parts of the pandemic, because that would have seemed ridiculous and wrong given the workers exposing themselves to actual, real death. Analysts were safe, inside, in their homes, away from the bombs and
Psychoanalysts could not describe themselves as frontline workers during the worst parts of the pandemic, because that would have seemed ridiculous and wrong given the workers exposing themselves to actual, real death.
able to make a “good living,” where now, even though the bombs have much diminished, many would rather not leave, and for good reason. However, we now know in the après coup that the mental death caused by the pandemic is high, that countless lives have been lost here, and that in some ways, we remain with the walking dead, particularly in ourselves. We are going to have to confront this when we “go outside.”
I wonder if the impact of the psychic-somatic threat of the pandemic, a kind of structural violence inflicted on everyone, which catalyzed the recognition of other structural violences, is what opens the way to a psychoanalytic response that shifts the aims of psychoanalysis. When psychoanalytic thinkers introduce notions of community psychoanalysis, they index the idea of community that the director of the institute cites when he says, “We have always worked in the community.” They also respond to the radical disruption of Western ideals that the pandemic brought to group consciousness by putting into question who and what psychoanalysis serves. Are these thinkers in community
psychoanalysis saying that in the era of civilizational globalization (mondialisation), we need a psychoanalysis that transcends ideals for all? If so, then we have a mutant psychoanalysis for sure. l l l
By introducing new things, elements of otherness not already represented in American psychoanalysis, actors involved with community psychoanalysis enact a kind of coolness, bringing air into Melanie Klein’s stuffy rooms. Otherness, however, is not a domain unique to psychoanalysis, but to every field of exploration. Psychoanalysis uniquely deals with psychic-somatic otherness, which has been, for quite a while, easily locatable in psychoanalysis with respect to the constitution of a self. What happened to the integrity of this psychic-somatic self when everyone’s ability to think and live, to “breathe” in the metaphor of the pandemic, diminished, reduced to a matter of life and death, all separate from one another?
For some reason, a reason not necessarily known to us before or after the event of an
après coup, we became worried that breathing together would not be possible again. We needed to breathe together, because we weren’t sure that we could continue to breathe apart, at least not on land. Psychic-somatic otherness escaped the self and leaked into the whole world, or perhaps it was the ocean, filled with plastic, which sprung a leak… z
Aciksoz, S. C. (2016). Medical humanitarianism under atmospheric violence: Health professionals in the 2013 Gezi protests in Turkey. Culture, medicine, and psychiatry, 40(2), 198-222.
Agamben, G. (1998). Homo sacer: Sovereign power and bare life. Stanford University Press.
Desjarlais, R. R. (2011). Shelter blues: Sanity and selfhood among the homeless. University of Pennsylvania Press.
González, F. J. (2020). First world problems and gated communities of the mind: An ethics of place in psychoanalysis. The Psychoanalytic Quarterly, 89(4), 741-770.
Kristeva, J. (1982). Powers of horror (Vol. 98). University Presses of California, Columbia and Princeton.
Gherovici, P., and Christian, C. (Eds.). (2018). Psychoanalysis in the barrios: Race, class, and the unconscious. Routledge.
Librett, J. S. (2019). The subject in the age of world-formation (mondialisation): Advances in Lacanian theory from the Québec Group. In Aner Govrin & Jon Mills (Eds.), Innovations in Psychoanalysis (pp.75-99). Routledge.
Throop, C. J. (2022). Looming. Journal of Critical Phenomenology, 5(2), 67-86.
In writing about class divisions within psychoanalysis and what a gift economy affords this problem, I utilize a spinning method of knowing. This is similar to “yarning,” the collective knowledge and decision making conveyed in the book Sand Talk (Yunkaporta, 2020), or “weaving” multiple lines of knowing together, as put forward in Braiding Sweetgrass (Kimmerer, 2013). These examples represent Indigenous forms of knowing, which are not one-directional and are altogether less linear than Western argumentation. Although I am a white woman and have no claim to direct Indigenous knowledge streams, the form they take is recognized to be innate. The decentered form is one I find necessary to developing a model of psychoanalytic care that blends the logic of the gift economy with the current realities of the market economy, and spinning is the way I have come to understand it. By spinning, I mean to suggest a knowing that comes through circularity, a deep connection to multiple threads in a repetitive, recursive fashion. Such as: What is experienced in mothering? As a citizen affected by, and capable of effecting, public policy? In being part of the more-than-human world and observing
natural processes? In clinical work, with each case bringing its own idiosyncratic language? From our subjective centers, we can remain grounded yet spin through all of these experiences and identities which in turn shape a psychoanalytic vision. In this spinning form itself there is a gift—back and forth—without expectation but nevertheless with generativity.
For starters, what is a gift? Here I follow on Genevieve Vaughan’s (2015) work on the maternal gift economy. It is distinct from the market economy based on monetary exchange and value determined by supply and demand. Rather, a gift economy is based on a recognition of community, disbursement of resources in the community in real time according to who has need and who has excess, and a connection to the inherent and unique value of gifts themselves that cannot be reduced to money. Vaughan’s theories are based in anthropological studies, while also offering a critique of the gift as it has been studied in the patriarchalized anthropology of Mauss and others who followed him. Gifts, she argues, do not expect a return. They
Tracy SIDESINGERare a precondition for the other’s survival and depend upon the care one can give to another. In bringing a long-neglected maternal sensibility into economics and anthropology, Vaughan considers the real possibility of a unilateral gift that expects no return, the necessity of mothering and being mothered, as foundational to social life.
Furthermore, need for the other is not something that occurs only in infancy, but follows us in different ways through life’s development. If you consult a financial advisor in the market economy, you will almost certainly receive advice as to how to accumulate and hoard wealth for yourself and your direct lineage. This is premised on the idea that there is no hope of care for you and your family outside of monetary exchange; you forego interpersonal need for a large bank account. By contrast, the maternal gift economy is premised on distributing excess in the present moment according to need. Excess yield, it has been said, need not be stored in private silos where it can rot, but in the bellies of one’s neighbors, where it can see its fullest value realized (Vaughan, 2017/2019). Value, through the gift, never exists in the token,
but in the other themselves. We don’t have to expect a return of our value if we see that it is already there in the one we have given it to.
Such an orientation is hard to fathom inside a market economy that focuses on scarcity, fear, and safeguarding one’s own resources. What if I see value in the other, but no one sees it in me? Dare I be the first one to give? Even if we theoretically believe in unilateral gifting, it is a stretch to consider it professionally. How will we make a living? How will we pay our educational debts? How will we take care of ourselves as we age? Let us pause those private questions for a moment to consider collective need, and where value might lie at times more in the other.
When I’m not working, I often follow a fascination of forests and the interconnected tangle of trees and mycelium. Suzanne Simard (2021) studies the collaborative nature of this web. In her book Finding the Mother Tree (arguably another iteration of the maternal gift economy) she posed a question that stopped me in my tracks: “What were the fungal threads of this odd-shaped mushroom doing, and how were they helping the coral fungus make a living?” (Simard, 2021, p.49). That turn of phrase, to make a living, seems to mean something entirely different in the context of a forest than that of a consulting room. Or does it?
Obviously, nothing in a forest is making money (not for itself, at least). The living to which Simard is referring has to do with vitality. Moreover, in her observations of species helping each other make a living, she has demonstrated that trees don’t only look out for their own survival or even that of their own kind, but that they collaborate to support others in their ecosystem. For example, water and nutrients can be carried from mature trees through mycelial networks to younger trees of various species to aid in their development. So at least in some corners of the world, making a living doesn’t have to do with money, and it doesn’t have to do just with oneself.
In psychological and analytic corners, however, we feel the tension between generating wealth and contributing to vitality. I don’t want to suggest that our profession as a whole operates against vitality to the extent that we are engaged in financial exchange. We can’t bypass the systems of our civilization. However, the dictum that “the rich are getting richer and the poor are getting poorer” can only grow more true the longer capitalism continues, where wealth is built from legacies and investments that expand prior wealth, fees are set by those competing to survive on top, and those who have no wealth to build on get drowned out.
Is psychoanalysis only for the wealthy?
Recently, this question has received more attention as the community psychoanalysis movement has experienced a resurgence. In Freud’s Free Clinics, Elizabeth Danto (2005) showed how in its early years, psychoanalysis was practiced as an agent of social change intended to be accessible to all, based significantly on the assumption that everyone has an unconscious. It is neither the origins of analytic work nor the inherent structure of the mind that necessitates class divides; rather, our acceptance of the capitalist model has furthered the divide between those who can and those who cannot experience psychoanalysis. Private practice itself isn’t the enemy; but as it becomes increasingly the last place where psychoanalysis can be found, it can’t benefit anyone but those who are able to pay for it themselves.
Are Class Divisions the Last Frontier in Psychoanalysis?
Many things can be said to be the last frontier of psychoanalysis: gender; race; religion; class. All of these are routinely kept out of the canon of psychoanalysis, despite the ways the profession as we know it is constituted by certain positions around them. There are journals and departments dedicated to gender in psychoanalysis, and yet how we understand gender identity or the mother’s position in Oedipal development is fraught. Even among training institutes that intentionally strive toward a diversity of voices, BIPOC candidates are hard to recruit, not seeing themselves reflected in theory or practice, and historically even considered to lack an unconscious (Stoute, 2017). Freud’s The Future of an Illusion (1927/1961) established religious belief as pathological and childlike in a way that we have not recovered from, despite a swelling mysticism in the field (Grotstein, 1981).
Psychoanalysis no longer has a unified theory. In my understanding of psychoanalysis as working in an unconscious that is multiple and fundamentally beyond total knowability, there cannot be a single theory. Unified theories sustain their unity by force of domination and repression. Theories of difference are thus required. Furthermore, how we understand where differences arise, and what we do with difference, are the significant issues.
What about class difference? Do we believe in clinical practice that class difference exists, or do we pretend it doesn’t, assuming that anyone who needs treatment can get it at the market rate? Do we believe that class differences are innate, and anyone without sufficient funds to seek treatment at the market rate doesn’t have the mind to benefit from it anyway? Do we believe that class difference exists as a problematic cultural construct, but turn a blind eye to it so that we can keep afloat in our own private lives?
I suggest that class is yet another underexplored facet of psychoanalysis. In our failure to explore class divisions, we both deny the interpersonal role culture has in constructing difference and remain inured to capitalism as the rules of play.
But what kind of difference is class? I do not believe that class differences are innate aspects of identity. Herein lies the distinction between identification and identity (see Zong, 2021 for a historical discussion of these terms). In my view, identification is a social-interpersonal construct that may be internalized, whereas identity is what remains in an individual authentically even as the social layers are worked through. Class distinctions are identifications writ large; they are defined by one’s relationship to the collective perhaps more than any other. This is what makes class—and therefore the accessibility of psychoanalysis across class divisions—so hard to talk about in a field which has tended to think of minds in isolate form, identity and identification being one and the same. Because the social-interpersonal construction of class is so strong, it may well be the final frontier in psychoanalysis, which is now also rediscovering multiple layers of external reality that are relevant to the internal mind.
Just as no single theory can make sense of all psyches, no aspect of identity is the total fundament of being, and I stand with others who see an intersectional approach as necessary to understanding identity in the individual and the collective (Kanwal, 2021; Butler, 2006). Theories that expand our understanding of gender and race as culturally constructed also force us to move the needle on how we understand class identities and the degree to which we see collective, external determinants of such identities as relevant. Indian psychotherapists have begun to address the complex issues of class and religion as a necessary response to early psychoanalytic thought in India, which was aligned with the hierarchical and oppressive caste ideology (Davar, 1999). Theories being developed by others in areas of explicit oppression and classism are no less relevant for those of us who have class mobility. In the United States, our American dream is a reinforcement of classist division, albeit with the built-in illusion that we can achieve victory if we exclude others enough.
Not only does oppressive classism occur in public life, but it is also endemic to the fabric of European and American psychoanalysis; in the language of Lynne Layton (2020), we are implicated subjects even if we are not directly causing harm to identifiable others or acting out of malevolence. Here, I follow the guidance of Hassinger and Pivnick (2022), who respond to this implication not with blame but with curiosity as to how to care for the well-being of others given the ways we are each uniquely situated in society.
Addressing blindness to racialized identifications, Stovall (2019) discussed how whiteness has been left out of psychopathology training and is routinely avoided on the analytic couch, yet it exists as an influential group cultural reality. Also speaking of race, O’Loughlin (2020) considered the ways racialization is deeply embedded in the psychoanalytic imagination, centering whiteness and otherizing non-white experiences and structures of mind. While these authors consider race, perhaps the same could be said of class: there is a significant group cultural phenomenon that conveniently evades individual scrutiny.
Where we do consider financial issues of a treatment, it is likely to be on a personal level and not a systemic one. In an economy of supply and demand based on scarcity, might we instead wonder how one person’s having is premised on another’s not having? Why don’t we? Several contemporary interpersonal analysts including Kuriloff (see Fuchsman, 2022) and Philipson (2017) have discussed the ways in which survivors of World War II shaped an individualistic psychoanalysis as it defensively protected them from confronting the too-raw traumas of social influence. This war led to a diaspora of analytic minds; the closure of many free clinics, which were developed after the first World War to create social change through analytic engagement (Danto, 2005); and a concurrent doubling down on psychology as intrapsychic. All of these forces together reinforced the privatization of care. We have turned our eyes away from social forces for too long, understandably because sometimes it has been too hard. But it is also the case that not contending with the social forces influencing class inequities is tantamount to compliance with and adherence to classist domination. We have a choice about what we are willing to sacrifice here.
In Eula Biss’s (2020) collection of personal essays, Having and Being Had, she explores capitalism, work, and class by interrogating troubling facts, such as the extractive source of the Guggenheim Foundation funds that enabled her to do her work. In it, she painstakingly observes how capitalism is built on an ethic of exclusion, a system of hoarding wealth and having more than one needs to prove one’s value as a matter of comparison against others. Of the title, we can imagine she refers to the individual compulsion to work and possess increasingly more capital, which has us instead; but we can also imagine a more collective interpretation, referring to those who are had as pawns in a game, left to suffer as if their psyches did not matter.
Who, in the working through of an analysis, would release themselves from social class identifications to recognize themselves as inherently “poor,” “middle class,” or “wealthy?” Seeing that class is something constructed,
categories remaining outside of identity; we may well have to see the individual beyond the intrapsychic and do something external to the consulting room to address it.
Eric is a white, unemployed gay man who is sustained by a trust fund. He originally came to treatment to deal with traumatic losses in his family, for which he saw himself as “cursed.” For many reasons, he felt unacceptable and even poisonous to others. He was harassed for his sexual orientation. Several years into treatment, however, it became clear that despite all of these concerns, the most shameful and hidden identification for Eric was his wealth. This was the single issue that he refused to tell his friends about. He was entrusted with decision making about his family’s charitable giving, but this only caused more angst. He saw the social divide between those who were socially conscious (his friends) and those who were
she writes, “The economy of the economists is a false slice of life.”
Jessica shares with me a recurrent thought after years of working together: “Therapy is bad for my mental health when I have to figure out how to pay for it.” She is one of many patients who don’t want to devalue therapy by paying a reduced fee but spends more time than she can afford fighting her insurance company to reimburse her according to their stated policy.
And lastly, Theresa sees the conversation of family wealth as pertaining to more than just her family. She refuses her family’s offer to pay for her graduate school tuition, which they see as a gift that only makes sense to be given to her. Wealth is a legacy they didn’t have the benefit of as immigrants. They worked hard to achieve this legacy for their children, so they see Theresa as the rightful recipient of it. Theresa, in contrast, wonders about her peers. Why does this legacy not belong to them? Why, when her rent is already paid for, should she have an extra boon above her classmates? She read her family’s financial gift not only as a token between parent and child, but as a communication in collective space about who does and does not deserve resources. After long deliberations, Theresa decided to sever herself from all her parents’ financial resources at age 26. This also meant she was only able to pay one-sixth of the fee she had previously paid me.
wealthy (his family) as irreconcilable. Eric’s unease about accumulated wealth suggests that class divisions need to be addressed inside his mind as an individual, while also pointing to a larger problem of polarization in the collective.
Amy is also divided about her class identifications, though seemingly from the other side of the chasm than Eric. She received governmental assistance to feed her family, and when this was revoked, she began to shoplift from grocery stores. She is troubled by the fact that she looks wealthy (and white) enough to not be suspicious, because she wants others to have the same opportunities she does. Wanting to believe that there are enough resources to be distributed evenly, she collapses her class conflict and resigns herself to thinking, “Maybe I just don’t understand economics.” Vaughan (2015) has a different answer for Amy when
Here, I find myself at the crossroads of making wealth or contributing to the vitality of another. At the moment when Theresa asked to reduce her fee, she recalled that she went out of network to get adequate care when she was having a life-threatening breakdown. At that time, she remembers her therapist troublingly offering her smoothie recipes to help her cope with wanting to die. I see that she is worried about a flaccid response to her great need, whether from her parents or from another provider who is lowfee or low-value. To find vitality, she needs a way out of the market economy she knows. The most important thing I can bring to this equation isn’t measured in dollars.
Many readers may recognize themselves in providing pro bono and sliding scale fees for some. We often frame this as an exception to the rule of our standard fee. Instead, might we see this as the beginning of a new rule?
Practicing a psychoanalysis that addresses class divides means not only providing free or pro bono therapy for some, compensated by higher fees from others, but also by bridging these disparate identifications in our consulting rooms. Working with people of different class backgrounds who see each other in the same waiting rooms, who engage in group work and face their unequal class standings with one another. While the foundations of a gift economy may seem idealistic when we have become accustomed to capitalism’s profit drive, and while
…what we do with excess is the difference between a market economy and a gift economy, between a starving psychoanalysis and one that can help culture thrive. A market economy depends upon scarcity (lack), whereas a gift economy is predicated on having more than one needs (excess)…
there is no easy transition to a psychoanalysis that confronts classism, this transition is already alive in the minds of our patients.
Analytically speaking, we are psychologically composed to have not only lack but also excess. We long for what cannot be fulfilled, yes; and we also experience more than we need, but it is excess that has been pathologized and misunderstood in psychoanalytic theory. I have written elsewhere about a feminine return to excess as necessary to experiencing multiplicity without domination (Sidesinger, 2021). Here, I would like to take that argument one step further to suggest that what we do with excess is the difference between a market economy and a gift economy, between a starving psychoanalysis and one that can help culture thrive. A market economy depends upon scarcity (lack), whereas a gift economy is predicated on having more than one needs (excess) and therefore the ability to place that value in the other. Excess is not the chaotic original past that needs to be separated from the present reality of lack; rather, they are true in parallel, in pragmatic and enigmatic ways.
Here, I need to tell you the story of my home, because my home itself is a gift of excess that holds me and allows me to hold others. Shortly before Covid erupted, I went looking for a home in the Catskills where my children and I could have a long-term respite away from our unpredictable Brooklyn life. I didn’t really have the money for it, but with uncanny timing and the combination of a persuasive realtor, a contractor friend, a thoughtful seller who saw my potential for carrying on the home’s legacy, and an unexpected loan from my mother, one of the oldest homes in the region came under my care. I was told several years prior by a financial advisor that I would never have enough money to buy a home under the existing circumstances. Some might have suggested that what I needed wasn’t a home, but to reckon with my lack. However, a home and more came to me in a way that is beyond reason. I learned that it used to be an informal inn when there were no other homes nearby, which explains why it feels so natural to host retreats and friends. The longer I live in this house, the more I experience how not only is it under my care, but I am being cared for by the land, the house, and the surrounding community.
In this home, I have the security like never before that I am loved, full stop. Out of this security flows the potential to be stability and love. Other people experience this in different ways: in the abiding presence of a parent, a partner, a community or workplace in which there is a strong sense of belonging and acceptance. However, one knows that they are held in this life is a gift. For me, it
is my home and the land that gives a sense of belonging. Psychoanalysis ought to give us the tools to reckon with where we have not had love, where we crave it because we are ashamed of not being enough or of being abandoned, but not by way of further deprivation. It ought to help us find our solidity wherever it does exist. Can psychoanalysis give us that? Can we be solid enough in ourselves to know that what we have to offer is a gift, and not demand a return from it?
Eula Biss says that everyone practices a gift economy for those they consider to be in their inner circle. Those lines, however, seem increasingly drawn around the individual or perhaps the nuclear family, in contrast to the coded laws and tokens of exchange that grow out of living in unfathomably large civilizations. How we open back up the parameters of who we consider to be part of “us”—who we consider our community, and how large of a community our human minds can tolerate—perhaps needs to be another discussion altogether. For now, let it suffice to say that I believe the containment of a nuclear family is an illusion to the extent that our psyche’s excess extends beyond a few people. Our larger communities already contain much of our identifications projectively and have the capacity to contain and receive far more if we expand our conscious identities to include them.
My main premise is this: I have been given many gifts, even in nonlogical ways from the land and people around me. I am taken care of and I have more than I need. I don’t see life as scared or as scarcity. With this security, I trust that I will continue to be taken care of, and on that basis, I am free to take care of others.
To be clear, this is not self-sacrifice or martyrdom. It is not punishment or naivete. Practicing a gift economy is trusting that there is enough for all parties and acting out of that trust as both recipient and giver. It is based in the fact of excess. Sometimes we find ourselves with more than we need. What do we do with it? Do we hoard it for some future version of ourselves, fearing that we won’t have enough then, but failing to realize that money is a false guarantee of security? Do we hoard it for our children, enlarging our gift circle just the tiniest bit, so that they can benefit more than our neighbors from what we accumulate? Do we buy nice things or have nice experiences for ourselves, exchanging money but still keeping it to ourselves? As a child of the market economy, I admit to doing all of the above. But increasingly I realize there is more than enough, and that another economy exists in the space of excess. That is the economy of giving, which reinforces and adds sinew to the circle of trust. Not everything can be bought, after all.
In graduate school, I was taught principles of psychotherapy in a form that was insulated from any reality principle. I need not criticize my graduate program in specific, because this is common practice. Learning how to be a therapist doesn’t include considerations of how to earn a living, i.e., how to set the fee and ensure oneself a living wage within private practice, or where one can do sustainable clinical work that isn’t private practice. I spent my first decade as a clinician learning how much I got taken advantage of and could build resentment when I didn’t charge a fee commensurate with the attention put into my work, and then of how rewarding it could be for everyone involved when I did. I learned how to find my true value in a market economy.
But what about the original urge to offer what I saw to others in their suffering, simply because I saw it? To not link work and money? To see the cure as rooted in love? Are those urges only naivete and martyrdom? In their infancy, there was always the germ of something more. What led to resentment in early work is partly that I allowed patients to take the gifts of therapy without honoring its relational components. It’s time to return to the original desires many of us had in choosing to enter psychotherapy and analysis, this time not from a position of self-sacrifice, but of strength. I am not interested in representing a profession that is either misaligned from dominant culture because it does not know how to communicate its value there, or that is overly identified with a dominant capitalistic culture. I am interested in a psychotherapy like that of the analysts of the 1920s and 1930s, which can offer its unique value to shape society.
I write to you while engaged in my own seeking how to flesh out this archetypal reality, not from having found the answers. How we reenact a maternal gift economy within psychoanalysis is a work in progress that needs many minds. However, the most effective how starts with a why, and if the reason is grounded and important enough, we will find a way.
Primarily, we are concerned with making a living; that is, supporting work that is conducive to meaningful living for ourselves and the entirety of the communities we can effectively broaden ourselves to. As my clinical examples have shown, this work of disrupting classist structures and seeing excess and need simultaneously occurring is already happening in the psyches of our patients. Theory emerges of necessity from experience.
Examples abound, if quietly, of those who practice analytically out of a maternal gift economy ethic that excess is to be given and that value inherently resides in the other. In researching how to develop a community-based psychotherapy center, I’ve spoken to many who offer psychoanalytic therapy within community mental health settings but do so
in the shadows so as to avoid being ostracized by managed healthcare models, and many others who provide low-fee therapy on a oneoff basis in private practices. For example, the Kedzie Center in Chicago is partly funded by local taxpayer dollars, and the Greene Clinic in Brooklyn has a robust private group practice model of sliding scale fees to make it possible to serve the community broadly. Deborah Luepnitz (2008) has written about her work with homeless and very poor individuals as well as the super-rich in Philadelphia. Freud’s Free Clinics were supported as part of an accepted social progressivism; today, we find more of these offerings connected to religious charities or societies that tend toward sharing social burdens that therefore resolve some of the issues around funding. In the United States, we find ourselves at a crossroads of needing to do things outside of the consulting room to change what can happen inside of it.
The particular realities of classist divisions take our work beyond the individual. The psyche is interpersonal and relational, put upon with identifications from the social-historical realm, which affect who has access to care and what constitutes that care. If we truly want to work in the complexity of individuals, it behooves us to work toward expanded governmental and social support for therapies of depth and parity in psychological healthcare. We have all been variously afflicted and privileged by what happens at
the social level of engagement. And we have the benefit of trauma survivors, including Holocaust survivor analysts, to know the limits of what happens when social impact is only privately held or dissociated. In this new tumultuous time, we have more tools to envision the psyche and therapeutic engagement as also part of a social collective.
Class divisions have too starkly defined what is possible in psychoanalysis and who can access it since World War II. Seeing now that our minds are built around lack as well as excess, the maternal gift economy suggests that we have more to give than we realize. As analysts, we are uniquely attuned professionally to interpersonal need, and must therefore create a structure of care, financially and psychologically, that is consistent with seeing and meeting such need. It is possible to operate from a place of our own emotional security and attunement to create models of community alive in the collective unconscious, to be leaders in living a gift economy forward. If meaning and value are fundamentally inherent in each one of us, let us find a way to restore our recognition of value there. z
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The Mangrove Notebook Carlos PADRÓN1. Jean-Luc Nancy says that the individual is the residue of the erosion of community.
2. Nancy argues that two things negate community:
l the idea of an individual that is taken to be the point of departure of the common which decays into the atomization and privatization of experience (liberal, capitalist democracies)
l the idea of a fused collective body, which results in undifferentiation (real communisms).
Against these “betrayals of community,” he poses the thought that being in common has nothing to do with communion or individuals gathering to participate in a group of shared interests or characteristics.
Historically, these forms of organization have been based on a substantial, fixed identity of either the individual or the collective; the outcome has been different forms of totalitarian societies (past Soviet communism
or contemporary fascist capitalism, for example). This phenomenon is what Édouard Glissant calls the “totalitarian drive of a single, unique root.”
Roberto Esposito says that thinking about community is today more necessary than ever given the “failure of all communisms” and “the misery of new individualisms.”
3. Esposito asserts that community is not a “wider subjectivity” or a “unity of unities.” He says that this idea stems from a concept of the subject as absolute unity and interiority. Community, according to this perspective, is therefore a “property belonging to subjects that join them together: an attribute, a definition, a predicate that qualifies them as belonging to the same totality, or as a substance that is produced by their union.” The subject, individual or collective, taken to be “full” or “whole,” produces a notion of community as that which reflects “what is most properly our own.” Normally, this is related to some definition of the human or of humanity (language,
territory, etc.) In this sense, through community we gather what is most common to all of us and “communicate what is most properly our own.” Community, according to this thinking, which Esposito criticizes, is related to the proper, to property and to appropriation.
4. But if the common is that which unites the varied properties of the members of a community, then they must all have in common what is most properly their own. Esposito says, “they are the owners of what is common to them all.” The most proper (my own) is what is most improper (not my own). This is the starting point of a new thinking of community.
5. The common is not characterized by what is proper but by what is improper, by what pertains to more than one: what is public or general in contrast to what is private and individual, says Esposito. That which is common, public, and general is not a property but rather a debt and an obligation to the other, as well a
gift that is to be given to the other, all of which “establish a lack.” Esposito says:
“I owe you something” but not “you owe me something.” This is what makes [the subjects of community] less than a master of themselves, and that more precisely expropriates them of their initial property (in part or completely), of the most proper property, namely, their very subjectivity.
What is given as a gift, debt, or obligation is the voiding of one’s own subjectivity and its exposure to become other, improper. Psychoanalysis might say that what we share is our constitutive lack.
6. Community is not a fully structured body full of individuals. It is also not a place of mutual, intersubjective recognition, says Esposito. Rather, community is that which interrupts the possibility of suturing the subject, of it returning upon itself; it is that which turns it inside out, exposed to the other: “a dizziness, a syncope, a spasm in the continuity of the subject.”
7. It does not escape me that there might be a relationship between the impropriety of community and the impropriety of the subject of psychoanalysis. I wonder if we could think of the unconscious as the impropriety that is shared, the being inside out, the exteriority that is the most interior, the exposure to the other. If community, according to Esposito, produces “a dizziness, a syncope, a spasm in the continuity of the subject,” which is also what the unconscious has the capacity to produce in the subject, then: could we talk about a community of the unconscious, a community of dreamers who dream awake, as it were?
8. A dream continues to live and change when we tell it to an-other; like it demands circulation or contagion. Unconscious life flows between us through the hidden vessels of the words we use to share our dreams. There is a secret history of the world in concert with the world we see.
9. Interpreting Jean-Luc Nancy, the present tasks of being in common are:
l des-identification with fixed social roles (worker, parent, psychoanalyst, etc.)
l sharing a constitutive lack (of identity)
l being outside oneself and open to otherness (ecstasy)
l sharing what I don’t have, or what the I doesn’t have
l experiencing the experience of sharing which is a relation
l un-working, or working away from, the possibility of falling into substantial essences (individual or collective).
Play is fundamental here. It is an intermediate, transitional, liminal area of experience that represents a threshold between the beginning of a process and its completion. The unworking of community through play means working against any completion of the process of community and striving to stay at that threshold of experiencing. Winnicott says that play is a third area of experiencing, where inside and outside become indistinguishable or irrelevant: it is a way of being outside one’s self, a state of ecstasy. Just look at a child playing.
10. A community is a multiplicity of dynamic, unconscious relations that crystallize in—riffing off Gilles Deleuze’s terminology—generic singularities: a person, a tree, a dog, a school, a union, etc. Generic singularities are both unique and non-specific: they have no existence outside a relational matrix, and they are ecstatically open to otherness. A community is multi-
subjectivity and of its own praxis. The two are intimately intertwined. The model of the private office, as well as that of psychic suffering having its source mostly in intra-psychic conflicts, go hand in hand. This psychoanalysis has a model of the mind as a private consultation room. A community psychoanalysis disrupts this structure and its series of unthought equivalences.
12. A community psychoanalysis confronts the private, Cartesian “I think, therefore I am” with the “I was loved, therefore I am.” The subject presupposed by a community psychoanalysis is preceded by Eros and community and opens itself to them. The subject, fantasized as private within a certain institutionalized American psychoanalysis influenced by capitalism, finds its space in the other, in the space of the public, as we saw in talking about community. As Todd McGowan claims, “capitalism reverses the actual chronological relation of public and private. The subject first comes into existence as a public being and subsequently establishes a private world in which it shields itself from the public and fantasizes its isolation from others.” American institutionalized psychoanalysis has, with honorable exceptions that confirm the rule, fallen prey to this dynamic and forgotten that Eros is a force that binds and differentiates us publicly together. We cannot forget that the subject is a mournful being constituted by something that precedes it, names it, constituting it through the loss and lack implied in having been loved and loving back.
ply rooted and multilingual, says Glissant, a “rhizome of a multiple relationship with the other” which bases community on a “poetics of relation.” A community psychoanalysis drinks from the poetic source of multilingualism. It confronts the discourse of the Single Root with the poetic praxis of the Multiply Rooted Mangrove. In this sense, it is a critique of what I would call “technical psychoanalysis,” its private language and praxis, and its self-imposed mystification.
(A community psychoanalysis is a generic singularity that assumes the tasks listed in note 9—hence a community psychoanalysis and not community psychoanalysis as a substantive entity or concept. There is no space here to spell out each task and its relation to a community psychoanalysis; moreover: the connections between the latter and the new thinking on community of both Nancy and Esposito. Here I only offer some general ideas to be further developed in the future.)
11. American institutionalized psychoanalysis has had both a privatized model of
13. A community psychoanalysis takes psychoanalysis, and its notion of subjectivity, outside the realm of the private and moves towards a place of encounter, exposure, and ecstasy with what lies beyond, outside, other, with what is multiple and multiply rooted, with the ungraspable and improper realm of the common. I believe that, for a community psychoanalysis, the point of encounter, that which links it to what is other, is the experience of a suffering world.
14. Working on your “inner racist” (but we could also say: transphobe, homophobe, misogynist, etc.) is not some mysterious inner work that you do in the solitude of your room. Working on your inner racist means openly engaging with racialized others or the others who have been suppressed or attacked on account of their race: listening, asking questions, letting things get messy and confusing, making mistakes and fucking it up, being open to being corrected and changing your mind, getting hurt and hurting others who might get angry at you. It is a public engagement with the social world, not a private retreat into the self.
15. I remember that Simone Weil said that attention is a form of prayer. So maybe paying attention to the living is akin to
A dream continues to live and change when we tell it to an-other; like it demands circulation or contagion. Unconscious life flows between us through the hidden vessels of the words we use to share our dreams.
praying to the dead. Caring for those who live, their suffering, is a form of remembering whom we lost, of claiming their ancestry, their deeds and aliveness as ours. Praying, caring, and inheritance are interrelated tasks.
This is perhaps a way of interpreting Hans Loewald’s saying that psychoanalysis has to do with converting our ghosts into ancestors.
Without our dead, we’re just a gang, not a community. Community is also an engagement with the community of the dead.
16. We stand on our own feet but also on the feet of our dead.
Maybe they’re the same feet. There is no such thing as “our own” when it comes to human subjectivity and to community. Only otherness and history.
17. The psychoanalytic process is not only a mirror of the world but also a part of it and its history. It does not occur in a historical or socio-political vacuum (the private office fosters this fantasy). The difference between the analyst and the analysand in terms of class, race, or gender, for example, will be a carrier of intrapsychic meanings, but it also defines a historical and socio-political reality in which they are both immersed and that constitutes their subjectivities and their relationship. It is a reality that is unavoidably enacted in the psychoanalytic process in unconscious ways that require attention. This remains the unthought of many analysts who are too anxious to talk about it because it might undermine their power as “doctors” or their position as the ones who are supposed to know; their power.
The transference-countertransference matrix is not only the repetition of personal history; it is also the repetition of collective histories. The question is how to think the personal and the collective together, as relation. Community might be a third, intermediate, transitional space that articulates this polarity.
18. There is an unconscious knot that the psychoanalytic process illuminates for understanding: the constitutive relationality between the mind and the world, the intimate link between the socio-historical dimension of the world and the internal dimension of subjectivity. We might say: between what Loewald calls the inter-psychic and the intra-psychic. The configuration of the knot, always singularly crystallized in each person, manifests itself both in speech and action within the psycho-social space of the analytic field. It is a simultaneous recreation of:
l the unconscious structure of the analysand’s suffering in the world
l the unconscious structure of the world that produces such suffering
In this sense, the psychoanalytic process deals with both individual and societal issues; alienation is one.
19. Interpretations should not only be about personal intra-psychic dynamics but also about inter-psychic ideological ones. Ideology is, too, a clinical phenomenon.
20. For psychoanalysis there is a continuum between what we call “nature,” what we call “mind,” and what we call “social world.” This is evident in Freud’s Civilization and Its Discontents, for example. The three are mediated by what Gilbert Simondon calls pre-individual and trans-individual processes which produce both psychic and collective individuation. It is important to note that individuation, for Simondon, is a never completed process. Interestingly, he says that “it is necessary to break the link that
Without our dead, we’re just a gang, not a community.
Community is also an engagement with the community of the dead …We stand on our own feet but also on the feet of our dead. Maybe they’re the same feet. There is no such thing as “our own” when it comes to human subjectivity and to community.
connects being with individuation, identifies all beings with a being, with the individual.” Again, the individual cannot be a point of departure. Pre-individual and trans-individual processes constitute an “obscure zone,” he says, insofar as they have been unthought within the dichotomic conceptualization of the individual and the collective, or the individual and community.
21. Psychoanalysis has concepts to think about the obscure zones of passage between the different realms of reality; between subjectivity and community, between mind and body, between I and other.
For Hans Loewald, early, or pre-individual, integrative processes constitute/differentiate the mind-world. In this direction, Loewald says,
Projective-introjective processes, which are elements of the still rather obscure complex of integrative activities we call fantasy, continue in more highly differentiated forms to operate in the development and elaboration of reality during man’s [sic] lifetime. Otherwise reality would be static.
This means that these pre-individual processes (which he interestingly also calls
“obscure”) continue to individuate both the psyche and (social) reality in an always dynamic way, moved by a state of constant flux, which might crystallize into a set of possibilities and relations which conglomerate around an open-ended individuation thought as potentiality.
Integration and differentiation are the work of Eros. Eros, according to Freud, is a force that traverses all the living: mind, nature, community. In this sense, the individuating processes Loewald talks about are also trans-individual. The trans-individual that also individuates both the psyche and social reality is not a wider subjectivity to which individual subjectivities belong. It is a process, not an essential, fixed, state of being. Just like Eros, it is an impersonal force, a reserve of becoming, says Simondon.
22. In Rabe’s 1785 novel, Baron Munchausen pulls himself and his horse out of a swamp by his own ponytail. This can be seen as the fantasy of the mind conceived as a private entity being able to lift itself out of self-ignorance into pure clarity without the need of the other. As if the self could become fully transparent to itself, as if we were private islands and not communal beings constituted by lack and by the sharing of that lack. It is also an image of subjectivity as my own property. It is an avoidance of the swamp (of community), those transition zones between the groundedness of earth and the fluidity of water; it is an avoidance of its messiness, its capacity to suck you in, its heterogeneity, and its density.
In this sense, it is an image of today’s self-help consumerism, commodification, and branding of self-care and constant “healing,” me-culture obsessed with one’s body and self, narcissistic self-definition, and individualism disguised as autonomy. A community psychoanalysis confronts this Zeitgeist but must be careful of not becoming one more form of capitalist commodification and branding, or a manic search toward reparative action, or what James Baldwin called “virtuous rage,” a state that is less motivated by a true and ongoing concern for the other and more “by a panic of being hurled into the flames, of being caught in traffic with the devil.”
23. Community and psychoanalysis say: we will never know who we are until we make ourselves a question to the other. The other as Oracle. Then we become a question to ourselves.
24. I end with Édouard Glissant: “sometimes by taking up the problems of the Other, it is possible to find oneself.” This implies that we are all lost, and especially lost without the other. z
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Sergio Benvenuto is a psychoanalyst and philosopher. He is researcher at the National Council for Scientific Research (CNR) in Rome, Italy. He is the president of Institute for Advanced Studies in psychoanalysis (ISAP) in Italy. He teaches Psychoanalysis in the Intern. Institute of Psychology of Depth in Kijv. Since 1995 until 2020 he was the founder and the editor of EJP. European Journal of Psychoanalysis, and he is member of the Editorial Board of American Imago and Psychoanalytic Discourse
Dr. George Bermudez, Psychologist-Psychoanalyst, Training & Supervising Psychoanalyst at The Institute of Contemporary Psychoanalysis Los Angeles, and 2020-21 Visiting Scholar at the Psychoanalytic Institute of Northern California (PINC) has developed pioneering scholarship and practice –an expansion toward a social psychoanalysis–exploring the “social unconscious” through “social dreaming”.
Marisa Berwald, LCSW, is a practicing psychoanalytic psychotherapist, pursuing a doctorate in cultural and psychoanalytic anthropology. She conducts ethnographic research on the discipline of psychoanalysis, tracking how it shifts in response to changing aspects of human subjectivity in the Anthropocene.
Martha Bragin, LCSW, Ph.D. is jointly appointed Professor at the Silberman School of Social Work at Hunter College and the PhD Program in Social Welfare at the Graduate Center of the City University of New York. Dr Bragin is a Fellow of the Research Training Program of the IPA, and the editorial board of the International Journal of Applied Psychoanalytic Studies. She serves as a member of Inter Agency Standing Committee (UN-IFRCNGO) Reference Group on Mental Health and Psychosocial Support in Emergency Settings, a globally representative body that sets and monitors standards for psychosocial interventions in emergencies. Representing the International Association of Schools of Social Work at the United Nations. She is the author of numerous peer reviewed publications and is in private practice in New York City.
Nancy Burke, Ph.D. is a psychoanalyst in Evanston IL. She is Vice-Chair of EMHS-NFP, the Kedzie Center’s Board, and is a core faculty and board member of the Chicago Center for Psychoanalysis, Associate Clinical Professor at the Feinberg School of Medicine of Northwestern University, Founder of PsiAN, Secretary and Board member of ISPSUS and ABAPsa, active in SPPP’s Public Affairs Committe, and member of the 606 Project. Her writing has appeared in various psychoanalytic and literary publications.
Fernando Castrillón, Psy.D., is a practicing personal and supervising psychoanalyst, faculty of the Psychoanalytic Institute of Northern California (PINC), a licensed clinical psychologist, Professor Emeritus at the California Institute of Integral Studies (CIIS), and the founder of the Foundation of California Psychoanalysis (FCP). He is also the founding director of CIIS’ The Clinic Without Walls, an innovative psychotherapy clinic serving mostly poor and immigrant communities. Dr. Castrillón is the Editor-in-Chief of the European Journal of Psychoanalysis and a member of the Istituto Elvio Fachinelli ISAP (Institute of Advanced Studies in Psychoanalysis) based in Rome, Italy. He is the co-
editor of two books and author of numerous articles in Spanish, German, Italian, Russian and English and is currently writing a multivolume work on psychoanalysis and California. www.drcastrillon. com, www.journal-psychoanalysis.eu
Elizabeth Ann Danto, PhD, is professor emeritus, Hunter College of the City University of New York. She is an international lecturer and prize-winning author of Freud’s Free Clinics - Psychoanalysis & Social Justice, 1918-1938 (Columbia University Press 2005), Historical Research (Oxford University Press, 2008), and co-editor of Freud/Tiffany - Anna Freud, Dorothy Tiffany Burlingham and the ‘Best Possible School’ (Routledge, 2018).
Rossanna Echegoyén, LCSW is a Latina/Bilingual Psychoanalyst who is a first born American to Central American immigrants and is the first BIPOC CoDirector at Manhattan Institute for Psychoanalysis in New York City. She is founder and former Co-Chair of the Committee on Race and Ethnicity at MIP, CoFounder of the Psychoanalytic Coalition for Social Justice, serves on the Board of Division 39-Section 9 («Psychoanalysis for Social Responsibility») and is Co-Editor of The Psychoanalytic Activist. She is Faculty and Supervisor at Manhattan Institute for Psychoanalysis, NIP, The Stephen Mitchell Relational Study Center and teaches at the Smith College School for Social Work.
Thomas Marchevsky, Ph.D. is a psychoanalyst in private practice, licensed clinical psychologist, and supervising analyst based in California. He is an editor of the European Journal of Psychoanalysis, Clinic Director of The Clinic Without Walls, and an adjunct faculty member at the California Institute of Integral Studies. His current research areas are psychoanalysis, topology, subjectivity, jazz improvisation, and Tibetan Buddhism. www.drthomasmarchevsky.com
Kenneth A. Frank is an American clinical psychologist and psychoanalyst, and co-founder of the National Institute for the Psychotherapies in New York City, where he is Director of Training. A faculty member of the Columbia University College of Physicians and Surgeons from 1974–2009, he was Clinical Professor in Psychiatry from 1996-2009. He received his MA (1964) and PhD (1967) in Clinical Psychology from Columbia University.
Orna Ophir is an Associate Director of the DeWitt Wallace Institute of Psychiatry: History, Policy & the Arts, Weill Cornell Medical College, and an Adjunct Associate Professor at New York University. Ophir is a psychoanalyst in private practice in New York City and a member of the International Psychoanalytical Association (IPA), serving on its Committee on the History of Psychoanalysis.
Matthew Oyer, Ph.D. is a licensed psychologist and psychoanalyst. He is a Co-Director of the training program at the Greene Clinic, Assistant Clinical Professor at the Icahn School of Medicine, and Adjunct Supervising Faculty in the clinical psychology doctoral program at City College. He completed his doctoral training at the City University of New York and his doctoral internship at New York Psychoanalytic Society and Institute (NYPSI) and Mount Sinai Medical Center. With a small group of others, Dr. Oyer created and implemented a program
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of independent psychoanalytic training through which he continues to pursue lifelong formation. He has experience working in a wide range of settings, from inpatient psychiatric units and intensive hospital-based outpatient programs, to therapeutic communities, to substance abuse treatment facilities, to university counseling centers and outpatient mental health clinics. Dr. Oyer is on the editorial board of the European Journal of Psychoanalysis.
Carlos Padrón, LP is a licensed psychoanalyst with a background in philosophy and literary studies. Carlos was a faculty member at the Institute for Psychoanalytic Training and Research where he co-taught a class on clinical aspects of diversity. He was also the co-chair of Iptar’s Diversity Committee. He taught the Seminar on Psychodynamic Theory (Masters in Social Work) at the Silberman School of Social Work in CUNY. Carlos participated in the documentary “Psychoanalysis in El Barrio”, a film on working psychoanalytically with poor and working-class Latinx patients in the U.S., and has given talks and published on this topic and on clinical issues related to difference: race, culture, gender, class, ethnicity, immigration. Carlos has worked psychoanalytically in different settings and is currently a clinical associate of the New School Psychotherapy Program where he supervises PhD students in Psychology.
Tracy Sidesinger, PsyD is a feminist psychotherapist bilocated between Flatbush, Brooklyn and Upstate New York. Dr. Sidesinger serves as the Psychotherapy Action Network’s representative to the Mental Health Liaison Group, a nationwide policy group which advocates for equitable mental health resources through legislative means; and as artist residency coordinator on the Board of Directors for the Museum of Motherhood in St Petersburg, FL. Areas of interest include community psychoanalysis, gender and sexuality, motherhood, spirituality, and culture.
Kirkland C. Vaughans, Ph.D., is a clinical psychologist and Fellow/ Training and Supervising Analyst of the Institute for Psychoanalytic Training and Research {IPTAR}, Adjunct Professor in both the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis and at the Mitchell Relational Study Center, and Clinical Director of the Derner/Hempstead Child Clinic and Senior Adjunct Professor at the Derner School of Psychology. He is a founding member of Black Psychoanalysts Speak and serves on the boards of the Holmes Commission of the American Psychoanalytic Association, He is on the editorial boards of the Journal of Infant, Child, and Adolescent Psychotherapy, Psychoanalytic Dialogues, Psychoanalytic Psychology, and the Psychoanalytic Study of the Child.
Kalen Wheeler, MHC, MSEd is completing her postgraduate training as a clinical psychotherapist at a psychoanalytically-oriented group practice in Brooklyn, New York. She is also a part-time Adjunct Lecturer in the Department of Educational Foundations and Mental Health Counseling at CUNY Hunter College, which is also her alma mater. Before transitioning to clinical psychotherapy, Kalen worked as a school counselor and restorative justice practitioner in the New York City Department of Education.
