Westen, D., Shedler, J., Bradley, B., & DeFife, J. (2012).  An empirically derived taxonomy for personality diagnosis: Bridging science and practice in conceptualizing personality.  American Journal of Psychiatry, 169, 273-284.

Westen, D., Waller, N. G., Shedler, J., & Blagov, P. (2014).  Dimensions of personality and personality pathology: Factor structure of the Shedler-Westen Assessment Procedure-II (SWAP-II). Journal of Personality Disorders, 28(2), pp. 281–318, 2014

 

OK, I have to fess up to bias and vindication when I am reading these two articles.  I teach graduate students personality theory every year.  These students are all clinicians, so I am really trying to prepare them for clinical practice, and it is my firm belief that clinically derived descriptions of personality styles are much more useful than those that emerge from other traditions – the five factor model in particular.  So I assign ancient readings: Allport and Shapiro are, I believe, among the most useful – to expose them to clinical writings – empirically derived clinical writings – that describe clinical syndromes in ways that are coherent and hang together in my lived experience and, I hope, prepare them to use the diagnostic tools – the MMPI, MCMI, Rorschach, etc. that I believe to be bedrock tools in a clinician’s toolbox.

As long as I have been teaching I have gotten grief about this.  Some of my students see me as being hopelessly out of step, and there is almost constant concern that they are not learning enough about the five factor model – the model that claims universality in personality assessment.  I just don’t find that model to be as useful when trying to describe clinical populations and when trying to determine what sorts of interventions to engage in that will be useful to those who present for treatment.  The five factor model is an impressive achievement and has given us an important and useful tool to compare the personality functioning of individuals across cultures and to better understand important elements in the personality functioning of the “normal” human being.

One of my concerns about the five factor model is that it seems to have grown, despite some protestations, out of a kind of mindless procedure – factor analysis.  This procedure relies on linear algebra to produce clusters of variables that are inter-correlated and that, presumably, represent aspects of the same latent variable.  In this sense, factor analysis mirrors psychoanalysis in that both use manifest data to make inferences about latent functioning.  Why don’t I trust the procedure?  Maybe it’s a little Hogwarts in me – Rowlings cautions us through one of her characters never to trust magic when you can’t see the magician creating it.

So imagine my surprise that these two papers, using factor analytic techniques, support the existence of independent diagnostic entities that sound familiar to me in the clinical setting.  I think there are a number of reasons for this, but the first is the instrument that is used.  Instead of a self report instrument that, as the authors propose, “…presupposes that (a) the data necessary and sufficient to derive a comprehensive and clinically relevant model of personality do not require expertise in psychopathology; (b) individuals with significant personality pathology have sufficient self-awareness and insight that their self-reports (or those of untrained peer observers) are sufficient to derive a comprehensive model of personality and its pathology; and (c) that the language of lay observation (or attempts to summarize it via factor analysis) is adequate for a diagnostic manual intended to be useful to both clinical practitioners and psychopathology researchers” (Westen et al., 2014, p. 282 -283), the SWAP is a clinician rating of the functioning of the patients.

I think the second reason is that Westen and his colleagues (2014) are using the factor analysis to serve their own needs, not the other way around.  They do multiple factor analyses of the data, not a single one, and find the model that most closely fits their expectations of what psychopathology looks like.  I think it is also possible that the correlations work out the way that they do because the clinicians have in mind the diagnostic categories that show up (in other words, the factor analysis is a measure of whether the clinicians were paying attention when they were taught psychodiagnosis and are finding what they were told they would – a long and pernicious problem in psychology).  While I don’t doubt that this last factor accounts for some percent of the variance, Westen went to great trouble to recruit raters from a wide variety of backgrounds and chose the items for the instrument from a wide variety of sources.  This is not just rigging the data to get the desired result.

So what are the results?  When clinicians use the SWAP- 200, or in the case the new iteration, the SWAP –II, to rate the functioning of their patients, they rate each of 200 items on a Likert scale from 0 (not characteristic of the person) to 7 (highly characteristic of the person).  They are forced to rate each of the eight descriptors a certain number of times, approximating a normal curve (or actually half of one, 100 items are required to be rated 0 as not characteristic).  The items are not simple sixth grade reading items, but complicated descriptions of various aspects of personality functioning, e.g., “Appears to gain pleasure or satisfaction by being sadistic or aggressive toward others (whether consciously or unconsciously).”

The two papers report on two different ways of factor analyzing the data.  In the first paper (Westen, et al., 2012), a hierarchical factor analysis groups factors into four categories: Internalizing functioning, Externalizing functioning, Neurotic functioning, and Healthy functioning.  Within those categories, factor analyses are performed, with the Internalizing category including depressive, anxious avoidant, dependent victimized, and schizoid – schizotypal factors; the Externalizing category including antisocial, paranoid, narcissistic and borderline factors; the Neurotic including obsessional and hysteric/histrionic and the Healthy including one factor that is based on the items indicating psychological health.  A similar group of factors emerge from the second paper (Weston, et al., 2014).  In both papers, clinically cogent factors emerge: factors that mirror the experience of diagnosing the underlying personality styles of people presenting in clinical settings.

The inability of the DSM-V group to settle on a model for personality pathology indicates that we don’t have consensus about how best to understand the structure of people – the structure that supports the maladaptive difficulties that they present to us with and would like our help addressing.  I think this may, ironically, be an indication of the advances that we are making – we have a variety of perspectives that are demonstrating integrity in the description of personality functioning.  They are inconsistent with each other and none of them have coalesced as crisply and cogently as we would like.  Would that the psychological world were divided as crisply and evenly as Shapiro (1965) thought that it would be.  People are messier than that.  Describing their functioning requires caveats and is, at best, a way of locating them at a particular moment in time and identifying characteristic, but certainly not the only ways, that they function, especially in particular kinds of settings.

The hopeful part is that there is order to the mess.  There may be other models that are useful, but certainly the tried and true, the models that have been created by thoughtful people closely observing the functioning of others is supported in ways that will, I think, help us both in the clinical world of assessment and treatment, but also in that broader world that Freud dreamed of – a science of human functioning more generally.

Shapiro, D. (1965). Neurotic styles. New York: Basic Books.

If you are interested in responding to this post, please do so below.  If you have read a research article recently that you think would be of interest to an audience of clinicians and would like to write a 1000- 1500 word summary of that, please send it as an email attachment to Karl Stukenberg at stukenb@xavier.edu.  Include the words “Clinicians Reading Research” in the subject line.

By Wayne Wapeemukwa

In one of their early correspondences Freud invites Ferenczi to join him and his family on vacation.  Ferenczi happily agrees.  But then Freud forewarns:

“You are welcome at any time, whether you spend the weeks of your vacation in Berchtesgaden or whether you want to spend part of the time on the trip with me. It is understood at the outset that you will not disturb me in my work and that I won’t have to take any precautions against you…” (Brabant and Falzeder 11)

Thus it is understood that the neighbour may join so long as his presence is not felt.

*          *          *

“When Mexico sends its people, they’re not sending their best,” Donald Trump said during his presidential announcement speech on June 16, 2015.  “They’re bringing drugs.  They’re bringing crime.  They’re rapists.  And some, I assume, are good people.”^[1]  Now the Republican nominee for president, many are wondering how Donald Trump has only gotten more popular as a result of his bigotry.  On the surface it’s called the ‘Trump Effect’: xenophobic slurs fettered to cultural anxiety becoming the political strategy apt to win elections.^[2]  This effect seems to fly in the face of one of Western civilization’s most fundamental moral dictums, the commandment to love the neighbour.  Maybe “[t]he element of truth behind all this,” as Freud says in Civilization and its Discontents, “is that men are not gentle creatures who want to be loved” (SE21, 111).  Perhaps some of Lacan’s considerations on neighbourly love from The Ethics of Psychoanalysis can shed light on how a presidential nominee only gets more popular by calling an entire people rapists, why fundamentalists want to believe that all Arab refugees are sex criminals and how white-ressentiment can so easily turn ‘Black Lives Matter’ into ‘All Lives Matter’.  Maybe neighbourly love shares a deeper relationship with the Trump Effect than appears on first glance; and that love may index a deeper aggressiveness is a thought that can be traced to nascent rumblings in Freud’s anthropological works.

In Civilization and its Discontents Freud establishes the requisites of civilization, the first of which is justice and the last “a rule of law to which all…have contributed by a sacrifice of their instincts” (SE21, 95).  “In order for these aims to be fulfilled, a restriction upon sexual life is unavoidable” (SE21, 109).  The price of civilization is neurosis.  But within this “antagonism to sexuality,” resides “some disturbing factor which we have not yet discovered” (SE21, 108-9).  Freud goes on to say that the clue to this yet undiscovered factor lies in the moral commandment to love the neighbour (SE21, 108).  Within this moral dictum Freud finds “the strongest defence against human aggressiveness” (SE21, 142).  In other words, the dictum to love the neighbour is a moral overcompensation for an irreducible aggressiveness.  While Eros binds us together, Thanatos rips us apart: Homo homini lupus (SE21, 111).

Then in Group Psychology, Freud details how aggressiveness is re-directed against rivals.  Through bringing to light how rivalling camps can be deeply hostile to one another despite a plentitude of similarities, Freud provides what may be a prototype of the Trump Effect.  Aggressiveness is most readily re-directed against proximate rivals who, oddly enough, share a great deal with one another.  This re-directed aggression helps bond members together through identification.  Freud writes that “almost every intimate emotional relation between two people which lasts for some time–marriage, friendship, the relations between parents and children–contains a sediment of feelings of aversion and hostility” (SE18, 101).   This effect is similar to what Freud christens in Civilization and its Discontents as the ‘narcissism of minor differences’.  So, could this ‘narcissism of minor differences’ be what fuels the Trump Effect?  This would require a multitude of similarities between Trump supporters and their detested neighbours.  Intuitively, this does not seem to be the case since the targets of the Trump Effect are more like stereotypes, not real existing people who share a great deal with expounders of the Trump doctrine.  Apparently the Trump Effect relies less on a ‘narcissism of minor differences’ than the fantasmatic creation of a grotesque radically different other.  While Freud’s clue to cultural antagonism as concerns sexuality resides in the commandment to love the neighbour, perhaps our clue to the workings of the Trump Effect reside in the relation of law to fantasy.

Desiring subjects situate themselves in regards to lack through fantasy.  Thus the fantasy is a theatre in which the subject imaginarily makes up for lack.  In Bruce Fink’s words, “by cleaving to that rem(a)inder, the split subject, though expulsed from the Other, can sustain the illusion of wholeness” (Fink 59).  In sum, the fantasy is a pantomime in which the subject gets-off on the satisfaction of wholeness.  But since ‘desire is desire of the Other,’ the desire satisfied in the fantasy is in fact the Other’s, i.e., an imaginary compensation for the Other’s lack.  Satisfying the Other’s lack entails that the pleasure excreted in fantasy alienates the subject insofar as the fantasy makes up for the Other’s desire and not the subject’s.  In its essence, the fantasy is alienating.  Moreover, the pleasure ‘enjoyed’ in this fantasy may not even be experienced by the subject as pleasurable as a result of this alienation.  This pleasure is what Fink calls ‘phallic jouissance’ (though for my purposes I will simply call it ‘jouissance’).^[3]  In the fantasy the subject situates themselves in regards to the Other’s lack with a symptomatically enjoyable wholeness.  By these lights could the Trump Effect be a social fantasy of wholeness?

Trump’s doctrine solicits something like a fantasy of wholeness in its eschewing of the refugee, immigrant, muslim, etc.  With ‘Make America Great Again!’, a kind of pleasure is solicited dependent upon the alienation of others.  This “fantasy provides the pleasure that is characteristic of desire” –jouissance–  since it makes pleasurable the effacement of others (Écrits, 652).  And recall how it is the negation enunciated by the name of the father which initially occasions enjoyment: The Father’s paternal castration threat outlawing incest thereby relegating it to fantasy.  To this point Lacan will claim that the father’s law retroactively creates jouissance (Écrits, 200).  Law, therefore, is the structural condition of jouissance: it makes its infraction enjoyable.  So, if ‘Make America Great Again!’ is indeed a social fantasy soliciting a pathological jouissance based on the effacement of difference, then the enjoyment it proffers must have been instantiated by an initial law.  Perhaps our clue to unearthing this initial interdiction lies, as it did with Freud, in the commandment to love the neighbour.

Following this line of thought, the moral commandment to love the neighbour must serve in proxy as the condition of its own enjoyable transgression.  To explain this paradox Lacan echoes Paul: “What shall we say?  That the law is sin?  By no means!  Yet if it had not been for the law, I would not have known sin” (Romans 7:7).  Oddly, the law creates sin; sin is only sin after the law says so.  Thus invoking Paul, Lacan inverts the relationship between law and transgression in order to draw a haphazard identification between them.  In a very important way, prohibition and repressed desire are two sides of the same coin: “law and repressed desire are one and the same thing” (Écrits, 660).  The law anticipates, relies upon and engorges the repressed jouissance outlawed by its proclamation: “jouissance is evil” (S7, 184).  Freud theorized that culture was bound together through new libidinal ties formed after repression such as “strong identifications” summoning “aim-inhibited libido on the largest scale so as to strengthen the communal bound” (SE21, 108).  Lacan adds that these identifications are supplemented from without by “the transgressive space of our fantasies” –i.e., the transgressive jouissance created by the law– “an object that lies beyond it” (De Kesel, 188).  But what happens if this relationship is extrapolated to the level of culture?  Civilization is libidinally bound not merely by repressed individual aggressiveness (as Freud said) but also by an exterior (or as Lacan calls it, ‘extimate’) social fantasy space beyond culture’s repressive constellation.  This social fantasy, moreover, galvanizes a social-jouissance.  In terms of keeping up with the Jones’, “[t]he jouissance I fear in my neighbour refers to that ‘ex-timate thing’ around which my desire circles as well” (De Kesel, 146).  My fear of Trump’s Mexican rapist signifies the Mexican rapist inside me, ex-timate to me: “[m]y neighbour possesses all the evil Freud speaks about, but it is no different from the evil I retreat from in myself” (S7, 198).  Freud took the commandment to love the neighbour as indicative of innate human aggressiveness; Lacan takes it as an imaginary misrecognition of the evil jouissance we fear in the other since it is within ourselves as well.  “If this prohibition has a meaning,” Lacan says, “it is that images are deceitful” (S7, 196).  The imaginary deceives; and thus my neighbourly love also deceives, hiding from myself the ex-timate evil jouissance it relies upon.  As Freud hinted, the imaginary of neighbourly love hides an evil reality.  In David Lynch’s Blue Velvet (1986) the opening montage shows idyllic images of suburban America and neighbourly love: roses, white picket fences, children crossing the street, waving fire-fighters, etc.  But then the camera slowly dollies underground revealing a subterranean mycelium of insects and dirt: the ex-timate reality covered over by the surface’s neighbourly love.  Could neighbourly love then, truly be founded on evil?  Are these the roots of the Trump Effect?

This foundational evil that is hidden by the imaginary brings to light some of Lacan’s clinical remarks, specifically, how wanting what is ‘good’ for the analysand may indeed solicit itself with good intentions but in fact serves to obstruct analysis.  Desiring what is ‘good’ for the analysand results in problematic counter-transferences which culminate in the analyst identifying with the analysand, thereby colluding with the analysand’s ego against their repressed desire.    “What I want is the good of others provided that it remain in the image of my own,” Lacan warns (S7, 187).  By extension, the day to day imaginary of neighbourly love yields a similar misrecognition because it conceals innate human aggressiveness as well as the ex-timate jouissance-engorged fantasy it relies upon from without.  Were one to actually uphold the commandment to love the neighbour–were one to truly and intimately love the other–one would necessarily do so according to their deceptive and orthopaedic self-image, which could only result in an expungement of the other’s jouissance…what could otherwise be called ‘rape’.  In this vein Lacan underscores that “to love one’s neighbour may be the cruelest of choices” (S7, 194).  The thought here is that my neighbour may enjoy so long as they reflects my jouissance.  Today this very logic is operative in Norway where sex-education classes are offered on a voluntary basis to Sudanese migrants so as to ‘help them adjust’ to European sex-culture.  Legislators in Denmark are already vying to make classes such as these mandatory for incoming refugees.^[4]  Clearly, there are limits to neighbourly love.  But the radical thesis Lacan expounds is that loving one’s neighbour is not obstructed by xenophobia, but rather that xenophobia is neighbourly love’s normative condition: underneath neighbourly love is evil-jouissance–just as in Blue Velvet (1986).  Ironically, the Trump Effect is what we ought to expect from a culture cherishing neighbourly love.

On New Year’s Eve 2015 in Cologne, Germany approximately 1000 German Caucasian women reported being victims of sex crimes committed by ‘dark-skinned’ refugees.  Right-wing nationalists were keen to exploit the aftermath of these allegations.  Yet figures from the German Federal Criminal Police Office reveal that under one percent of felonies committed by immigrants in 2015 were sexual offences.^[5]  Could this discrepancy evince the conclusion reached above regarding the jouissance engorged fantasy of the evil neighbour?  Perhaps we do not resent the neighbour for breaking our law, but rather because their jouissance does not conform to the image of our own.  We welcome refugees with open arms if they enjoy as we do, do not impinge upon our jouissance and so long as they allow us to hatefully fantasize about their eradication.  Here the commandment to love the neighbour is not only Freud’s clue to innate human aggressiveness but the imaginary misrecognition of a passionate jealousy, what Lacan names in Encore, ‘jealouissance’.

As stated above, the Trump Effect cannot be a ‘narcissism of minor differences’ since it is not redirecting repressed libido against similar rival group members.  Instead, the targets of the Trump Effect are fantasmatic creations, full-blown libidinally charged xenophobic nightmares.  Neutralizing the nightmare of the sex-criminal refugee, Trump deploys the tantalizing fantasy of ‘Make America Great Again!’.  With this fantasy Trump intends to bring America closer to the good through the elimination of difference.  But, as was previously elaborated, a demand for the good is never just that.  This demand belies a hidden a sexual reality: “[e]very ethical demand for the good is…a desire for enjoyment” (De Kesel, 147).  This suggests a paradox of liberal democratic tolerance, ossified in the commandment to love the neighbour: the more we tolerate and love our neighbour, the more we rigidify a tumultuous ‘jealouissance’, apt to burst into opportune xenophobia.  Freud taught that the commandment to love the neighbour hides a deeper, more horrific condition of humanity; Lacan added that the resentment we house against our law-breaking neighbour is a structural residue of our integration into culture; for Freud the cost of culture was neurosis; for Lacan one becomes a social subject at the expense of the other’s jouissance; for Freud culture had a price; for Lacan culture reimburses you with jealouissance.  To confront the Trump Effect then would be “to confront the fact that my neighbour’s jouissance, his harmful, malignant jouissance, is that which poses a problem for my love” (S7, 187).  The neighbour’s jouissance, of which I am jealous, is what problematizes my love.  The islamic militant, the Syrian sex criminal, the Mexican rapist, are all fantasies siphoning the jouissance within ourselves left-over from our integration into Western culture.  The Trump Effect is our own creation, Frankenstein, indexing our repressed social-desires.  In the day we love the neighbour, at night we dream of hanging him: the two are one and the same.

The key to undermining the Trump Effect then must lie not in stretching our love further,^[6] but in scrutinizing our own ex-timate jouissance, mirrored within us.  Does our neighbour want our love?  Do we even want theirs?  If so, will we settle for love not in the image of our own?  The problem, as I have expounded, is that the commandment to love one’s neighbour goes hand in hand with the Trump Effect; it could even be said that the Trump Effect is a symptom of neighbourly love.  Yes, Donald Trump is a bigot–but a bigot signifying our shared responsibility to take an ethical stance in regards to the transgressive jouissance underpinning the commandment to love our neighbour.  Love cannot be, therefore, the answer to Trump.

FOOTNOTES:

^[1] Maraniss, David, and Robert Samuels. “Donald Trump’s False Comments Connecting Mexican Immigrants and Crime.” Washington Post. The Washington Post, 8 July 2015. Web. 30 Apr. 2016.

^[2] Longworth, Richard C.  “How the ‘Trump Effect’ is Taking Hold in Europe Too”  Chicago Tribune & New York Times Op Ed. December 10 2015

^[3] Fink defines ‘phallic jouissance’ in reference to Lacan’s seminar Encore: we should “understand ‘phallic’ as ‘fallible,’ to hear the fallibility in the phallus. Phallic jouissance…is susceptible to failure, and it fundamentally misses our partner. Why? Because it reduces our partner, as Other, to what Lacan refers to as object a, that partial object that serves as the cause of desire.” (Barnard and Fink, 37)

^[4] Higgins, Andrew. “Norway Offers Migrants a Lesson in How to Treat Women.” The New York Times. The New York Times, 19 Dec. 2015. Web. 30 Apr. 2016.

^[5]Dearden, Lizzie. “Refugees Responsible for Tiny Proportion of Sex Crimes in Germany despite Far-right Claims following Cologne Attacks.” The Independent. 19 Feb. 2016. Web. 30 Apr. 2016.

^[6] As Freud says: “My love is something valuable to me which I ought not to throw away without reflection” (SE21, 109).

REFERENCES:

Brabant, Eva and Falzeder, Ernst et al., eds., The Correspondence of Sigmund Freud and Sandor Ferenczi, Cambridge, MA: Harvard UP, 1993

Barnard, Suzanne & Fink, Bruce. “Knowledge and Jouissance” Reading Seminar XX: Lacan’s Major Work on Love, Knowledge, and Feminine Sexuality. New York: State University of New York Press, 2002.

De Kesel, Marc.  Eros and Ethics: Reading Jacques Lacan’s Seminar VII.  Trans., Sigi Jottkandt. SUNY Press, New York: 2009. Print.

Fink, Bruce. The Lacanian Subject: Between Language and Jouissance. Princeton, NJ: Princeton UP, 1995. Print.

Lacan, Jacques.  Le Séminaire IV: La Relation d’Objet.  Ed., Jacques-Alain Miller.  Champ-Freudian Seuil, Paris: 1998.  Print.

Lacan, Jacques.  The Seminar VII: The Ethics of Psychoanalysis.  Ed., Jacques-Alain Miller.  Trans., Dennis Porter.  WW Norton, New York: 1992. Print.

Lacan, Jacques.  The Seminar VIII: Transference.  Ed., Jacques-Alain Miller.  Trans., Bruce Fink.  Polity Press, New York: 2015. Print.

Lacan, Jacques.  The Seminar XI: The Four Fundamental Concepts of Psychoanalysis.  Ed., Jacques-Alain Miller.  Trans., Alan Sheridan.  WW Norton, New York: 1998. Print.

Lacan, Jacques.  The Seminar XVII: The Other Side of Psychoanalysis  Ed., Jacques-Alain Miller.  Trans., Russell Grigg.  WW Norton, New York: 1992. Print.

Lacan, Jacques.  Ecrits: The First Complete Edition in English.  Trans., Bruce Fink,  Héloïse Fink, and Russell Grigg. New York: W.W. Norton, 2006. Print.

Freud, S. (1921). Group Psychology and the Analysis of the Ego. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XVIII (1920-1922): Beyond the Pleasure Principle, Group Psychology and Other Works, 65-144

Freud, S. (1913). Totem and Taboo. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIII (1913-1914): Totem and Taboo and Other Works, vii-162

Freud, S. (1930). Civilization and its Discontents. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XXI (1927-1931): The Future of an Illusion, Civilization and its Discontents, and Other Works, 57-146

Gabbard, Glen O. M.D., On Hate in Love Relationships: The Narcissism of Minor Differences Revisited, Psychoanalytic Quarterly, 62:229–238

Roberto Harari, Lacan’s Seminar on Anxiety: An Introduction (2001)

This is a philosophy of science paper. I will summarize the emergence of psychology, psychiatry and psychoanalysis from the Western philosophical tradition, and use Bacon’s (1620/1993) definition of science and the contemporary philosophy of “Critical Realism” to argue that excluding psychoanalysis from science rests on an erroneous valorization of subjectivity or a constricted definition of science.     My axiomatic assumptions:  1) I am real and I have some degree of will power; 2) You are real and, similarly, have will power.  To believe otherwise would suggest “depersonalization,” “derealization,” and “abulia,” impairments of mental functioning. Subjectivity is real and worthy of scientific study, but is not the sole reality for a scientific psychology.  Descartes’s “Cogito ergo sum” is, despite post-Cartesian argument, correct; Berkeley’s “Esse est percipi” is not.

Exploring the world starts at birth, perhaps some few weeks earlier.  Neonates have immediate sensations that slowly become organized, forming a core subjectivity that will be present throughout life.  Toddlers begin to develop a theory of mind, an accurate belief that others also have a subjective core.  Such recognition gradually leads (under supportive conditions) to “I am not the center of the universe; reality exists beyond my perception and will.”  Reality-testing – the differentiation of internal and external – is a basic, though imperfect ego function.  This is a cursory ego-psychoanalytic description of early development.

That psychoanalysis is scientific has been disputed for decades; the debate remains heated.  Recent issues ofPsychoanalytic Psychology (2015) and the International Journal of Psychoanalysis (2015) were largely devoted to psychoanalytic research, and an extensive discussion played out on Division 39’s listserv.  Science advances from argumentation as well as data.

Healing, Science and Philosophy

I’ve proposed (2013) that the discipline of psychoanalysis, like Freud’s ego (1923), serves three masters: healing, science, and the history of ideas.  These domains have different standards and methods.  Many conceptual problems in psychoanalysis stem from attempts to meet the conflicting standards.  Epistemology is the philosophical context for psychoanalysis as science, with Ethics, the philosophy of values, also relevant.  Science, philosophy, and history are intellectual domains. Clinicians must respect ideas while attending to the pragmatics of helping patients; in a treatment situation, therapeutic intent should have priority over scientific aims (Stone, 1954).

History

Psychology emerged by addressing three central philosophical issues: the problem of knowledge (cognitive psychology), the problem of action (behavioral psychology), and the problem of evil (clinical psychology). Psychiatry advanced from demonology through humane caregiving to become part of scientific medicine that itself emerged just a bit more than a century ago.  Psychoanalytic treatment addressed the clinical phenomena of neurotic suffering.  Freud advanced propositions and a method for exploring the dark side of human nature, a dynamic unconscious.  “Social” sciences emerged: sociology, anthropology, economics and politics, each developing validity criteria and methods fitting its subject matter.

Philosopher Francis Bacon (1561-1626), called the father of empiricism, defined science as “an attitude toward the universe in which observations are made using the best methods available; logic is employed; and contradictions or magical, supernatural, and ad hoc solutions are rejected.”  Brenner noted that all sciences are inferential and influenced by the observer’s psychology, but facts rule (2006).  Experimentation may be employed but is not required (e.g., Galileo’s astronomy); quantification is a tool of science, not its essence.  Two principles to add to Bacon’s and Brenner’s: scientific conclusions are tentative, and although “psychological reality” is rife with contradiction and paradox, its methods are rational and empirical.

Science was first called natural philosophy; epistemology asks how we know.  Plato’s answer: look inward, using “the mind’s eye” rather than easily-deceived senses.  Aristotle declared otherwise: observation is primary.   Descartes followed Plato: we know only what our minds can grasp; we think, we doubt.

The British Empiricists, especially Berkeley, extended Aristotle’s program: perception defined reality.  Perception enhanced by technology: the telescope, microscope, fMRIs , remains subjective. Science requires replication and consensus to validate perception; psychoanalysis attends to counter-transference.  Renik’s “irreducible subjectivity” (1993), suggests that subjectivity is altogether irreducible, rather than not reducible to zero.  That we are imperfect instruments rules out neither scientific activity nor reality-testing.   Physicians rely on subjectivity, asking patients to rate their pain; self-report and lab tests together validate treatment.

The Age of Reason led to the Age of Enlightenment, with observation and reason superseding revelation for comprehending the world.  John Dewey’s pragmatism (knowledge is what works), and Sartre’s choice (of what to believe) are 20th Century contributions to scientific epistemology. Contemporary science rejects supernaturalism, and is uncomfortable with a radical relativism of choice.  Post-modernism treats subjectivity as a spur to scientific inquiry, with certainty always beyond reach.   Scientific disputes focus on methodology.   Science is better served by “both/and” rather than “either/or” approaches to method.  Aristotle promoted empiricism without rejecting Plato’s rationality.

Critical Realism

Philosopher-Psychoanalyst Charles Hanly, a former IPA president, described the central tenets of this epistemology (2014, pp 903 ff): A real world exists, independent of our senses.  Appropriate scientific methods of observation can help us know reality to a degree, as can unaided observation that allows commonsense knowledge of other persons and other things.  Following Freud (1927), Hanly goes on: Evolution has enabled the human mind to “develop precisely in the attempt to explore the external world (p 55).”  Children learn to assess reality with degrees of accuracy.  Freud asserts that the human mind is part of nature, knowable just as any natural object only in a mediated way, and that mind is determined not only by its own structure, but by the objects (i.e., people) that affect it – an early relational idea.

Freud’s arguments support my critique of the distinction between “social” and natural sciences that implies lesser status.  For Descartes and the empiricist philosophers, subjectivity was the basis for knowing, while naysayers see mind as unable to judge reality, leaving it only with constructions.  Critical Realism sees subjectivity as a limiting factor, requiring continuous scrutiny of the reliability of observation, rather than dismissal or mushy relativism.  Hanly states: “there is no end to observing and correcting our clinical observations (p 904).”  [Ongoing debate about “truth” and the nature of evidence in psychoanalysis is addressed by Levine (2016) and others in a recent special issue of the Psychoanalytic Quarterly.] Psychoanalysis has abandoned the idea of a godlike analyst with immaculate perception.   Busch’s (2015) IPA Congress plenary address underscored tentativeness in clinical psychoanalysis as a major change from the approach of earlier generations.

There is hard science – and harder (not lesser) science that must contend with the problem of subjectivity.  Rogers (2014), reviewing Stanislas Dehaene’s “Consciousness and the Brain” (2014), supports this position.  Dehaene acknowledges that subjective reports can mislead, but states that the subjective report of the viewer in the lab is exactly what is meant by conscious awareness.  “Subjective reports are the key phenomena that a cognitive neuroscience of consciousness purports to study. They are primary data (p. 42)… along with …psychophysiological observations.”   And: “The Self is “a statistical deduction from observation…” Every self is different from all other selves, and differs from itself over time” (p. 113).

Reality-testing, an ego-psychoanalytic concept and emergent property of mind, is essential despite imperfect perception.    For Plato, Descartes, the empiricists, and we healers who inquire about thoughts and feelings, subjective consciousness is a natural phenomenon subject to scientific exploration.  Freud deepened the understanding of human subjectivity by focusing on meaningful unconscious mental processes (psychological reality), also natural phenomena.

Reductive Causality vs. Emergence

Reductive causality declares mind to be brain, brain to be chemistry, chemistry to be physics and physical particles and sub-particles to have their character determined ultimately by the Big Bang.  A consistent reductionism would claim our universe is not only determined, it is predetermined; if we can state necessary and sufficient antecedents, everything follows.  That seems as predetermined as the notion of an all-powerful god whose omniscience must include immutable knowledge, even of the future.   Contra this radical determinism, scientific domains develop methods of study of phenomena not adequately understood by their contingent precursors.  There is no dispute about proximal causality or causal chains; free association relies on such chains.  Despite the claims of Churchland (2013), emergent phenomena cannot be radically reduced.

“Emergence” is a conceptual alternative to reductionist determinism.  Particles come together to form atoms and molecules with properties different from the particles; these come together over a vast time span in which life emerges with reproductive abilities not present in earlier material forms.  Evolution generates new forms by variation and mutation.  Life evolves toward complex nervous systems and the human brain.  The brain’s properties include consciousness, self-consciousness, language, a procedural unconscious that allows walking and riding bikes thoughtlessly, and a dynamic, meaningful unconscious.  At each level, the properties are natural phenomena – not epiphenomena – around which scientific disciplines develop.  Each discipline focuses on phenomena within its domain, developing methods specific to their study.  Humans continue to evolve to create groups, economies, polities and cultures.   Each emergent form can be studied scientifically.  Social, political and economic realities exist; science itself must be funded to survive.  Borderline disciplines address transitions.  The brain is the hardware of mind.  Lesions and other hardware differences (variations, mutations) have effects studied by brain science.  When neural hardware seems intact, psychology, psychiatry and psychoanalysis become relevant; philosophy’s Problem of Evil will not be solved by biology alone.

Evolution is progressive because a few hardware changes increase adaption and survival.  Inbreeding produces fewer changes; variety in a genetic pool advantages survival.  Social evolution works in historical, not geological or cosmic time.  Evolution has accelerated since the 1890s: through technology (built on science), social equality (built on evolving value systems), and the population explosion (built on agricultural and medical advances).   Science has become an industry with space-age applications that generate new questions and better answers.

In addition to the personal investment we have in our own offspring, every baby represents a potential Copernicus, Darwin, Freud or Einstein.  The population explosion creates a new set of environmental conditions – not all beneficial, but every baby (including identical twins) is different from every other.

The complex phenomenology of humanity therefore extends itself indefinitely, as long as we do not destroy ourselves and the planet.  Each baby is unpredictable.  Individuals interact based on proximity, creating different cultures, political and economic systems, and now global connectivity.  These phenomena are worthy of scientific study, not to be restricted (as was anatomy by religious bans on dissection), or demeaned by a “scientism” strangled by its narrowness.

The study of individuals addresses commonalities as well as uniqueness.  No generalization fully describes an individual. Intensive individual study will be incomplete, but essential for understanding anyone.  Individualized medicine assumes the same stance as clinical psychoanalysis.

Over-determination, “Multiple Function,” Parsimony

Freud (1895) asserted that a “convergence of several factors” is required to generate a hysterical symptom; human behavior is not based on simple causality. The search for causes is replaced in psychoanalysis by a search for multiple motives operating together and sometimes in conflict; conscious intent is never a single or even necessarily dominant factor.  A depth psychology is posited in which personal history, imperfectly remembered, contributes to thoughts, wishes, fears, symptoms and behavior.  Waelder (1930) described “multiple function” as behavior serving several aims at once. Science eschews teleology in principle, but human minds conjure possible futures or fantasies that motivate behavior.

Over-determination and multiple function are concepts analogous to interactions in statistical analysis of variance and covariance, where outcomes result from single variables and interactions among them.  Psychology is multifactorial and loosely assembled; rarely does simple causality help to understand people.

Parsimony is a scientific principle; it does not overrule actual complexity.  Though I admire its elegance, I find Brenner’s parsimony inadequate for my own clinical work.

Free Will

Philosophy of science discussions are often sidetracked by semantic issues.  Free Will is an issue that appears to contradict science.  The seeming paradox of the psychoanalytic “free association,” which we know is not at all free, is resolved by semantic precision.

“Freedom” is a concept, applicable in several domains: statistical, political, and psychological among them.  For traditional science everything is determined (unfree).  Contemporary science recognizes emergence as a property of evolution. Statistics uses “degrees of freedom” to measure indeterminacy.  Political science measures freedom by rating elections, independent judiciary and press freedom to compare nations.  Natan Scharansky felt he had more freedom in the gulag than did his guards: freedom of thought.  Freedom in any domain is a relative matter; it is a Platonic Idea.  Enhanced agency is a primary aim of psychoanalytic treatment, freeing people from inhibitions, symptoms and anxieties.

Modesty, Ambition and Progress in Science

Scientists focus on specific phenomena to fit their methods.  Dissertations conclude with a section on limitations of the study that may limit generalization (e.g., sample size and population).  Research programs address limitations with further research.  Scientists must be modest in their claims.

Scientists are also expected to be ambitious.  Research does aim for generalization, and for applications.  Freud was ambitious, attempting a complete understanding of the human mind.  His range came to include humor, art, literature, and the psychopathology of everyday life.   Darwin’s propositions have become the overarching paradigm for life sciences.

Ambition leads to error; Freud made many.  The subtitle to his Narcissism paper (1914), “an introduction, could apply to much of his writing.  Freud is chided for having no summary.  This omission may be his recognition that his system, like Darwin’s, was incomplete.  Freud’s view of psychosis is questionable; his psychology of women is undermined by its phallocentric viewpoint.  “Anatomy is destiny!” was publicly challenged in 1951 by Christine Jorgenson, recently by Caitlin Jenner, following a 40-year political movement by the transsexual demographic.  Freud’s “bedrock” (penis envy in women, castration anxiety in men) was a leap of faith.  His rejection of other-than-clinical research promoted an isolation that still hampers scientific progress.

The atomic physics of the 1940’s gave way to nuclear physics and to strange entities; even to “quantum weirdness.”  Nobel Laureate physicist David Gross sees ignorance – and new questions – as driving science.   Scientists must be ambitious and modest.  Ambition expands the frontiers of knowledge; modesty limits premature claims. Scientists devise more refined methods to make progress.  Popper led a philosophical assault on the scientific standing of psychoanalysis over 50 years ago; Grunbaum continued the assault more recently.  Responding to Grunbaum, Howard Shevrin conducted a series of increasingly refined studies.  The philosopher cried “Uncle;” acknowledging Shevrin’s (2012) work as a valid demonstration of psychoanalytic hypotheses.

Best Evidence; Convergent validity

“Best evidence” is a complex concept,” determined – always provisionally – by social, cultural, even political consensus; the FDA recently approved a new pill for enhancing female desire by a vote of 18-6.

Despite Meehl’s (1954) finding statistical prediction superior to clinical judgment, the latter is standard for individual decisions in all health care practice; cases also remain the primary source of psychoanalytic data.  Experimental findings don’t readily translate to individuals; operational definitions and exclusion criteria limit generalizability, and patients may be statistical outliers. Statistical significance often falls short of practical significance, experimental conditions differ greatly from those of clinical practice, and contamination and fraud are not unheard of.    Failure to replicate is common for all areas of scientific research.  Randomized controlled trials (RCTs) are considered a “gold standard” for empirical research, but a close look at RCTs comparing drugs or psychotherapies frequently shows results to be tarnished (Wachtel, 2010), leading to “fool’s gold” claims (Shedler, 2015). It is understandable that practitioners are critics of controlled research; Hoffman’s (2009) rejection of quantitative studies drew a standing ovation at his invited APsaA address.  I read summaries of research papers, often finding full articles dull reading and rarely directly relevant to my practice.

Yet I must admonish fellow clinicians that an art whose claims are more than aesthetic needs more than claims for affirming its value. A google search shows nearly 500,000 listings for psychoanalytic research; with significant support for treatment effectiveness, as well as clarification of therapy concepts and process.  Many studies use quantitative methods to provide normative data; social policy research is scientifically respectable. “The Authoritarian Personality” (Adorno, et al, 1950) initiated political psychology.  Clark, Chein and Cook (1952) were cited in the Supreme Court’s 1954 decision outlawing school segregation.

Scientific method begins with systematic observation, and correlation; clinical evidence may be limited to these methods.  Psychoanalysis is not unique in this regard (e.g., meteorology, astronomy), nor is it unusual for much of health care practice. Scientific judgments are based on current empirical evidence and best rational arguments.   “Convergent Validity” – a preponderance of observation, correlation, relevant experimentation, and findings from related disciplines – is a proper standard for “best evidence.”  Life forms evolve; subjectivity seems to have infinite potential for variation.  Lest we find ourselves in the hatchery of Aldous Huxley’s dystopic “Brave New World,” individuals must be treated as unique.  Science corrects its findings with changing consensus over time.  There can be no complete theory of everything (Critchley, 2015). Researchers and clinicians should stop fighting: “The farmers and the cowboys should be friends” (Hammerstein, 1943).

Epistemophilia and its Discontents

The urge to know motivates infants.  Freud spoke of an epistemic drive.  Panksepp’s recent work (2012) supports this idea.  Curiosity is basic to science and to the future evolution of our species.  Knowing is resisted because knowledge can be painful.  Weaning requires accommodation to a reality beyond personal need; toilet training inhibits urges; the Oedipus complex redirects and defers desire; mortality leads to adaptations, from depression and despair to the search for meaningful lives.  The Western creation myth forbids tasting the fruit of the Tree of Knowledge; Biblical knowing is a synonym for sex.  What Freud made explicit has been in plain sight since Eve met the serpent.   Science aims to discover realities. Psychoanalysis focuses on subjectivity and approaches its task with the best methods available.

Daily headlines demonstrate the failure to solve the Problem of Evil.  Science is not alone in its efforts; by evoking personal engagement, the humanities provide a second path.  Freud was as inspired by Sophocles, Shakespeare and Goethe as he was by Brucke and Meynert.  Psychoanalysis bridges C.P. Snow’s (1959) “Two Cultures.”  The study of superego phenomena exemplifies a psychoanalytic approach.  Religion may provide comfort to multitudes, but its “side effects” – intolerance, fanaticism, cultism and holy war (common expressions of a punitive superego) – undermine its claims. Freud’s genius allowed him to create from his efforts to heal a new science that has become a permanent contribution to the history of ideas. This science, a disciplined curiosity based on a set of ideas, continues to address the challenges of the Problem of Evil.

Robert M. Gordon, Andrea Blake, Robert F. Bornstein, Francesco Gazzillo, Janet Etzi, Vittorio Lingiardi, Nancy McWilliams, Cheryll Rothery, and Anthony F. Tasso ¹

While the DSM and ICD basically classify mental disorders according to manifest symptoms, the Psychodynamic Diagnostic Manuals (PDM Task Force (2006) 1 and 2 (Lingiardi & McWilliams in press) are taxonomies based on the dynamics of the whole person. The PDM considers in addition to manifest symptoms: personality organization (healthy, neurotic, borderline, psychotic²), personality disorders or syndromes (e.g. schizoid, histrionic, narcissistic, etc.), and mental functioning (e.g. capacity for intimacy, defensive level, self observing capacity, etc.). The aim of this categorization is to better inform psychotherapy. However, since the PDM is associated with a psychodynamic orientation, it is uncertain if the typical practitioner would accept a taxonomy not based on manifest symptoms.

In order to assess this, we asked a sample of mental health practitioners from a wide range of educational backgrounds and theoretical orientations. The participants filled out a demographic survey, rated a recent client on the Psychodiagnostic Chart (PDC) and then rated the clinical usefulness of each diagnostic taxon (1 = not at all helpful, 7 = very helpful).

Robert M. Gordon and Robert F. Bornstein (2012) developed the Psychodiagnostic Chart (PDC) as an operationalized guide to the Adult diagnostic section of the PDM. Gordon and Stoffey (2014) found excellent construct validity and excellent two-week test-retest reliability. The PDC was recently updated for the PDM2.³

The volunteers (N = 438) were recruited from 14 workshops on the DSM, ICD and PDM.  In this sample, 46% held doctoral degrees, 67% were female, 60% were age 50 or older. Primary orientations were 41% Family Systems, Humanistic/Existential or Eclectic and 33% CBT.  Only 26% identified themselves as primarily having a psychodynamic orientation.

The results of our survey indicated that the percent rated as “helpful – very helpful” (ratings from 5-7) in understanding their patient for each diagnostic taxon were:  level of personality organization 75% (M = 5.3, SD = 1.40), personality disorders 62% (M = 4.9, SD = 1.49), mental functioning 67% (M =5 .0, SD = 1.40), and cultural/contextual issues 41% (M= 4.7, SD= 1.54).  Only 30.5%  (M = 4.2, SD =1.47) rated symptoms as “helpful-very helpful” in understanding their patient. Wilcoxon Sign Ranked Nonparametric Paired Tests was used due to the skewed distributions. All of the diagnostic dimensions were significantly different at p < .0001, except the differences between personality disorders and cultural/contextual issues which was p = .004.

These results suggest that the typical practitioner would find the taxonomy of the PDM1 and PDM2 as clinically useful (the PDM2 has essentially the same taxonomic classification as the PDM1). They even value personality organization, personality disorders or syndromes, and mental functions more than manifest symptoms for helping to understand their clients. However, students and practitioners need to be educated about the PDM, and it needs to be taught whenever the DSM and ICD are introduced.

Footnotes

^{1. Coauthors after Dr. Gazzillo are listed in alphabetical order.  Many thanks for the help with recruitment and data collection go to: Debra Kay Bennett, Amy Brosof, Robert Galligan , Jenny Holcomb, Arpana G. Inman, Linh Luu, Bindu Methikalam, Sneha A. McClincey, Susan C. McGroarty, Allison Otto, Bethany Perkins, Judi Ralph and Ken Ralph (J&K Seminars), Val Spektor, Lauren Turner and Christina Villani. The IRBs of Muhlenberg College and Chestnut Hill College determined that this project adequately protects the welfare, rights, and privacy of human subjects.}

^{2. The PDM1 did not include a psychotic level of personality organization, but psychotic level is in the PDM2.}

^{3. For free copies of the Psychodiagnostic Chart go to: https://sites.google.com/site/psychodiagnosticchart/} 

References

Bornstein, R. F. and Gordon, R. M. (2012). What do practitioners want in a diagnostic taxonomy? Comparing the PDM with DSM and ICD. Division/Review: A Quarterly Psychoanalytic Forum.

Gordon, R.M., & Bornstein, R.F. (2012). A practical tool to integrate and operationalize the PDM with the ICD or DSM. http://www.mmpi-info.com/pdm-blog.

Gordon, R.M. and Stoffey, R.W. (2014). Operationalizing the Psychodynamic Diagnostic Manual: a preliminary study of the Psychodiagnostic Chart (PDC), Bulletin of the Menninger Clinic, 78, 1.

Lingiardi, V. & McWilliams, N. (in press) Psychodynamic Diagnostic Manual-2, Guilford Press.

PDM Task Force (2006) Psychodynamic Diagnostic Manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations.

I wonder if “conversion disorder” — a classical psychiatric term for the conversion of psyche into soma in the form of psychosomatic issues — could be one way of thinking about the present. Especially with so many patients complaining of bodily symptoms, armed at times with cadres of healers; with so many seeking recourse to pharmacological treatments or bodily modification of various sorts, plastic and otherwise; with young men and women seemingly willing to direct violence at any-body, including themselves, in the name of powerful religious ideals. Something increasingly insists on the level of the body.

There are even times when I feel like we are living in the nineteenth century. The fads for body-based healing reminiscent of an age of sanatoriums and hydrotherapy in Europe and the global pull toward religious fundamentalism akin to the intensity of something like the burned-over district of western New York. In fact, the metaphor of burned-over feels apt, meaning that there is no fuel left to burn, everything having been converted — a nod to the chemical meaning of conversion as instantaneous and complete transformation.

Conversion disorder is a late-nineteenth century term originally fastened to hysteria, a term taken from the Greeks to denote bodily symptoms, mostly feminine, that were medically inexplicable and so linked to psyche more generally. Hysteria eventually disappears from the medical lexicon in the 1980s, marking the centennial anniversary of psychoanalysis with its absence. Conversion, however, remains. Ambiguous. More gender-neutral. Less arduous of a term than “conversion hysteria,” but one that still speaks to the problem of the relationship between body and mind — all those puzzling aches and pains that seem to come with anxiety or depression, that act like a constant companion of sorts, or, on the more extreme end, problems like hypertension and colonitis, and the more ambiguous diseases like auto-immune issues or the chronics of Lyme, pain, and fatigue. Conversion disorder carries within itself the failure of diagnosis mapping so many bodily issues that seem to follow the fault lines of culture.

Historically, of course, conversion is linked to the idea of complete personal transformation in the religious sense. A.D. Nock in his classic book Conversion from 1933 sees religions of conversion arising at a point when the older religions couldn’t speak to the predicaments of the present. The prophet, he says, is someone who knows the hot house in which he lives, knows how to “fuse into a white heat” the combustible material that is there, to express and “to appear to meet the half-formed prayers” of his contemporaries. Maybe conversion — there like a beam of light in a rather murky present — will tell us why bodily disorder and the promise of transformation, body and soul, continue to slip into every realm of life. What is possible? What conversion may be hoped for?

Here I want to pick up the term again as a psychoanalyst, because conversion is linked to combustible effects, to desires and fears that remain hidden, unspoken, but ripe, a demand that takes place through the body. This is certainly the situation with the original “conversion hysterics” of psychoanalysis. “I have a sounding board in my abdomen…if anything happens, it starts up my old pain,” said a woman to Breur in Studies in Hysteria (1895, p. 204). Some thirty-odd pages later, Freud takes over, as he would do, this hysteric’s imagery as his own, laying down the foundation for the existence of “unconscious ideas” and the “splitting” of the mind on the basis of her words. Freud writes, “the lively affects into which they are thrown by relatively trivial causes become more intelligible if we reflect that the ‘split-off’ mind acts like a sounding-board to the note of a tuning fork.” Conversion hysteria is an act that preserves some part of your psyche or emotional life in the body, not allowing it to undergo the usual wearing away.

These women’s bodies and personalities move in concert — Breur and Freud describing them as lively, restless, intolerant of monotony, volatile, and impressionable. The unity of soma-psyche in conversion hysteria provides Freud, paradoxically, with a model of the dis-unity of the human mind. Or perhaps better, this logical ordering of their disorder provides Freud with a similar psychological theory. Breur and Freud followed the signals on their body from strange paralyses and pains, blackouts, coughing fits, and the like. The goal was not simply the removal of the pathogenic disturbance in order to return to normal. Freud abandons the cathartic aim — perhaps something closer to an idea deconversion — because it doesn’t last. He must find a more radical change, leaving us with one of the greatest of tautologies in psychoanalysis: conversion must be subject to conversion.

We are only a few short steps away from the invention of psychotherapy, which, far from the clichés of digging up one’s love or hatred for parents, was already at this time — 1895 — a listening to these women’s unknown indictments of the present via their history as well as their wish for a more just and equitable life, their longing for intimacy and sexual satisfaction. This story is perhaps familiar to many, but it is worth telling again because conversion disorders have not gone away. If anything, they have multiplied and mutated, permeating most sectors of life, love, and work.

What psychoanalysis locates is the importance of listening and listening closely; not to hear that these symptoms were psychosomatic and so therefore not real — Freud always said the maladies were real, meaning in the body. Rather, the analyst attempts to hear what is real in these wishes, what in reality, in the present situation, these wishes are responding to — their discontented bodies a sounding board to the note of the tuning fork of civilization.

The psychoanalyst, unlike the prophet or the guru, does not bend these wishes to his or her will, but rather returns them to the patient, returns what the patient has learned from her body-like-an-antenna concerning the contemporary landscape. “Conversion disorder” speaks a powerful truth about the way our bodies are affected by the world around us — a world we are born into, and so did not chose, which moves at lightning speed and with which we are all trying to catch up.

Let me illustrate with the case of a 10-year-old girl I will call Jessica. Jessica was the first daughter of a second-generation mother of Hispanic parents who immigrated to the United States. Being a female in this family meant identifying with potential sin and devastation in the realm of love and family as well as probable failure and poverty in the attempt at professional success. Her mother practically daring the child not to identify with her only made Jessica cling to her mother all the more. I watched this little girl enter into puberty with this injunction on her shoulders. Without the space to symbolize her obscure desires as an imagined woman, the narrow straights of conversion seemed to open up to her.

Her body was increasingly presented to me as a body either in pain because of strange feelings in her abdomen or skin or in play because of all the things a woman must do with her body — comb her hair, shave her legs, wax her private parts, do her nails — that felt like a curse. Jessica got her period when she was close to 12 years old and her mother said something to her like, “Now you can get pregnant.” The strange command had far-reaching effects on this little girl who was at the school nurse’s office for days complaining of stomachaches.

During a number of sessions, we pieced together the following story: there was a great deal of interest at home in her period, including by her little brother who was following her into the bathroom. At one point, he went to the bathroom, and then she went after him. Jessica realized she thought she might be pregnant from this because her mother told her never to put her underwear with her brother’s in the laundry bin, meaning she had a child’s theory of procreation as happening when things touch that aren’t supposed to.

This theory of touch has another layer because Jessica’s mother feared her daughter’s body (which she did not touch), which signaled to her the possibility of getting in trouble as she did, getting pregnant too young, with the wrong man, like all the women before her — hence, female underwear had to be separated as an object of shame. With this revelation, I heard in her mother’s strange ambiguous statement — “Now you can get pregnant” — the permission granted, as opposed to the prohibition that was consciously intended.

But this is not the end of it. A second conversion symptom emerges in the treatment! Jessica is at the school nurse’s office again, this time because she felt pains in her veins and she said she had a splinter — she doesn’t know where it had gone — and she heard that it could go into your blood and pierce your heart. She is in a state of terror and can think of nothing else. The compulsive thought is easily interpreted: she can now imagine something going into her, namely, her acknowledgement of sexual intercourse and the role of the penis in procreation that she had gained in the previous sessions. More than this empirical fact, however, in this strange conversion symptom one must also hear this child’s desire — for something to enter into her, the wish for love, for something to pierce her heart, to touch her intimately on the inside.

Perhaps this is a deeply held wish in the face of a mother who treated her like something to be afraid of. Perhaps also this is her response to the ambiguity of the “now you can” that spoke the truth of these women and their split-off desires: that they too crave sexual relationships, intimacy, something forbidden to them not only by religion, but also by the demands of a competitive atmosphere where all this must be put aside lest they remain entrenched in poverty, generations of the family stuck at the same level of education and hardship. The threat of poverty and giving into one’s feminine sexuality are often condensed in powerful ways for immigrant and marginalized women.

What fascinates me in this case is that conversion is not dissipated by therapy or a greater sense of reality, but instead intensified to reveal increasingly deeper truths. Access to these layers of truth reveals the present against the varied attempts at fending it off that fuel repetition and acting-out. In fact, in speaking this symptom to her analyst, the “can” is transformed into the freedom this mother desperately wants to give her daughter without knowing it or knowing how. The curse can finally be overturned, meaning her daughter’s conversion symptoms show exactly how she may be converted.

I wager that the particular truth of this case is true for many mother-daughter relationships in a time when equality has not always meant greater freedom or choice in one’s life as a woman. We cannot have it all — be mothers, be sexual, be attractive, be successful. To be told that we can brings further shame that no longer has a place except in our bodies. I also wonder whether this speaks to the questions we have about so many young western women being recruited by ISIS, which preys on their latent desires by acknowledging what is impossible for them, precisely, as women today. The false promise to them of something more certain touches them more intimately than the advantages we assume they think they have — our liberal perspective one more burden, one more denial coming from the outside.

Similar to Jessica, the very first patient of psychoanalysis, Anna O., suffered from a hysterical pregnancy, something that scared Breur into abandoning her treatment and intrigued Freud who insisted on writing Studies in Hysteria. Beyond Freud, what many don’t know is that Anna O. went on to become one of the first women social workers, went on to fight for women’s rights, especially prostitutes, young mothers, and orphaned children. Although she was furious at Breur and Freud — men she felt had used her for their own fame — one still wonders whether the therapy gave her the impetus to fight for exactly what she came to understand ailed her in her body as a young woman, desperately loyal to her family and caught in the contradictions of her day.

***

This article originally appeared in Public Seminar: www.publicseminar.org

Jamieson Webster is a clinical psychologist and psychoanalyst in private practice in New York. A graduate of IPTAR, she teaches at Eugene Lang College, as well as, supervising graduate students through City University’s doctoral program in clinical psychology. She has written for Apology, Cabinet, The Guardian, The Huffington Post, Playboy, The New York Times, as well as, for many psychoanalytic publications. The Life and Death of Psychoanalysis is published with Karnac (2011). Stay, Illusion! – written with Simon Critchley- is published with Pantheon Books (2013). She is currently writing a new book titled Conversion Disorder.

 

*in reference to Gwendolyn Brooks’ book of poetry of the same name

The denouement of a ten-year psychoanalytic treatment brings to mind the story of Jane Eyre.  I was seven years deep into my analysis when I began to have the feeling that, like Jane’s blinded Mr. Rochester, my analyst had lost sight of me.

From the precise moment I met Jane, and I can still see her seated in a dark room surrounded by a family not her own, she became a dear companion.  Reading this novel in childhood, I was unable to set it down.  As I walked to school, took a bath, ate dinner, I read.  So intent was I on absorbing Bronte’s words, I parted with them only to sleep.  Such was their elixir-like power over a seven year old me.

Jane, “a motherless woman,” eventually makes her way as a governess. Late in the novel, and after much hesitation, she accepts the hand of her employer, Mr. Rochester, and in so doing delivers perhaps the most powerfully glib line in English literature: “Reader, I married him.”

An invisible woman for the bulk of her life, she agrees to nuptials only when her betrothed has been blinded in a terrible fire, in other words, when he can no longer see her.  The frenzy of the visible was simply too much for Jane.

I understood Jane’s inner dilemmas well.  While not an orphan, at age three I was knocking on neighbor’s doors singing Barbra Streisand’s “People”.  Jane learned to take a quiet pride in her abstemious response to being passed over and neglected.  Not me.

According to family lore, at seven, I came home from school and, watching my father take my brother outside to play catch once again, let whatever fledgling restraint I had developed unravel: I declared my hate.  In my seventh year of analysis, I declared the same to my analyst who, often enough during my hour, appeared to be metaphorically throwing the ball to someone else.

My father told me that he never recovered from my words.  My analyst said, “I know.”

——————————

When transference is in full effect the analysis is imbued with a dominant color, a decipherable texture, a specific form. In my two previous analyses of long duration I had never had the experience of full on misprision.  But I had had it with my father.  Indeed, it was maybe the one thing I could depend upon him for, a legacy of sorts.  So when beset with the terrible feeling that my analyst had become impervious to my very mode and mien, that he “just didn’t understand,” I knew we were in the thick of it; at first, I pulled the curtain, becoming an obscurantist. Then, I redoubled my efforts, working with exquisite precision to make myself heard.

Here is how, initially, it looked.  While lying on the couch, pouring my heart out about the trials of work, my love life, a dream I had had the night previous, I would hear my analyst ask me a question that felt wholly alien. I would then intervene, initially politely, asking, “Wait, did you think I was talking about my brother? Did I,” I asked us both, “mention him?”  Gas lighting myself to stay connected was old hat.

As time passed, I began to search for something concrete on which to pin these misunderstandings: As he was old enough to be my father, I considered his age.  The next time I felt misheard, taking a risk to see if something worse than deafness was afoot, I asked, in earnest, about his hearing. When he told me his hearing was fine, I spoke more loudly anyway.

As I had done with my father, I increased my laborious efforts.  I began to work with great diligence, cultivating an intense focus as one does when feeling imperiled—as one does when one denies that one is helpless to remedy the situation.

Eventually, as the struggle to make myself known continued to falter, I verbally threw up my hands from time to time.  I would exasperatedly exclaim, “really?” in response to hearing my analyst offer ideas that felt far removed from whatever was the subject under consideration.  Sometimes I would even sit up and look at him directly, asking, “How many years have we been working together?  Why have you lost sight of me?”

The more I tried to convey, the more his not understanding both frightened and infuriated.  If he dreaded my session hours, I can’t say I blame him.

————————————

I recall waiting for my father to pick me up at the end of half-day kindergarten, where, to survive the wait, I would unrelievedly count and recount the buttons on my dress.  As my little throat tightened, I worried I had swallowed one; I also worried I would die.  Better to die than to have him not show up.

This is how a child’s mind works.

Tired of being misunderstood, tired of being held less than close, I felt a thing perhaps dangerous for a girl to feel; I felt I was smarter than my father.  I don’t think I was actually smarter; rather I defensively attributed his inability to resonate with me as deriving from an intellectual deficit rather than from an emotional conflict.  True to transference, the more my analyst misunderstood me, the more I thought him daft.

Of course the attribution of intellectual inferiority to my father and to my analyst was, simply, a defense, protecting myself from the particular pain of being emotionally orphaned, seen but not known.  A precocious child, I spoke early, read early, and painted with passionate seriousness.  I lived in a world of dolls, words, and watercolors—a world that my father had no idea how to enter. Sometimes I thought myself charmless and inarticulate, unworthy of love.  Other times I thought these men were deficient.

…………………………………………………………………………………….

There is a veritable cottage industry in psychoanalysis about the sources of an analyst’s feelings about the patient. I like the idea that patients may unconsciously position analysts to react in ways similar to significant figures from early life.  So around analytic year 8, while we were more or less drowning, I posed a question: “Dr., have I managed to get you to feel towards me as my own father felt?”  No slouch, he reversed my question adroitly: “What do you imagine your father felt towards you?”

I let a minute pass.  Maybe two.  Rather frightened, I uttered ideas I will never know the veracity of, (dear reader).  I uttered things we only feel and then reach for words so as to feebly narrate.  I speculated, saying, “You know the night before I went to college, on the precipice of beginning life outside the family, all our chances to connect through living daily life together fast drawing to a close, he, a young 49, suffered a massive heart attack. Maybe he had too much feeling for me?”

I liked this idea.  Maybe there was love underneath the immoveable thicket that lay between us.  If there was something there rather than a paucity of something, I could relax because I could cohere.

My analyst asked for more.

“When I would turn to him to share an accomplishment (never did I share with him my fears or worries) it was as if I had thrown him a ball he couldn’t catch and didn’t see coming.  Someone once used the phrase a deer in headlights.  That describes it.”

I then proceeded to speak the transference aloud: “And honestly, I feel the same way here Dr. as I try to reach you and you mishear my very words.  I fail to reach you. You can’t hear me. I watch myself disappear.”

A heavy silence coated the room followed by a paralyzing sadness both intense and sharp. I recall feeling a sudden rush of empathy for my father and for my analyst; I also recall wishing to disappear.

I hoped, with new words spoken, the analysis might come alive again.  I longed for the chance to open this closed door: it wasn’t always like this. I noticed I frequently watched the clock. The thought, “this is how it feels to be in quicksand” came and went and came and went. Then, an idea, buoyed by a fresh feeling, emerged.  I did not have to keep trying to be understood here, in this space, in this duo. I blush to think that it took Jane about as many years to decide to marry Mr. Rochester as it took me to have this seemingly facile yet unbelievably difficult thought.

So, with much still to analyze, dear reader, I left him. And while I decamped not quite mid-sentence, I took flight less than gracefully. Left to my own devices, I see even now that I repeat myself. You don’t have to tell me what I am doing, because this time I know, not that it stops me at all so here I go, here I go: are you listening to my confession, are you with me as I speak?  That is me, the one who wonders, the one who is still wondering, even now as you read me, can you actually hear me; can you hear what it is that I am trying to say?

The author comments on some of Freud’s essays – ‘The Theme of the Three Caskets’, ‘Transience’, ‘Thoughts for the Times on War and Death’ and part of ‘Beyond the Pleasure Principle’ – which address ‘the end’, understood both as conclusion and death, and as having goals or aims. He shows how the Freudian reflection on the ‘end’ as the final moment, and on the ‘end’ as an aim or goal, are, in a dialectical way, intricately intertwined. According to the author, this double face of the ‘end’ explains Freud’s later elaborations on Eros and Thanatos, which in turn lay out the metaphysical presupposition starting from which Freud constructed his entire doctrine (and clinical practice): that the essence, the quid, of a human being (and of living beings) is die Lust, that is, desire and/or pleasure. Lust appears ambiguously as the ‘end’ of human beings, given that their aim is pleasure, but also as the annihilation of desire. It is against the background of this dialectic between end and aim that we can thus finally grasp, in the ambit of Freudian doctrine, what the author calls a ‘contact with the Real’.

We live in an age when, in contrast to the ancient or medieval worlds, two of the meanings of the word end, end as ‘aim’ or ‘purpose’ and end as ‘termination’, are drawing more and more apart. The Greeks, with the word telos, did not really distinguish between the two concepts, though they also had the word skopos: a specific end. Generally telos meant ‘accomplishment’, ‘outcome’. According to the Greeks a life could only be judged starting from its end – thus the end (the conclusion) was their ends (aim). A beautiful death had a retroactive effect on an entire life, even if this life had been ugly. The beautiful end – which for a man was especially death in battle – made a life beautiful post factum, the French would say après-coup. In the same way as the sense of a Latin phrase can be captured at the end – with the verb – the sense of a life could only be captured at its conclusion.

The ancient Greeks had deified the end in the Praxíkai: these goddesses – like the Gorgons and Medusa – were heads only (Vernant 1985). Today, on the other hand, death is a tail end which no longer gives a post factum sense to life. Nor is it any longer deified. Even the Catholic church has turned the sacrament of the extreme unction to a mere ‘anointing of the sick’: it no longer seals the death of a Christian, it has become no more than giving comfort in illness. The end is an incident to be postponed as long as possible: more and more often people die in aseptic hospitals, on drips, with tracheotomy tubes in their noses, usually dazed and confused, while their relatives are at pains to make the meaningless event as least painful as possible, but not less meaningless. Our ends are all in life, and life, though it finishes has no other end outside of itself. Today life is a virtually limitless continuum that sooner or later snaps off, not like a sentence that finds its meaning at its conclusion.

Sigmund Freud, in the most mature phase of his thinking, dealt with the relationship between the end and the ends of life.

 

1. The Choice of Death

 

In 1913 Freud published a short text, ‘The Theme of the Three Caskets’ (Freud 1913). It deals with love and death and was written seven years before his capital essay Beyond the Pleasure Principle, in which he sets out the theory of life and death drives. The earlier work is inspired from the episode in Shakespeare’s Merchant of Venice where Portia’s three suitors have to choose between three caskets – one in gold, one in silver and the other in lead. If one picks the right one, he will marry the belle. The right casket is the one in the vilest metal. Freud relates this theme with the test King Lear gives his three daughters at the beginning of Shakespeare’s tragedy, with various episodes from the Gesta Romanorum, with Grimm’s fables, the judgment of Paris and so on. Here, like elsewhere, Freud manages to manipulate a heterogeneous range of literary and mythological data and submit them to his underlying thesis: this choice between three women (or between three containers symbolizing them) should ultimately be interpreted as a choice of death. Even though in the written or oral legends the one to choose is the most beautiful, the worthiest, the youngest and so on, the deepest meaning of these tales – according to Freud – is that man (the adult male or human beings in general?) has to choose between what all of us, with no exception, have to come up against: death. King Lear in particular is the old dying man who still clings to women’s love – and thus asks his three daughters to prove their love for him – rather than choosing the quiet Cordelia, in other words death.

Freud’s interpretative tour de force was no easy task, if we consider that in German ‘death’ is masculine – der Tod. Freud resorts to the subterfuge of the Todesgöttin, the Death-goddess, who ‘like the Valkyrie in German mythology, carries away the dead hero from the battlefield’ (GW, 10, p. 36; SE, 12, p. 301). For him death is feminine, like Atropos, the third of the Fates, who ultimately cuts the thread of any life. And Freud assigns a female figure to the three essential moments of his human life: she who generates him, she who will be his companion throughout it and she who will annihilate him. The last of these is mother earth, who takes him back into her bosom.

Here – like elsewhere – Freud simply identifies the human condition with the male condition. He had already done so with his Oedipus: the so characteristically male story of Oedipus becomes the story of every human being. Is this the ‘male chauvinism’ Freud has so often been accused of? In any case, Freud never believed in the symmetry between the male and the female psyche: the latter is a turn (or stop-gap?) of the former.

No cultural anthropologist today could accept this hermeneutical slalom of Freud’s. For the serious anthropologist today it is absolutely forbidden to gather together, as variations of a single series, myths, tales and fables extracted from different cultural contexts. It would be like an astronomer stating that, because two stars look close by to the naked eye, they really are at a short distance one from the other. And even less so is it legitimate to read into the watermark of these variants a single basic meaning. Here Freud would be as naïve as Jung (and there is undoubtedly a Jungian side to Freud) in wanting to extract an ultimate meaning, a universal sense in the mythologies of all ages and civilizations. Significantly, Freud was inspired by Robertson-Smith and Atkinson, two approaches that have left little or no influence on modern anthropology. After Lévi-Strauss’s Mythologiques, anthropology now reads all myths, fables and literary works not as threads converging towards a unifying sense, but as a continuous unraveling, an endless shifting of meanings with every version based on an older text, modifying it, twisting it around, enriching it or impoverishing it, always deflecting contents and forms towards directions it is impossible to put together in a definite and definitive single meaning.

This analysis by Freud basically has no objective value. Yet… we have to admit that with his bold identification of the ‘third’, the youngest and most beautiful, with death, Freud strikes us. He makes us think. As if he had seized on a truth. But how to consider a truth something that cannot actually be proven, the supposed hidden sense of legends and texts? Is it perhaps not an objective but a subjective truth he is talking about? And what on earth can ‘subjective truth’ mean to us today? Yet we have the feeling that Freud is giving us a convincing interpretation here, because he somehow manages to verbalize an actual relationship we have with death. Wittgenstein (1967) said that with psychoanalysis Freud did not explain the ancient myths: he invented new ones. But this is what every epoch does: it reinterprets old tales according to its spiritual priorities, it builds a new fable (mythos) by reinterpreting ancient ones. Not all myths are mystifying – Plato’s myths were supposed to be demystifying. So, Freud excels in interpreting previous texts and myths in the right way for us today, in a way that perspicuously describes – in this case – our relationship with love and death. Freud is important not because he explains things causally, but because he represents effectively. We shall later see in what sense he does this.

And Freud also represents himself effectively. In a letter to Ferenczi (dated July 7 1913) he connects the choice of title for the essay to his own three daughters and mentions his satisfaction with his youngest daughter, Anna (born in 1895). We could of course ‘Freudianly’ interpret this interest of Freud’s in the ‘three belles’ and ask ourselves whether Freud wasn’t in fact elaborating his choice of Anna, his own Cordelia. Anna, his youngest daughter, had always been his favorite and the only of his children who would later become a psychoanalyst, an intellectual and a writer. Just when Anna, age seventeen, appears to the world in her full blooming femininity, Freud associates his (unconfessable, but not unconscious) ‘choice’ of Anna to the choice for his own death? To Ferenczi he specifies that his other daughter Sophie (born in 1893) had become engaged in the summer of 1912 – and would marry during 1913. Of his three daughters Anna was not only his favorite, but also the one who never married. In a certain sense she was like Antigone with Oedipus, always by her father’s side. On the one hand his daughters, now young women at a marriageable age, on the other Sigmund, now 57, four years away from the fatal age of 61, when according to his superstitions he would die: his identification with King Lear was evident. Freud already felt like a dying man. He had to choose the youngest and most amiable between Mathilde, Sophie and Anna. But what could he himself now choose if not death?

This is the year when he is writing that text, 1912, and also the year when the belle Lou Andreas-Salomé moves to Vienna for her initiation to psychoanalysis. As we know, Freud fell in love with Lou, five years younger than himself, even though perhaps there was nothing sexual between them. But undoubtedly, the presence of Lou, already a famous femme fatale in the German-speaking world, was for Freud an opportunity to reconsider himself as a man in need of a woman’s love – exactly like old Lear. Anna’s love, Lou’s love – or death’s love?

But Freud’s subjective truth is also ours. What did he mean by writing (to himself) that death, precisely because it is a necessity no one can elude, must be chosen? We don’t choose the two essential events of our lives: coming into the world and leaving it. Suicide is only a putting off of the latter and, appropriately – before the Christian anathema – suicide was valued by the Stoics and other philosophers as the only possible absolute act of freedom for human beings. More recently, Pasolini (1970), in an essay about freedom, incontrovertibly affirmed that freedom is nothing more than ‘the freedom to choose to die’. But, suicide aside, what can it mean to have to choose something we cannot elude?

We shouldn’t give a banal psychologistic answer to this bizarre prescription of Freud’s. We must not just think that we have to get used to the idea that we have to die and accept it without too much whining. Common language says that we ‘have to come to terms with’ things like death, with ours and with that of others. What terms? To give meaning to our own death? But giving a meaning to one’s own death is different from coming to terms with it. The common expression coming to terms with is like two belligerent parties opening negotiations to settle the terms of an agreement. Should we also negotiate death with our enemy? Should we try to verbalize it? A verbalization, however, that evokes the end, terminus – the words, the terms we use, also represent the end, the completion. Is the homonymy between term as limit and term as word really a coincidence? The etymology is the same: from the Latin terminus and termen, meaning ‘boundary pole’. The Latin pole comes in turn from the Greek termon, the tree that belongs to two neighbors. A word, therefore, is something like a boundary post, a limit, something that belongs to two different properties and marks them off. So, death is a term, both in the sense that it is like a separating fence and in the sense that, like a word, it helps to communicate: in the same way as a word marks the point of contact between signifier and signified, so death marks the point of contact between life and nothingness.

Some time ago, in a public debate, a girl asked whether it would be a good idea to ‘educate the young to death’. As today the media give a vain and vapid image of life, it may be better to remind them they must die. But what does it mean to educate to death? De facto, we cannot think about death, but only about life, our life or that of others. Those who think about death a great deal, think about the cessation of life, hence they think about life. Living beings are condemned to life: death, in their life, has no space. But it is precisely because it has no space that death distresses us so.

Can we ‘reason about death’? Here I mean ‘reason’ in the medieval sense, i.e. to talk: to talk about our end, to find the words to say it, to ‘subjectivize’ it, some would say. Are to speak and to resign oneself two faces of the same medal? If I can speak about pain, does it mean that I have somehow resigned myself to it? And does speaking about death, giving it names, mean finally accepting it?

But perhaps, more generally, ‘coming to terms with it’ means trying to join – success is impossible, but one can try – the end (as in Ende, Schluss) with the end (as in Zweck, Ziel, Absicht). Every positive upshot, every happy ending, every edifying comedy or fable, aims at linking the two meanings of end: ‘…and they lived happily ever after’. Is this ending ultimately the end of every human being, to live happily ever after? But then in what sense is the real end not happiness and wellbeing, but the end?

 

2. Caducity and Eternal Return

 

In November 1915 Freud wrote a brief note entitled ‘On Transience’ (Freud 1915a). It begins with an anecdote, when ‘I went on a summer walk through a smiling countryside in the company of a taciturn friend and of a young but already famous poet. The poet admired the beauty of the scene around us but felt no joy in it’ (GW, 10, p. 358; SE, 14, p. 305). The young man could not help thinking that all the beauty would come to an end in the winter; just like everything else that is beautiful and noble in the human lot. ‘All that he would otherwise have loved and admired seemed to him to be shorn of its worth by the transience which was its doom’.

Today we know the poet in question was Rainer Maria Rilke and the silent friend Lou Andreas-Salomé, Rilke’s former lover (the walk took place in August 1913 in San Martino di Castrozza on the Dolomites). On that occasion Freud challenged Rilke’s idea that the caducity of the beautiful implies its debasement: on the contrary, the rarity and transience of beauty increases its value. Freud obviously took the point of view that we today consider the wisest: let’s enjoy the present, let’s welcome the joys life gives us, albeit we know how ephemeral they are! And indeed, Freud reads Rilke’s discontentment as a ‘revolt against mourning’ (GW, 10, p. 359; SE, 14, p. 306), as a refusal to accept the loss of dear and precious things. In that very period, in fact, Freud had worked on his essay ‘Mourning and Melancholia’ (Freud 1914), where he described mourning as the painful job that tends to break us away from lost loved objects.

But, rather than as a refusal of mourning, Rilke’s ‘protest’ against the transience of things could be interpreted as the bitterness that everything – our life first and foremost – will come to an end. Not just Rilke, but many others too – usually moved by great ambition – are obsessed by the thought: ‘what is the point of trying hard in life, of loading it with ambitious meanings, if it will soon come to an end?’ Not only one’s own life, but everyone’s. Cosmology assures us that our solar system will come to an end, that it will become a supernova and then – in a death process of matter itself – will probably turn into a black hole, a wound in the body of the world that will swallow up everything there ever was. In an interview Woody Allen once said: ‘It’s terrible to think that everything we consider immortal – even Homer, Shakespeare, Freud… – it will all end!’ And added: ‘There’s a thought that can ruin your evening, even if you go to the best restaurant.’

What is the point of living a life that is not eternal in a world that is not eternal? In other words, in a life and a humanity that will come to an end, are human purposes themselves destined to end, to become futile? Are we not destined to limit ourselves to the immediate end of surviving while getting a bit pleasure in the process? Note that in this article Freud, without quoting Nietzsche, evokes the eternal return [ewige Wiederkehr](GW, 10, p. 359; SE, 14, p. 306) when talking about the seasonal cycles of things, in contrast with the irreversibility of our existence. The metaphysical myth of the Eternal Return of the Same was also for Nietzsche an attempt to rediscover a dimension of eternity in a world that had killed God and hence the belief in the immortality of the soul. Even atheist thinking, to be able to laugh jovially in life, feels the need to find consolation in caducity as an eternizing perspective: every event of our life will be lived out again throughout eternity.

 

3. ‘Si vis vitam, para mortem’

 

Freud had actually written about his own death – rather than about those dear things – a few months earlier (Spring of 1915) in the essay ‘Thoughts for the Times on War and Death’ (Freud 1915b). Here he says that in our unconscious we do not believe in our own death – though we certainly believe in that of others and sometimes even wish it. Freud – in contrast with most later psychoanalysts – does not believe in the least in ‘death anxiety’ (Todesangst): he does admit that we are dominated by it more often than we believe, but ‘is something secondary, and is usually the outcome of a sense of guilt’ (GW, 10, p. 351; SE, 14, p. 297). So, why does Freud consider sense of guilt but not death anxiety as a part of the unconscious? Why does something that implies a moral law appear to him as more fundamental, more primitive, than something as instinctive and emotive as death? In fact, he believes that the sense of guilt springs precisely from wishing the death of others, what M. Klein would later call ‘the talion principle (an eye for an eye, a tooth for a tooth): what I wished to do unto the other, the other will do unto me. More than a moral law, guilt is for Freud the passive reflex of an active death wish towards others, in the same way as in the mirror image, the gesture I make towards my image appears as the gesture the image makes at me.

But everything becomes more complicated when in the same essay Freud connects these reflections on death to those on war, which was raging across Europe at the time. In fact, following a common cliché of the time, Freud surmised an Urmensch, a primitive or primal man, not yet civilized, who was the expression of the unconscious en plein air. This primitive man – the authentic man, who lives according to the unconscious – does not believe in his own death, he only wishes to inflict death onto the other, who he hates, and he has ambivalent feelings towards those he loves. In other words, for the authentic man – for the authentic subject in all of us – one’s own death does not exist, while that of the other exists and is craved, both when the others are loathed and when they are loved (in the latter cases guilt comes into play, as a death threat for having wished to kill a loved one). Civilized man rejects this authenticity, he represses it, but he pays dearly for this: with Unbehagen, with psychic malaise. Now, thanks to the war, primitive (authentic) man reemerges, in the sense that, to be able to engage in war, contemporary society needs to ratify the drives of the primitive man. The warrior can be heroic only if he draws on the archaic conviction that he will not die; that his brother-in-arms can die, but not himself. For Freud one can be a hero only thanks to a providential delusion: that of one’s immortality. After all, in this way he can give free rein to his craving for killing those he hates, his enemies. And thus the ambivalence finds its legitimization too, thanks to the war: by sacrificing thousands of my compatriots I achieve the profound ambivalence regulating my relation to my fellow man, whom I am prepared to sacrifice in war so easily.

But, as often happens in Freud, at a certain point – in the final paragraphs of the essay on war and death – the discourse, which seemed linear, becomes twisted: what seemed apparently clear reveals a staggering complexity. Indeed, if the war puts into action a massive regression to the ‘primitive man’, this does not mean pathology, on the contrary: for Freud psychic pathology is not simply the result of regression, but of the conflict that a regression causes. Very often war is Socio-Syntonic: it makes someone who kills or gets killed feel not a mental sufferer but a hero for the Cause, for whom to perhaps erect a monument. Precisely because war makes our secret belief in our immortality socially acceptable and useful, it makes room for something that, through the ever tighter meshes of civilization, insists and persists inside us and will sooner or later emerge. So Freud asks himself

 

Would it not be better to give death the place in reality and in our thoughts which is its due, and to give a little more prominence to the unconscious attitude towards death which we have hitherto so carefully suppressed? (GW, 10, p. 354 ; 354; SE, 14, p. 299)

 

What is Freud trying to say here? Is he talking about his own death or that of the other? As we have seen, for the unconscious one’s own death does not exist, only that of the other; so why does he say that we have to give death the place which is its due? Earlier in the text he says that the recurring of wars should induce us to ‘recognize the truth’: what truth? It would seem that the truth Freud alludes to is not the existence of my death, but the truth of the unconscious, which is also the opposite of objective truth: it is our conviction that the other will always die, but I never will myself. A paradoxical truth, but ultimately an irrefutable one: as long as we live the dead will always and only be the others. But what leads Freud to taking this enormous action of calling a ‘truth’ what from every other point of view is a supreme illusion?

And Freud goes on: war, this regression to our truth, ‘has the advantage of taking the truth more into account, and of making life more tolerable [erträglicher] for us once again’ (GW, 10, p. 354 ; 354; SE, 14, p. 299). Incredible, Freud is saying – obliquely: war makes our life more bearable. He seems to be giving his own version of the futurist motto: ‘war, the world’s only hygiene’. Even though here he is talking about a psychic hygiene. He is obviously talking not only to the fighters, but to all those involved in one way or the other in the war (at the time everyone felt a part of the Great War): insofar as war makes us regress, it eases the pain of living; because for Freud the pain of living does not derive from cruelty and death, but from the fact that we have abandoned the illusory truths of Urmensch. War, with its trail of death, helps us bear life better! And he adds: ‘To tolerate life remains, after all, the first duty of all living beings’.

In what sense is tolerating life the first duty of the living being? Does naked biological life have duties? He knew perfectly well that in melancholy – major depression – a living person fails in this duty: he can no longer bear life. Here Freud seems to be raising a sort of superior moral commandment the depressive has betrayed: The living person who cannot bear life betrays his duty. And here he is not referring to the morals of churches, which abhor suicide (besides, he did not belong to any church). It is as if bearing life were an incredible ‘natural duty’, something ‘according to nature’, in the Aristotelian sense.

In fact, here Freud is structuring a principle embraced by what was undoubtedly the most representative philosophy of the twentieth century, and probably the most influential: pragmatism. What this philosophy says is that, after all, what we choose to call true is what we actually need; what, in other words, reinforces our will to live. Truth and delusion must not then be considered as objective statuses given by an external observer, but as two sides intimately implied in life. And in fact Freud adds another ambiguous sentence, readable from more than one perspective: ‘Illusion becomes valueless if it makes this [duty of tolerating life] harder for us’. But what illusion is he alluding to, here? Is he alluding to the illusion of the primal man (who does not believe in his own death) or to that of the civilized man (who is afraid to die)? Now, Freud has just told us that the presence in us of the primal man’s belief is useful: it helps us bear life, making it appear endless. If this illusion is useful – and the desire for war proves this – why mention illusions we no longer need, insofar as they do not help us bear life? Is he perhaps insinuating that the vital origins of scientific objectivity and of truth as adequacy of discourse to the thing are connected to the fact that, at one point, particular delusions fail in their function? That yearned scientific objectivity is nothing more than the end of a disenchantment that particular delusions have crushed? Freud suspends any clarification here, leaving us to imagine what he does not say (or what he says obliquely).

But just when our perplexity as readers seems to have reached its acme, Freud, in two brief final paragraphs with an aphoristic tone, delivers a sort of hermeneutic final blow. After reminding us of the old Latin saying si vis pacem, para bellum, he leaves us with the burden of deciphering the last sentence in his essay:

 

It would be in keeping with the times [zeitgemäß] to alter it: Si vis vitam, para mortem. If you want to endure life, prepare yourself for death.

 

This conclusion actually opens a whole range of questions, as if, as it proceeds, his writing instead of giving us answers were pushing us to ask ever more embarrassing questions. This conclusion could be the epigraph to the whole essay, which has the seal of keeping with the times: zeitgemäß. And it could also be an epigraph to the essay on the three caskets. King Lear, according to that reading, faces a desperate life, to the point of madness, precisely because he is not prepared to accept death. But here Freud is talking about war, in other words a psychological regression thanks to which only the death of the other exists. Is this death we have to accept in order to live then our own death or the fact that we have to accept war as the death of others, loved and/or loathed?

 

4. Eros and Thanatos

 

As the title itself says, Jenseits des Lusprinzips (Freud 1920) – Beyond the Pleasure Principle, as it has been translated – in this essay Freud essentially deals with the extent and limits of the Lustprinzip. But, as far as this text – one of the most charming and least convincing of all twentieth century thinking – goes, we have to dot the ‘i’s and cross the ‘t’s.

Heidegger said that all great thinkers have built their bulk of works around a unique thinking.

 

We give the name of ‘thinkers’ to those elected among men destined to think a unique thinking – and this always ‘about’ the Being as a whole. Each thinker thinks only a unique thinking (Heidegger 1991, pp. 394–95).

 

Now, if Freud is a great thinker, we have to ask ourselves what his unique, or essential, thinking consists of – not on Being as a whole, but on the essence of the human being.

Both psychoanalysts and philosophers believe that Freud’s unique thought is the concept of Trieb, translated into English as drive, into French as pulsion. One talks of Freudian psychoanalysis of drives, as opposed to post-Freudian theories (‘object relations’, ‘relationism’, ‘hermeneutic psychoanalysis’, and so on.). But Nancy points out (2009),

 

drive or the French pulsion stress in two different ways the mechanical thrust, constriction. It is a suffered traction more than a sought for attraction. [Instead] Trieb in German designates a thrust considered as activity: the growth of a plant or the care given to an animal that is developing. It is in the order of impetus and desire. It pushes itself forward, it activates itself. There is a considerable amount of polymorphous activity in the semantics of the verb treiben.

 

This verb means ‘to push’, ‘to do’, ‘to move’, ‘to exert’. Instead of translating the Freudian Trieb with ‘drive’, we could translate it with to push up, forward push.

But is then Freud’s invention – I stress: invention (a mythical one) and not discovery (a scientific one) – all just based on pointing out the power of this efficient cause, of this pushing up? (I refer here to the Aristotelian distinction between the four causes: efficient, final, material, formal.) Trieb, this pushing-up is in fact the ‘efficient’ cause of human life in actu, an act implying other causes. For example, a final clause that could be pleasure. Pushing-up as efficient cause refers then to an even more essential ‘becoming in action actual’.

This becoming actual – or acting out – is for Freud the essential truth about human beings (and ultimately of all living things): die Lust. Freud polarized the twentieth century with a decision in the metaphysical order: the basic force that moves human beings, the force underlying the beginning and end of their vicissitudes, is Lust. In English the term was translated as pleasure. But in German Lust has the same erotic connotation as lust in English and can equivocally mean desire and pleasure, concupiscence and enjoyment.[1] Freud himself was tempted by the term Lust rather than the one he eventually chose, the erudite Latin libido: but he excluded the term from the common language precisely because of its ambiguity of meaning (GW, 5, p. 33, n. 2; SE, 7, p. 135).

Given the ambiguity of the term, a correct translation of the essay we are dealing with could be ‘Beyond the desire-pleasure principle’. Now, the double meaning of Lust itself contains the double sidedness that Freud attributes to drives or pushes, insofar as they are distributed according to a hard core polarity: Eros and Thanatos, life and death drives. Precisely, Lust as desire is Eros, Lust as pleasure lies on the side of death. ‘Beyond the Lustprinzip’ therefore means that, in a certain sense, we are still and always within it: that the principle in question has a power to chain and one to unchain, it has a life side and a death side.

In fact, in this text Freud points out that the end (aim) of every Trieb, of every pushing-up, is pleasure, or the zeroing out of the tension every pushing-up consists of. Lustprinzip ultimately relates to something Freud calls the ‘constancy principle’, i.e. the tendency of every physiological-psychological apparatus to keep excitement at the lowest possible levels. The telos of the libidinal life of humans is homeostasis. In other words, the end of every pushing-up is its own end, the zeroing out of the tension pushing-up consists of. But if the zeroing out of the charge, of the tension, is the ultimate end of the psychic, we can then generalize – Freud argues – and say that the end of life is its end, death. And here I do not mean experienced life, Erlebnis, but the essentiality of the pushing-up that life intimately consists in. Empirical death, if I may use the expression, can also be a haphazard event, an external one; but death – which is fulfilled at one point in physical death – should be seen from a point of view that a philosopher would call transcendental: death is the effect of a movement internal to life, something basically structuring life. ‘Everything living dies for internal reasons… the aim of all life is death’ (GW, 13, p. 40; SE, 18, p. 38, original emphasis).

This makes us understand why Freud never accepted the idea that in our unconscious we can experience a ‘death anxiety’: indeed, precisely because life is transcendentally turned towards death, life is not what causes it anxiety. On the contrary, I would say that life aims at the enjoyment of death, at death as an enjoyment, at the death of desire in enjoyment. The anxiety the ego suffers considering its own death is nevertheless an ‘erotic’ reaction of the ego – which tends to preserve life – when it confronts the mortal vocation of life.

So, how to explain the conservation instinct that all of us, some more and some less, are equipped with? For Freud it is an instinct that does not ultimately oppose ‘internal’ death (the fundamental death according to Freud) but only ‘external’ death, occurrences that actually threaten our life. This is because each organism wants to die in its own way. The organism, and the psyche that expresses it, has its own unique specific way towards death. We can say that the organism’s end (as aim) is not any end, but its own end, the one most appropriate for it: the end of itself as its most proper end. Of course, this mortal vocation of life reverberates with Heidegger’s being-for-death: the human being’s most proper possibility is his own death.

If then the ultimate end of pushing-up is the end, is death, on the other hand this process is continually postponed, interrupted, by a sort of exception: by sexuality as Eros. On the one hand we have the sex drives which, like all drives, are geared towards death, but on the other sexuality and tension towards union with the other aims at uniting two in one. Now, for Freud it is precisely this search for the other that creates the drive. The other pushes us up to seduce him or her, thus inducing suffering in us: Eros, love, is not at all ‘contentness’ with dying one’s own way, but an active search for trouble, and hence life. Eros is a whiling away of time by living. This explains, for example, our desire to have children, and our pleasure in having them, even if children are a risky product. Not necessarily will they give us great satisfaction, but we contain in ourselves this basic need to worry about and be anguished by others. It is always with an other that the living being fights against death, against one’s own death; in other words, it is when the other becomes our end that we fight our own end. So, the other is not only a means by which our drives are soothed, but also a cause of drives – to live is to desire desires that will die. The other is not limited to being the object of investment of desire, but also the efficient cause of this desire.

The famous Eros and Thanatos dualism between life and death drives is not then an authentic dualism, it is not the contraposition between two elements that exclude each other: the way Freud constructs the concept makes them two dimensions of the same element. As Ricoeur writes, ‘in a sense everything is death, since self-preservation is the circuitous path on which each living substance pursues its own death. In another sense everything is life, since narcissism itself is a figure of Eros […] This dualism [between Eros and Thanatos] expresses rather the reciprocal superimposition of two kingdoms that cover each other perfectly’ (Ricœur 1965, p. 292).

Several other commentators have pointed out the coincidence on which the ‘dualism’ between Eros and Thanatos is based. Indeed, instead of writing ‘life or death’ or ‘life and death’, Derrida writes: ‘life death’. This stresses how in Freud life and death are ultimately on the same continuum; they are two faces which, if followed coherently, represent a Möbius strip. A Möbius strip is a bidimensional surface with only one side and one boundary component: from the outside we may think we are seeing a strip with two sides, but it actually only has one. Eros and Thanatos also appear as two sides of life, two inverse upward pushes, but after a subtler analysis they will appear as two moments of the same thing.

Let us consider coitus. Insofar as it satisfies a desiring tension and comes to its completion with orgasm, coitus runs towards its end – it soon ends and the two tired lovers fall asleep. Omne animal post coitum triste est – the joy of the discharge is followed by the sadness of the end. A long romantic tradition that associates sexual enjoyment to death stresses that, insofar as coitus satisfies certain drives, it rushes towards its end. Seen from the perspective of pushing up, coitus moves in the dimension of death. But, insofar as these two people met, desired each other and wished to merge through coitus, insofar as their encounter aroused desire in them and insofar as this desire does not end completely with coitus – insofar as, in other words, they aim at a union with a future, at a relationship that will resist the zeroing out of excitement – then their sexuality is Eros. Therefore ‘Sexuality is at work wherever death is at work.’ (Ricoeur 1965, pp. 292–93). This is what Honoré d’Urfé expressed in the pastoral novel Astrée (XVII century): in love two become one and one becomes two.

But what pushes Freud to closely relate death drives with destructiveness and aggressiveness, sadism and masochism? It is the fact that, when we destroy, our end is the end of what we want to destroy – even ourselves, as is the case in melancholia. Thanatos is, in general, a hurrying towards the end – whereas incautious Eros marks the mishap of love.

Later analysts who take up the Freudian concept of death drives actually tend to identify them with destructive aggressiveness. But in Freud destructiveness manifests the death drive insofar as its end is the end, of oneself or of the other. Aggressive feelings are not the key to Thanatos, what matters is that the aggressive impulse wants to put an end to life.

 

5. ‘Et in Arcadia Ego’

 

A subject in analysis talked about a recurring dream. When he had an experience of enjoyment – an overwhelming coitus with a woman, an outstanding professional success giving him special satisfaction, and so on – he nearly always had the following dream, with only a few variations: medical tests reveal he has AIDS, or a cancer in metastasis. Basically, that he is going to die. Yet, in the dream, he feels fine, and this gives him a feeling of disbelief. At the same time, however, in the dream he feels that he had always known about his illness and the medical tests are just forcing him to face a truth the acknowledgment of which he had kept postponing; he had been told a long time ago he was going to die, but he has always repressed the fact. The nightmare consisted precisely in having to accept this reality he believed he had repressed. Even though in the dream he tells himself ‘there must be some deception in this clinical truth!’ In it he seems divided, as the terminally ill often are when faced with the truth of their condition: on the one hand they know they are dying, on the other they talk and behave as if they were not. In these dreams too a part of him had to believe it, another could not believe it. Sometimes he was woken by the distress of the situation.

What seems to emerge in this dream is a primacy of a traumatic relation to reality – a future reality which is inevitable: one’s death. The common sense of dream – as desiring the fulfillment of something – which is also the Freudian sense, seems overturned here: just when the subject is experiencing a ‘dream-like reality’, he dreams of the terrible reality he could or will experience. These dreams seem to be telling our hero that the real reality is dying. Resorting to the interpretative routine – like saying ‘with the dream, the subject’s Super-ego is punishing him for his forbidden enjoyments’ – would be laughable here. (Besides, the Freudian Super-ego is in itself a request for enjoyment, though it is an ‘other’ enjoyment, at the expense of the Ego).

These dreams are reminiscent of the classical painting style of ‘Et in Arcadia Ego’ (Panofsky 1955): in an idyllic pastoral atmosphere, in the middle of the youth games, in a wild life devoted to sexual activity and thoughtlessness, it is possible to spot – but one often does not notice, because it is so discreet – a skull. As to say: ‘even here, in heaven on earth, in the innocent carefree enjoyment of life, I, death, am here!’ But why remind the pleasure enjoyers of this? Why does the subject, in defiance of Lustprinzip, confront itself – in art as in the dream – with something blacklisted as the non plus ultra of the real, the horror of a death that is sure to arrive?

Indeed, at one point the analytic speculum confronts itself with a dimension of the real not reducible to subjectivity: to a resistance that is hyperbolic, radical (Derrida (1996) dealt with the theme of repetition compulsion as radical resistance). But where does this real that is paradoxically not reducible to the subject appear? And in what way does it not get confused with the reality the subject has to wallow in to try and enjoy life, i.e. in Freud’s words, ‘to die his own way’?

It is as if the real – illustrated here in the form of the necessary end of life – had imposed itself in the very heart of the desiring subject (obviously subjugated to Lustprinzip): as suffering and absolute end, as ‘something that cannot be believed and which yet must be believed’. Suffering and death are indexes of the real.

In fact, in Freudian thinking – where die Lust is primary and final cause, the essence, of subjectivity – this irruption of the unthinkable real seems to be no longer ensnared by the logic of the desire-pleasure principle. Analytic theory, which is so subject-centered, gives a paradoxical result: the dreams of terminal illness can be understood only as enjoyment not of the subject, but of something in him. An enjoyment that coincides with the hyperbolic suffering of his Ego, which imagines it is terminally ill, destined to the agonizing sufferings of the disintegration of life. The subject suffers, but – if one wants to remain faithful to the Freudian paradigm – something in him has to enjoy. And he enjoys precisely in that real which causes the annihilation of the subject, his pain in sickness and death. Is this paradox acceptable? And what could this thing that enjoys at the subject’s expense, at the very heart of him, be?

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

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

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

Of course, psychopharmacology is everywhere, and it has had a positive impact on the reduction of emotional suffering for many people, but, as the journalist Robert Whitaker has pointed out, with the advent of biological psychiatry as the standard of care for the treatment of mental illness, there has also come an exponential growth in the number of people on disability because of mental illness (Whitaker, 2010).The newer, relatively side-effect free antidepressants are so widely used now that trace amounts of Prozac have been found in the drinking water in the United Kingdom (Hurley, 2004), yet the suicide rate remains at least as high as it ever was and continues to change in response to the same variables as always (such as the economy).

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

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

The myth of Cupid and Psyche is ancient and Greek, but our oldest surviving account of it is from the Metamorphoses of Apuleius, a text best known today as The Golden Ass, the only novel of classical antiquity to survive in its entirety (Apuleius lived between 125 and 180 CE) (Kenney, 2004). According to the myth, Psyche was a human princess who was deemed the most beautiful woman in the world. In time, her beauty was praised as greater than that of Venus. This infuriated the goddess of love, who ordered her son, Cupid, to make her fall in love with someone so degraded that she would be humiliated by the match and her beauty would be forgotten.

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

 

“No human son-in-law (hope not) is thine,

But something cruel and fierce and serpentine,

That plagues the world as, borne aloft on wings,

With fire and steel it persecutes all things,

That Jove himself, he whom the gods revere,

That Styx’s darkling stream regards with fear.”

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

 

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

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

To make a long story short, Psyche’s curiosity, provoked by her sisters’ envy, eventually got the best of her—after all, she had been told by the oracle that her lover would be something monstrous and why wouldn’t she want to verify this was not the case? One night, while he slept, she lit a lamp and saw that he was none other than Cupid, Desire himself. When he awoke and realized Psyche had seen him, he fled, angry at her for how foolish she had been. “Simple-minded” (V. xxiv, p. 89) is what he called her. Psyche was crushed.

We will finish the story later.

The myth of Cupid and Psyche is focused around a very specific problem: the nature of desire. In each part of the myth, a different facet of this problem is presented. In the beginning, there is the growing adoration of Psyche, which ends up being a source of heartbreak for the princess and her parents. Then there is the oracle’s prophecy, telling Psyche’s parents that her only partner would be something inhuman—a monster who “persecutes all things” and whom even Jove feared. There is also the discovery of Psyche’s unhappiness—she is so beautiful, so perfect in the eyes of those around her that no one feels competent to woo her—she is no more approached than a leper would be, and she is miserable as a result. Finally, there is the mystery of the castle and Psyche’s lover, whom she can never see, but only encounter by fumbling in the dark.

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

The motif of fumbling in the dark, I was interested to learn, is a significant one in myth. In Hindu Vedic literature, the story of King Pururavas and the Apsara (a kind of demigod), Urvashi (Masson-Oursel & Morin, 1968). Most of the details of the story are different from the Psyche myth, but one element is similar: the female, Urvashi, was forbidden to see the king naked and when she did, the relationship was brought to a sudden end. This myth also is resolved in a way very similar to the myth of Psyche—which I will get to later. The other myth I will mention only briefly is the story of Jacob wrestling the angel. Jacob had, up to this moment in his story, been sneaking his way around his older brother Esau and his father Isaac, trying to get as much power and wealth as he could until, feeling guilty about all this, he tried to make peace with his brother. When night fell, Genesis tells us (Genesis, 32:22–32),  Jacob, alone, finds himself fighting with something totally mysterious that he cannot identify or name, but from which he demands a blessing before he will let go.

In all three of these stories, there is a similar detail: the inability of the subject of the myth—Psyche, Urvashi, and Jacob—to see the object of his or her desire combined with a wish for knowledge. These characters are not just in the dark, they are in the dark trying to find something related to their desire. For Psyche and Urvashi, the desire is to know/see their lover; for Jacob, it is to receive a blessing from the mysterious stranger.

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

And that is a description that fits desire well. As it is worked out in human life, desire often seems to make no sense. In the Psyche myth, the most desirable person in the world finds herself completely alone. In the account of the myth we have, the oracle’s description of her lover suggests a fearsome monster. The fact that this monster turns out to be Desire himself, as he is described in the text, is ironic and unexpected but does not change the fact that he is a monster, that he is feared by the gods. In both the Greco-Roman and Hindu myths, the knowledge of the desired object is actually forbidden; in the Hebrew myth, Jacob doesn’t even know what he is doing and his unknown antagonist finally causes him an irresolvable groin injury (he will have a crooked gait the rest of his life from it).

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

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

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

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

O spirit of love, how quick and fresh art thou,

That, not withstanding thy capacity

Receiveth as the sea, naught enters there,

Of what validity and pitch soe’er,

But falls into abatement and low price

Even in a minute.”

(1.1. 7–14)

 

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

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

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

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

But during the more than two years I worked at a student health center, my skepticism mushroomed. I could prescribe the same antidepressant to different people on the same day, for the same symptoms, and inevitably get radically different responses from each person. This was most striking in this context, I believe, because the population I was working with was relatively homogeneous: all were in their late teens to mid-twenties; all were ambitious; most came from fairly prosperous middle-class backgrounds; there were few cultural differences to take into account; nobody was trying to get disability; and so forth. But after the first dose, while one person would declare that the antidepressant had changed his or her life, another would insist that he or she would never take that medicine again, though both of these people had presented with the same symptoms at roughly the same time. Most people were somewhere between these extremes, but no matter how similar their stories, symptoms, or treatments, no two had the same treatment response. I found it very hard to believe that I was doing anything more significant than distributing snake oil.

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

To my surprise, I found that there were some things these drugs did fairly consistently. First, I noticed that anyone who said they cried when they were depressed reported that they stopped crying when they took an SSRI. What was noteworthy was how people responded to this fact: some were relieved that they weren’t crying anymore, while others stopped taking the medication because it prevented them from shedding tears. And then there was the one person who cried only when she talked about how wonderful Prozac was because before she started taking it she cried all the time.

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

What I believe I learned from these observations was that loss of libido and of emotional intensity were not side effects of the medication: dampening energetic investment was how the SSRIs worked. In other words, even though the effect was a biological one—the manipulation of serotonin levels in the brain to decrease emotional intensity—this wasn’t really a disease-specific effect, as one would see with antibiotics for bacterial infections or insulin for diabetes. Instead, the effect of taking these antidepressants was to blunt the expression of libido, with the consequence that they sometimes (often) palliated symptoms. A more proper analogy for how they worked, it seemed to me, would be the predictable effects of drinking alcohol. The biological effect of alcohol would be to disinhibit the drinker, which might make it easier for one person to talk to strangers but might make somebody else look for a fight and somebody else take a nap.

What is of secondary importance for our discussion, but what excited me the most about all this at the time, was the way it supported Freud’s understanding of what a neurotic symptom is: a substitute for sexual satisfaction. This seemed clear to me from the way that both libido and the symptom of depression or anxiety were removed by the use of the drug. As it happens, a few years after I left the student health service, a French psychiatrist and analyst, Gerard Pommier, published a book on “how neuroscience demonstrates psychoanalysis” (Pommier, 2004). The relation of SSRIs to libido was one example of that demonstration.

After all, the discovery that there was some connection between serotonin and mood was made entirely by accident and not in an obviously psychiatric context. It happened when a new drug for tuberculosis (TB) was studied at an asylum for TB patients and it was observed that the patients were less emotionally upset while taking this drug than any of the others. When the drug was analyzed for its chemical effects, it was found that this particular anti-TB drug, Iproniazid, enhanced serotonin levels in the blood (Lopez-Munoz and Alamo, p.1566). But those who responded to the drug were not an obviously psychiatric patient population. They were unhappy for a reason, as we say—diagnosed with tuberculosis, they had been forced to leave their homes and take up residence in a treatment center with other sufferers so that they wouldn’t infect others with the disease. Nobody, at that point, would have argued that there was a biological basis for their low moods; they were just in a bad place. Similarly, the first antipsychotic medicines were just anesthetic agents, major tranquilizers, which had the effect of calming down severely agitated people. There was no necessary relation between the effects of these drugs and assumptions about the fundamentally biological basis of psychotic agitation. How did psychiatry get from these rudimentary observations about the effects of some drugs on some emotional states to the NIMH’s decision to only fund research into the biological origins of psychopathology?

In the first session of a teaching seminar he gave in 1967–1968 (Lacan, 1967–1968), Jacques Lacan asked the same question of a famous experiment in behavioral science—Pavlov’s work with classical conditioning. Pavlov tested the hypothesis that one could induce physical reactions in animals by conditioned responses to artificial stimuli, as opposed to the natural responses to appropriate stimuli. Most famously, he linked the sounding of a trumpet to the presentation of food, then, after a certain number of repetitions, he sounded the trumpet without presenting the food. As is well known, the animals responded to the sound of the trumpet at this point in the same way they would have responded to the presentation of food—by generating an increase in the secretion of gastric juices. Pavlov was able to observe this because he had surgically created a gastric fistula in the animal, allowing him to measure the secretions.

Lacan’s view of this experiment is that it involves a certain sleight of hand. As with the examples of biological psychiatry mentioned above, Pavlov’s experiments suggest that there is something “in the brain” (1967–1968, 15 November, 1967) of the animal in the experiment that leads to the outcome. But this completely overlooks the fact that, if someone had not wanted to do the experiment, it would never have happened. There is nothing natural about what Pavlov did here. In the words of the psychoanalyst Alan Rowan, “what is silently eliminated from this experiment is the prior act of the experimenter who … actively introduces the very sign that he or she wants, indeed obliges the animal to respond to” (Rowan, 2012). In other words, what is left out of the experiment is the fact that a subject, Pavlov, is essentially forcing an outcome in a study that could never occur in nature and for which there could be no earthly use, except for the experimenter’s desire.

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

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

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

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

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

But whether we are talking about Kraepelin or the DSM or Freud, there is no question that there is an active desire in play, a fact, as Lacan notes in his discussion of Pavlov, “that is not… the first thing that foolish people may think about”(Lacan 1967-68, 15 November 1967) when looking at the results of all this research. “Foolish people” brings to mind—at least to my mind—“simple-minded” Psyche. Let’s finish the story.

Because of the oracle and her sisters’ gossip, Psyche had anticipated that her lover would be a horrible monster and so had planned to kill him. She is so surprised by what she finds when she does see him that she cuts her finger on one of Cupid’s arrows and spills oil from her lamp on his shoulder. He wakes up and discovers her disobedience only after he feels the burn of the oil. As Apuleius tells it, the agent of vision, the lamp that allows Psyche to see her lover, is also the agent of betrayal.

Cupid flies away immediately, but Psyche is able to hold on to him for a little while before her strength gives out. When she has fallen, he explains what has happened: after Venus told him to humiliate Psyche, he fell in love with her on sight. Disobeying his mother, he arranged that he could have Psyche as his wife; therefore, out of his mother’s hair with nobody the wiser. This is why it was so important for Psyche to not know who he was. Saying farewell, he told her that her only punishment would be his absence.

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

Throughout these tasks, we could say that the only attribute Psyche brings to her adventures is her desire and the fact that everybody and everything that encounters her, except her mother-in-law, finds her eminently attractive. At the very end of her very last task—bringing the boxed beauty of Prosperine back to Venus, a box she has been told she must never open—she tells herself, “What a fool I am, to be carrying divine beauty and not to help myself even to a tiny bit of it, so as perhaps to please my beautiful lover.”(Kenney, p. 104) She opens the box, which does not reveal a goddess’ beauty to her, only a deep sleep. Even to the end, Psyche’s curiosity is her undoing.

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

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

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

In the myth, Psyche’s searches do not end until she is taken out of the realm of human discourse, when she becomes a god. Since neither psychoanalysis nor Prozac nor Haldol (or CBT or EMDR or resilience training or whatever) can raise us above the level of discourse—that is, since none of these can make us gods—it is at least arguable that enriching the discourse is a more valid goal than trying to bring it to whatever we might define as a satisfactory conclusion.

Another way to say this is, desire can never be pre-empted by data and stories are at least as important as neurotransmitters. In fact, whatever discoveries neuroscientists make in carrying out the NIMH’s mandate in the coming years, they will certainly be caught up in stories in a way that stories are not caught up in scientific findings. In a very real way, it is the mind—the psyche—that creates the world and not the other way around.

 

References

Belluck, P., & Carey, B. (2013, May 6). Psychiatry’s guide is out of touch with science, experts say. New York Times. Retrieved from http://www.nytimes.com/2013/05/07/health/psychiatrys-new-guide-falls-short-experts-say.html?pagewanted=all&_r=0

Carey, B. (2014, February 3). Blazing trails in brain science. New York Times. Retrieved from

http://www.nytimes.com/2014/02/04/science/blazing-trails-in-brain-science.html

Davis, D. (1990). Writing Freud. Retrieved from  http://internationalpsychoanalysis.net/2013/02/04/freuds-unwritten-casethe-patient-e/

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

Hurley, K. (2004, August 8). Prozac seeping into water supplies. The Scotsman. Retrieved from

http://www.macalester.edu/academics/psychology/whathap/ubnrp/depression05/history.html

Kenney, E. J. (2004).  Apuleius: The golden ass or metamorphoses.London.  Penguin Books.

Kraepelin, E. (1992). The Manifestations of Insanity. History of Psychiatry, 3(12), 512.

Lacan, J. (1967–1968). The psychoanalytic act (C. Gallagher, Trans.). Retrieved from http://www.lacaninireland.com/web/wp-content/uploads/2010/06/Book-15-The-Psychoanalytical-Act.pdf

Lane, C. (2007). Shyness (pp. 39–103). New Haven.Yale University Press.

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

Lopez-Munoz, F and C. Alamo (2009): Monoaminergic Neurotransmission: The History of the Discovery of Antidepressants from 1950s Until Today.  Current Pharmaceutical Design, 15, 1563-1586.

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

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

Rowan, A. (2012). The psychoanalytic act as act and orientation. LCExpress.  Retrieved from

http://lacaniancompass.files.wordpress.com/2011/05/lce-02-18-2012.pdf

Shakespeare. (1993). In B. A. Mowatand & P. Werstine (EdS.), Twelfth Night, or What You Will. New York. Simon and Schuster.

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

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

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

Book Review

Clinical Implications of the Psychoanalyst’s Life Experiences: When the Personal Becomes Professional By Steven Kuchuck

New York: Routledge, 288 pp., $47.95, 2014.

Some time ago, I wrote a short personal essay about my conflicted relationship with my Jewish identity for a small journal on religion. Shortly after it came out in print, I learned that the journal also maintains a website on which all of its articles are available and openly accessible to the public. The editor never informed me that the essay would be posted on the journal website. In fact, I only found out about its existence when a patient told me that she had Googled me and read the essay online. My personal life was out there and available to anyone who went looking for me, and I didn’t even know it—I felt completely exposed.

After my patient revealed what she had found out about me online and told me about her reaction to this discovery, I went through what felt like a slow-motion internal self-inventory: How do I feel about my patient’s newfound portal into my private life? How does she feel about it? Who else has read my essay? How do I fix this? Where can I hide? Even as I weathered my internal meltdown, I somehow had the wherewithal to recover myself and reengage with my patient despite my shock, and together we were able to go on to explore the meanings of the somewhat personal feelings and divulgences exposed in my essay, both for her and for our work together. But after our session I felt haunted by a lingering vulnerability, protectiveness over my privacy, and some real concern about the potentially negative effects the article could have on other patients and on my professional identity in general. Was this a part of myself I wanted to reveal to the world? Was this a part of my personal life that I felt prepared to integrate into my impression of my professional self?

What to do with the analyst’s subjectivity? This question has been tackled in various iterations throughout the history of psychoanalysis from its very genesis, beginning with Freud’s papers on technique. His famous injunction to psychoanalysts to “model themselves during psycho-analytic treatment on the surgeon, who puts aside all his feelings, even his human sympathy, and concentrates his mental forces on the single aim of performing the operation as skillfully as possible” (1912/1958, p. 115) successfully banished the person of the analyst from the standard practice of psychoanalysis for some decades, relegating it to the shadowy corners of the consulting room in the form of perceived analytic misdeeds and shameful feelings of analytic contamination.

But though he seemingly exiled the individual person of the analyst from the room, with the innovation of his theory of countertransference Freud inadvertently planted the seed of potential for the analyst’s subjectivity deep underground. With the evolution of psychoanalytic theory and the advent of postmodern thinking, the influence of the analyst’s subjectivity on psychoanalytic treatment has slowly been unearthed, blossoming into arguably one of the most important issues in contemporary psychoanalytic discourse today. Steven Kuchuck’s new collection, entitled Clinical Implications of the Therapist’s Life Experience: When the Personal Becomes Professional (2014), is the latest outgrowth of the movement to throw off the repression of Freud’s dictums and excavate the personal life of the therapist—a sort of group exposure therapy meant to bring the collective person of the therapist out from shameful hiding as a reparative counterbalance to its previous expulsion from the consulting room.

Indeed, Kuchuck views the edited volume as a challenge to the shame-inducing secrecy of the classical tradition, stating in his introduction that the book “is borne of the storming in of my own and the profession’s subjectivity . . . a collection that celebrates an emergence from hiding on the part of authors, analysts, and a profession” (p. xxiv). And the book accomplishes this goal to a large extent through the exceedingly personal autobiographical accounts the analyst-authors offer in each of their unique chapters. Each narrative explores some idiosyncratic historical experience or character trait that the author feels has shaped his/her subjectivity and particular psychoanalytic identity. In the process, the reader is taken into the storyteller’s confidence as the intimate gaze is turned inward—but in this case with a view toward telling the private stories of those who customarily do most of the listening.

As my patient told me about her experience of reading my personal essay online and the internal shake-up that ensued, I found myself in deep identification with her experience. The incident brought me back to a time at the beginning of my own analysis, when after a few weeks of treatment, I Googled my own analyst’s name. As I scanned through the ample search results, weeding out others with the same name as I went, I came upon a news article in which my analyst was featured as an expert on helping people deal with certain tragic life events. Tentatively, I read through the piece with my eyes partly shielded—I kind of wanted to know, but I also kind of didn’t. My stomach sank as I read it through; the article quoted her extensively, revealing that she had experienced the same misfortune in her own life as those she was helping. It all felt shockingly personal, too much information that I had not expected to find and did not particularly want to know. I was devastated. It was the beginning of my analysis and I felt like the safety of the analytic space was tenuous, and the power of my analyst to help me to contain and understand my own tragedies limited at best. The experience felt violent, both in my intrusion into my analyst’s privacy and in the intrusion of her private life into my analysis.

Encountering otherness in the psychoanalytic situation carries a particular weight and can be a powerful catalyst for change that reverberates intrapsychically and interpersonally for both participants. For me, coming into contact with such personal information threatened my need to feel held by a strong container, someone who did not need to be pathologically accommodated or narcissistically shored up. But her inadvertent disclosure on the Internet ushered in another part of my analyst that I could not help but incorporate into a painful transferential narrative based on my own history. I didn’t know how it would ever feel okay. Being in analytic training, I realized I should probably talk to my analyst about the article, so I eventually broached the subject with her—slowly and carefully. But talking to my analyst about all of this turned out to be a harrowing experience and the seed for the first rupture of the treatment—with emotions running high on both sides. I desperately wished I could unknow what I now knew about her, and she expressed regret that the author disclosed her name in the article without permission. Despite my feelings of guilt and insecurity, we got past the rupture, and I eventually folded the “real-life” version of the analyst I discovered on the Internet into the fantasy of who I needed her to be. But we have never discussed her inadvertent disclosure in the article, its impact on me, or the rupture again—at least so far.

The therapist as a subject poses a special relational dilemma. How to introduce otherness when the presence of an other has often been historically traumatic for the patient and/or analyst? Can we be expected to conceal large chunks of who we are in order to shield the patient from experiencing us as invasive or insensitive intruders? The asymmetry of the analytic relationship imbues it with the power to catalyze deep change. But with that power comes responsibility for monitoring the impact of one’s interventions and one’s unique person on the therapeutic relationship to safeguard, as Kuchuck puts it, “a patient’s right not to know” (p. xix). Over the course of a treatment the pendulum swings from awareness of difference to fantasies of sameness, each with their own potential to heal and hurt; analysts are constantly taking the temperature of the transference/countertransference, trying to get a handle on the needs of both participants, and are often forced to make fraught, difficult choices about how to relate to competing needs for recognition and privacy in both patient and analyst.

It is difficult to theorize prescriptively about the analyst’s subjectivity because the topic is slippery, often creeping into a more concrete discussion of self-disclosure. Perhaps we can more freely theorize about self-disclosure by virtue of the fact that it has long roots in our analytic tradition, is a part of our common language, and is a concrete clinical event about which we can construct definitive guidelines. With the rise in popularity of postfoundational thought and with our respect for the idiosyncratic outlooks of every individual, it becomes more and more difficult to draw out theoretical conclusions that are generalizable to many. There are no more universal “truths,” and this often leaves us without ways to effectively communicate with each other about how to “do” psychoanalysis, except for in highly individualized ways. By definition, subjectivity and its impact on the analytic situation comprises an aspect of the therapeutic relationship that we can try to understand on an individualized basis, but is not something we can make blanket value judgments about as it pertains to particular attributes of the analyst’s self.

But one does sense that some subjectivities are better than others, and over the ages, discriminative determinations have been made about the desirability of various personality traits and subjective characteristics within the psychoanalytic profession. This topic is of particular significance to psychoanalysts, since as a group, most of us struggle with issues around concealment, accessibility, hiding, and exposure. By revealing the influences that have shaped the practices of the established psychoanalysts who share their lives with us in this book, Kuchuck has widened the range of the acceptable subjective qualities that shape our professional roles. More importantly, he has helped detoxify potentially shame-filled personal experiences that might otherwise be sidelined or dissociated in the consulting room. Indeed, Kuchuck opens the door for psychotherapists and psychoanalysts to examine more of their theoretical leanings and personal styles without judgment and thus make one’s personal makeup and history more of a live and living part of the therapeutic relationship.

When I next met with my patient again after that fateful session, I had access to more of myself and was able to more nondefensively broach what meanings she had imbued into her newfound knowledge of my private thoughts. And this felt good. It feels good to be able to transcend the “facticity,” as Sartre called it, of the human condition—to go beyond the concrete facts of a person’s life to dream up a fantasy of what we think or even wish it could be. For in the end, it is not really the reality but the meanings we imbue it with that give relationships their vitalizing power.

Even as I dealt with my patient and the feelings our enactment brought up, I also deliberated on my presence on the Web and my corresponding needs for privacy. It was and remains important to me to give patients the option of not having to know any personal information they find out about me on the Internet. In the end, I called up my editor and we negotiated a compromise that felt satisfying to both of us. If the article had to be out there and my name had to be on it, I wanted to leave the possibility of doubt open to those who wouldn’t want to know. I told the editor that he could leave my article on the site, but only if he removed the byline that contained information that identified me in ways that would indisputably link me as a person to the personal feelings I had written about in my article. That way, I reasoned, if a patient did an Internet search and read the article, she would have the choice of whether she wanted to credit it to me or maintain the doubt that some other person with the same name wrote it. A small difference, but to my mind it keeps open some potential space that protects the patient from intrusion, leaving the objective truth in the realm of play, somewhere between fantasy and reality. What’s more, it provides the illusion of protecting my needs for privacy by giving me a slight sense of flexibility around my identity. I like the idea of having the option of hiding, even if it is only in fantasy.

When one talks about subjectivity there is always some slippage—what feels certain in the intimacy of one’s own mind can become convoluted in its communication to an other. This is partly because subjectivity has no fixed content—as time passes, every moment of life reveals a new sense of self (Oksenberg Rorty, 2006). Subjectivity and the ingredients that go into shaping distinctive affective experiences have been the topic of much discussion in psychoanalytic circles of late. In fact, the term has become a political symbol of sorts, with different analytic camps fashioning their battle cries around the claims they make on subjectivity and its construction. And it is a subject worth fighting over. The study of the complicated ways that inner experiences interact with and reflect life events can disrupt and expand our notions of what is possible, on individual and communal levels. What makes life real? What is a “good enough” life? The study of subjectivity holds out the promise of organizing the chaos of human relations into a model of a life well lived; indeed, it holds the seeds of potential for reclaiming and transforming the way we think, the way we feel, our deepest senses of self (Kleinman & Fitz-Henry, 2007).

Kuchuck’s new collection brings the hopefulness of human narrative into the psychoanalytic collective consciousness, allowing us to recover sidelined parts of self as active agents with the power to decide for ourselves what it means to be a real person and a good psychoanalyst. Whether it is Galit Atlas’s reclamation of herself as a woman and as a sexual being, Irwin Hirsch’s ability to turn his failures and disappointments into generative learning opportunities, or Anna Ornstein’s tenacious ability to turn the most unspeakable tragedy into a life-affirming ideology, the stories told in this book remind us again and again that we have the power to author our own lives. Our transformative life experiences recursively intermingle with intimate internal processes that together have the potential to become both the sources of deep suffering and the roots of a satisfying life full of meaning. As Sartre said, “[Y]ou can always make something out of what you’ve been made into” (cited in Flynn, 2013), and Steven Kuchuck generously holds up the invitation and the challenge for all of us to do the same.

 

References

 

Flynn, T. (2013). Jean-Paul Sartre. In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy (Fall 2013 ed.). Retrieved from http://plato.stanford.edu/archives/fall2013/entries/sartre/.

Freud, S. (1958). Recommendations to physicians practising psycho-analysis. In J. Strachey (Ed. and Trans.),Standard edition (Vol. 12, 109–120). London: Hogarth Press. (Original work published 1912)

Kleinman, A., & Fitz-Henry, E. (2007). The experiential basis of subjectivity: How individuals change in the context of societal transformation. In J. Biehl, B. Good & A. Kleinman (Eds.), Subjectivity: Ethnographic investigations. Los Angeles: University of California Press.

Kuchuck, S. (2014). Introduction. In Steven Kuchuck (Ed.), Clinical implication of the psychoanalyst’s life experiences: When the personal becomes professional. New York: Routledge.

Oksenberg Rorty, A. (2006). The vanishing subject: The many faces of subjectivity. History of Philosophy, 23(3), 191-209.

The following is an excerpt from a chapter by Morris Eagle, entitled “Inner Conflict in Freudian Theory”, from the forthcoming book Psychoanalysis and Conflict: A Critical Reassessment edited by Morris Eagle, Chris Christian, and David Wolitzky, to be published by Routledge.

Introduction

By Morris Eagle, Chris Christian and David Wolitzky

Since its inception and throughout its history psychoanalysis was defined as, first and foremost, a psychology of conflict (Kris, 1950; Brenner, 1979; Richards and Willick, 1986; Arlow, 1991). Mental conflict, which formed the bedrock of Freud’s tripartite structure of id, ego and superego, also became the signature of ego psychology – the dominant theoretical paradigm in American Psychoanalysis for over 30 years. Yet, in time, the tripartite model of conflict would be challenged within ego psychology itself by the development of modern conflict theory – a term used to describe Brenner’s (1982) approach to psychoanalysis.  Modern conflict theory emerged as a response to a growing concern that ego psychology had become too mechanistic defined by abstractions that seemed too far removed from clinical data.  Brenner aimed to strip ego psychology of the problematic reification of structures of the mind, such as the id, ego, and superego, which were believed to be in conflict with each other, and in its place emphasize processes.  However, he retained the centrality of compromise among conflicting aims. Additional challenges to the central role of conflict in mental life, and as the defining feature of psychoanalytic technique, were prompted by other developments in the field, including the widening scope of the psychoanalytic patient, which led to an emphasis of developmental defects and arrests; ongoing contributions made by infant observation studies; advances in neuroscience, and a growing acceptance of a pluralism of psychoanalytic perspectives.  In regards to this emerging pluralism, the term conflict came to represent, like a codeword that betrayed allegiances, a dividing line between theoretical paradigms, whereby dynamic conflict was pitted against notions of developmental defects and under-developed capacities and structures. Some authors took issue, not with the ubiquity of conflict in mental life per se, but with the components that were thought to be in conflict with each other.  Thus, the idea that there were sexual and aggressive drive derivatives in conflict with moral imperatives was viewed as too narrow by some authors, including Greenberg and Mitchell (1983; Greenberg, 1990), who nonetheless accepted an inherent state of conflict.  However, this conflict was not derived from drive pressures and regulation but rather from what Greenberg and Mitchell described as shifting and competing configurations of relations between affectively charged self and object representations that vie for expression.  Other examples of alternatives to the id-ego model that retained the centrality of conflict include Mahler’s symbiosis-separation-individuation dimensions, and Fairbairn’s (1952) emphasis on the conflict between the libidinal ego and anti-libidinal ego and the accompanying conflict between the rejecting object and the exciting object. Although many agree that these reformulations regarding the role of conflict, the type of conflict, and for which kind of patient, had a salutary effect in the advancement of psychoanalytic knowledge, the bifurcation of conflict and developmental arrests and other models of the mind may have unduly restricted our understanding and appreciation of the ubiquity of unconscious conflict in psychic life, and across levels of pathology.

In Psychoanalysis and Conflict: A Critical Reassessment, authors from a wide range of theoretical perspectives situate conflict in their theories of therapeutic action and in their research. Authors includes:  Fred Busch, Adrienne Harris, James Fossaghe, Steven Portuges, Jonathan House, Phillip Wong and Ben Sanders, Heather Berlin,  Marilia Aisenstein, David Lichtenstein, Anton Kris, Miriam and Howard Steele, Steven Ellman, Neal Vorus, and Chris Jaenicke.

In the following section of his chapter, Eagle addresses inner conflict and psychoanalytic treatment.

Inner Conflict in Freudian Theory

By Morris Eagle

According to Freudian theory it is not inner conflict per se that is pathogenic. Indeed, inner conflict is assumed to be inherent in the human condition. What renders inner conflict pathogenic is mainly how one deals with it, namely, through repression. Thus, as discussed above, coping with inner conflict through repressive defenses is a critical mediating factor in the pathogenic consequences of inner conflict. As we have seen, this is so for at least three main reasons: (1) repression prevents the adequate discharge of the “quota of affect” associated with conflictual desires and experiences; (2) repression prevents the assimilation and integration of conflictual mental contents that have been rendered isolated through repression into the rest of the personality; and (3) essentially equivalent to (2), but stated at a different level of discourse, repression keeps the individual from confronting and attempting to resolve his or her conflicts in the light of reality considerations. It should be noted that all three consequences of repression serve to weaken the personality: through the build up of excessive excitation and its conversion into somatic symptoms; through burdening the personality with isolated mental contents that function like a “parasite;” through requiring a “constant expenditure of energy” (Freud, 1925) that could be directed toward more constructive activities; and through the prevention of resolutions of conflict that would allow the individual to pursue developmental goals (see Eagle, 2000).

Given the above conception of psychopathology, it would follow that therapeutic interventions would be directed to: (1) facilitating adequate discharge of affect surrounding the repressed mental contents – in short, abreaction; (2) bringing the repressed mental contents to consciousness so that they can be integrated into the “great complex of associations known as the ego” (Breuer & Freud, 1893-1895, p. 9) – in short, can be integrated into the rest of the personality; and (3) also as a function of being brought to consciousness, repressed mental contents can be evaluated in the light of reality consideration.

There is little point in repeating the familiar story of the evolution of Freud’s techniques from the use of hypnosis and abreaction to what came to a commonly agreed upon method, in particular the use of free association and interpretation. My interest is in demonstrating the logical links between Freud’s conception of the factors involved in psychopathology and the nature of psychoanalytic treatment. I also want to call attention to two observations: one, abreaction was dropped from the psychoanalytic repertoire of techniques and process goals despite the fact that its theoretical justification embedded in the constancy principle had not been relinquished; two, what remained at the core of the theory of psychoanalytic treatment were the goals of enhancing conscious awareness and integrating hitherto unintegrated mental contents into the personality structure or, in more experience near terms, into one’s more expanded and realistic sense of who one is – and perhaps, into one’s more expanded, integrated, and realistic sense of who one wants to be.

One important clinical reason that Freud gave up the use of hypnosis lies in the fact that although hypnosis might succeed in bringing a hitherto unconscious mental contents into conscious awareness, these content were likely to remain unintegrated into the individual’s personality and his or her sense of who he or she is. And yet, that did not deter Freud from identifying as an essential goal of psychoanalysis “making  conscious what has so far been unconscious” (Freud, 1896, p. 164), which, in itself, does not necessarily entail integration of what has been made conscious. Freud was obviously aware of this possibility, but attributed it to resistance and invoked the concept of working-through (e.g., Freud, 1926[1925], p. 158) as a means to dealing with such resistance. He writes: “One mist allow the patient time to become more conversant with this resistance with which he has now become acquainted, to work through it, to overcome it, by continuing, in defiance of it, the analytic work according to the fundamental rule of analysis” (Freud, 1926[1925], p. 158). However, what is actually involved in working-through is not at all made clear by Freud.

Although the therapeutic primacy of integrating isolated (repressed) mental contents into the rest of the personality is clearly implied in Freud’s early emphasis on bringing these contents into contact with the “great complex of associations,” one can easily lose sight of this aim in the context of identifying making the unconscious conscious as a primary therapeutic goal. For, as noted, unconscious material can be made conscious without being integrated into one’s sense of who one is and what one is doing. This outcome is not limited to hypnosis, but would apply to any means of making the unconscious conscious, including the use of interpretation.  Further, the Freud who emphasizes the renunciation of unconscious wishes once they are made conscious seems to suggest that certain wishes cannot be readily integrated into the rest of the personality. With the exception of sublimation, which does suggest successful integration, renunciation is the patient’s only realistic and healthy option. This is so, I believe, because inherent in the id-ego model as well as the formulation of the theory of the Oedipus Complex is the implication that at least certain instinctual wishes cannot be realistically integrated into the personality. With regard to the former, in view of the posited primary antagonism between the id and the ego and the danger that excessive strength of instinct represents, integration of certain infantile instinctual wishes into the rest of the personality would not appear to be very possible nor desirable. As for the theory of the Oedipus Complex, it is the relinquishment of incestuous and hostile wishes, not their integration, that enables normal development to proceed. In both cases, renunciation and sublimation are the only realistic options.

It was not until 1933 that Freud articulated as the overarching goal of psychoanalytic treatment, “where id was, there shall ego be” (p. 80). Understood in a particular way, this aphorism has important implications for the possibility of integration and for one’s conception of the goal of psychoanalytic treatment. One can understand “where id was, there shall ego be” in a number of ways. As Apfelbaum (1966) has pointed out in a classic paper, from a traditional ego psychological perspective, it can be understood as where infantile instinctual wishes were, there shall greater ego control be. This interpretation is compatible with an emphasis on renunciation of infantile wishes as a therapeutic goal. From this perspective, infantile wishes are kept in check by a strengthened ego.

However, there is a different way of understanding the aphorism, particularly if one keeps in mind that original German “wo es war, soll Ich wedern” (Freud, 1933,  p. 80) ). One can now read the aphorism as where impersonal it was, there shall I be, which conveys the extremely important idea that an ideal outcome of psychoanalytic treatment is one in which the I (self) is expanded to now include and integrate hitherto unintegrated aspects of oneself that had been defensively excluded and rendered as an impersonal it, as a sort of foreign alien body (See Brandt, 1961; Bettelheim, 1983 ).

The possibility of integration between id and ego runs counter to the assumption of primary antagonism between the two, and as such, suggests the possibility of treatment (and developmental) outcomes that are not envisaged by the usual conception of id-ego relationship. On the traditional view, given the inherent antagonism between the two, the timelessness of the unconsciousness and therefore the inevitable ‘frozen in time’ unchangeable nature of infantile instinctual impulses, the best one can expect from even highly successful treatment are renunciation, sublimation, and greater ego control of impulses. Contrastingly, in the interpretation of where id was, there shall ego be that  I am proposing (and as proposed in Apfelbaum’s 1966 paper), developmental maturation of id impulses themselves can occur, which renders greater ego control less of an issue, and which permits the possibility of integration of id and ego as developmental and treatment goals.

Freud himself discussed the possibility of the latter developments at various points in his writings. For example, at one point, Freud (1915) suggests that it is the repressed status rather than their inherent nature that renders instinctual wishes so formidable a threat. He writes “that the “repressed instinct-presentation…develops in a more unchecked and luxuriant fashion. It ramifies, like a fungus, so to speak, in the dark and takes on extreme forms of expression” that are alien to and terrify the individual because of “the way in which they reflect an extraordinary strength of instinct. This illusory strength of instinct is the result of an uninhibited development of it in  phantasy and of the damming-up consequent on lack of real satisfaction” (p. 149). This passage is one of few suggesting that the formidable strength of instinct and the threat it represents to the ego to which Freud and A. Freud refer, is not, as suggested by the constancy principle, an inherent one, but is rather a fantasy fed by the circumstance that repressed impulses do not see the light of day and take on fantastic proportions.

In a relatively late paper, Freud (1926[1925]) writes that “there is no natural opposition between ego and id; they belong together, and under healthy conditions cannot in practice be distinguished from each other” (p. 201) – a formulation that utterly contradicts the idea of an inherent and necessary antagonism between id and ego. Indeed, Freud’s statement suggests that a necessary antagonism between id and ego is more descriptive of psychopathology than of healthy functioning; and also implies that the main task of psychoanalytic treatment is to restore or contribute to an increasing unity between id and ego – a task that is implicit in the goal of where id was, there shall ego be when that is understood as where “it” was, there shall “I” be.

If, because it is based on fantasy and allowed to ramify in the dark, the strength of instinct is partly illusory, it is not clear why renunciation is always or frequently necessary. Once the repressed wishful fantasy ‘sees the light of day’, it may become modulated, more susceptible to integration, and therefore not require renunciation. However, although this possibility is clearly implicit in Freud’s above statements, it is not compatible with a whole set of Freudian assumptions regarding the nature of instinctual wishes, including assumptions about the sheer quantitative demand made by the id that renders it an inherent threat to the ego, that the id is immune to influences from the external world (See Hartmann, 1939), and that sequestered instinctual wishes, including infantile wishes, cannot themselves mature. As Apfelbaum (1966) noted, given these assumptions, it is understandable that the options for development and therapeutic change are limited to renunciation, sublimation, and, more generally, greater ego control over timeless and unchangable instinctual impulses. When these assumptions are relinquished, the problem I described in Footnote 10 (p. 20) becomes less of a problem. That is, if instinctual impulses themselves can mature and become modulated, their demand on the mind is considerably lessened, and the possibility of various options, – not only renunciation and sublimation – becomes less of a puzzle.

There are, in effect, two Freuds in regard to the origins and fundamental nature of inner conflict as well as its consequences and its fate in treatment. There is, as we have seen, the metapsychological Freud who ultimately locates inner conflict in the constancy principle and the inherent relationship between the id and the ego. And then there is the Freud who locates the source of  inner conflict more contingently in interpersonal experiences, that is, in parental prohibitions and punishments in relation to instinctual wishes and the “danger situations” of loss of the object, loss of the object’s love, castration threats, and superego condemnation that certain parental behaviors generate.

According to the logic of the latter Freud, were parental behaviors (and, more generally, society) less punitive, conflict surrounding instinctual wishes would diminish – a state of affairs Freud thinks is possible in so-called ‘primitive’ societies. Contrastingly, according to the logic of the former Freud, because it is a function of our psychobiological nature, inner conflict between instinctual wishes and the ego is inevitable and is relatively independent of parental (and societal) behavior and demands. For this Freud, treatment aims for renunciation and/or sublimation of instinctual wishes. For the Freud who understands inner conflict as largely contingent upon environmental influences, the treatment aims of id-ego integration and unity of the personality can be more readily envisaged.

This latter position, the more optimistic one, places Freud in a broad historical spiritual-philosophical context in which unity of the personality is an overriding and lifelong quest, for example, reflected in Kierkegaard’s (1847) definition of purity of heart as willing one thing and Confucius’ (translated by Lau, 1979) pronouncement that at seventy, I could follow what my heart desired, without transgressing what was right.  This latter Freud also belongs to a conception of an overriding goal of psychoanalytic treatment as discovering what Stone (1997) refers to as the “otherness of oneself” (p. ), avowing this discovered otherness as one’s own and integrating it into an expanded and more unified concept of oneself. What is especially interesting is that this goal of unity and integration is essentially a return to the early Freud who viewed isolated mental contents as pathogens and who essentially identified as a treatment goal the restoration of the unity of the personality that obtained before the patient was best by an “incompatibility” between an idea and the ego.