_Paul Schimmel _** **
This paper was previously published in the Australasian Journal of Psychotherapy, Vol 28, 1&2, 2009
Psycho-analysis is considered to be the activity of investigation of the mind for the purpose of delineating personal psychic truth. In so far as the aim of psycho-analysis is the pursuit of truth it is considered to be a science. The relationship between psycho-analysis and psychotherapy is considered, as are certain elements of the psycho-analytic encounter. It is suggested that hatred of psycho-analysis will be encountered in all parties, consequent upon the inevitable presence within us of a hatred of, or resistance to, the delineation of psychic truth.
In Shakespeares Hamlet Polonius advises his son Laertes who is about to travel abroad,
This above all - to thine own self be true,
And it must follow, as the night the day,
Thou canst not then be false to any man. [Act 1, Sc 3]
The question of authenticity or being true to oneself is as fundamental to the human mind as Hamlets question; To be or not to be. We might even suspect the two issues come down to much the same thing; that a false existence is just that, an existence, but no real life, no real being. The psycho-analyst Donald Winnicott (1960) proposed the idea of a false self, which arose as an adaptation to developmental experience that is not growth promoting. He saw this false self as a way of staying in existence, of keeping alive the possibility that one day something of the authentic being within the person may be realised. Winnicott called this latent potential the true self.
That Shakespeare gives Polonius wise words should give pause for thought, because Polonius, was in life a foolish prating knave, as Hamlet comments, after he has mistaken Polonius, who is hiding behind a curtain, for his step-father, and stabbed him to death [Act 3, Sc 4]. It is a case of hidden and mistaken identity. Psychically Polonius real self is in hiding; it has never come to life. He is the step-father or false father of the mind. Without a mind of his own, his identity is a false one, so he bends like a reed in the wind with the prevailing opinion:
Hamlet: Do you see yonder cloud thats almost in shape of a camel?
Polonius: by th mass, and tis: like a camel, indeed.
Hamlet: Methinks it is like a weasel.
Polonius: It is backed like a weasel.
Hamlet: Or like a whale.
Polonius: Very like a whale. [Act 3, Sc 2]
In giving Polonius the words To thine own self be true, Shakespeare ironically draws attention to the fact that this task, of being true to oneself, is no easy one, as the self in question must be conceptualised as having not only conscious but also unconscious dimensions. If it is not to be avoided, the task will prove a lifetimes work. For some of us this work includes psycho-analysis and psychotherapy.
As he developed his psycho-analytic technique Freud (1895d) placed roughly equal emphasis on the aims of treating the minds of his patients and investigating the minds of his patients. Although the two may be difficult to separate, there is merit in considering the investigation of the mind as the primary aim of psycho-analysis. The reason being that optimal therapeutic effects are consequent upon true understanding, so the primary aim of clinical psycho-analysis can be considered that of understanding the mind of the analysand or patient. Paradoxically, therapeutic ambition, and in particular the desire to cure the patient of symptoms and suffering, tends to undermine the pursuit of understanding. Of necessity, the process of understanding comes first, and any inherent therapeutic effects are consequent. The curing of the mind, to the extent that this takes place, is a by-product of the activity of understanding.
Freud (1923a) came to define psycho-analysis as broadly covering three things. First, a procedure for the investigation of mental processes which are almost inaccessible in any other way; second, a method for the treatment of psychological disorders; and third, a body of theory accumulated into a scientific discipline. Just as the therapeutic effects of psycho-analysis follow from the process of investigation, so the accumulation of a body of scientific theory, Freuds third definition of psycho-analysis, is also secondary to the process of investigation. General theories can be hypothesized by induction from particular instances discovered in individual patients.
Clinical psycho-analysis then is an activity concerned primarily with investigation of the mind and the delineation of personal psychic truth.
In the collective Western psyche, the term psycho-analysis remains associated with Freud and his theories, and certain aspects of the psycho-analytic technique, such as the couch. But these objects, even the illustrious Freud himself, have no essential link to the concept of psycho-analysis under consideration. This psycho-analysis is not dependent upon any particular theory, has nothing to do with the cult of personality, and nothing to do with any particular school of psycho-analysis, nor does it belong to any psycho-analytic institution. An understanding of this particular psycho-analysis is not dependent upon a psycho-analytic training, although good training can greatly promote it. It does not depend upon the title psycho-analyst. It may or may not be present in a psycho-analyst, in a psychotherapist, or indeed within anybody. If it is to be located at all it is identified in a psycho-analytic attitude; that is an attitude, inherently scientific, of observation and inquiry towards psychic reality. This attitude of wanting to get to know about something, that has been designated K by the psycho-analyst Wilfred Bion (1962).
Although we think of Freud as the legitimate father of psycho-analysis, the psycho-analytic attitude that I am describing existed before Freud and in this sense there were psycho-analysts before Freud, Shakespeare, being one of the most notable. The literary critic Harold Bloom (1998, p. 6) identifies Shakespeares art of characterisation, with its focus on the inner self, as something that was radically new. Bloom points out the sense of reality that attaches to Shakespeares characters, something not achieved in the drama of his contemporaries.
As a further powerful example of Shakespeares imaginative grasp of psychological truth consider his development of the character of Lear in King Lear. Through Lear Shakespeare portrays the psychotic breakdown of the self, which leads ultimately to Lears painful realisation of his own foolishness and destructiveness, and to the beginning emergence of a new and more integrated self. In the first scene of the play, Regan comments of her father he hath ever but slenderly known himself [Act 1, Sc 1]. Lears tragedy is that self knowledge comes at the end of his life, but nevertheless self knowledge is affirmed as possible.
It is an observable clinical fact that some patients emerge from states of emotional breakdown and psychosis having attained a greater degree of psychological integration than previously, and a process of self discovery is often initiated by the breakdown of the existing structure of the personality. In such cases it is difficult to avoid the impression that it would have been impossible for the patient to gain his or her own mind without first losing it. It is very striking that Shakespeare possessed such a clear intuitive understanding of the potential therapeutic value of psychological breakdown. It is also striking that this phenomenon is largely ignored by contemporary psychiatry. The attitude of contemporary psychiatry towards this clinical fact is very much like Lears attitude towards his daughter Cordelia; disinherited and banished because she does not conform to the dominant paradigm.
Harold Bloom (1998) titled his book on Shakespeares plays The Invention of the Human. Bloom argues that the invention of what we call personality, and the modern conception of the self as a moral agent, really began with Shakespeare, who became, and has remained, an important force shaping the Western psyche. Blooms use of the word invention is not to be understood as suggesting something arbitrary, but rather as suggesting the realisation of a potential. He writes, Our ideas as to what makes the self authentically human owe more to Shakespeare than ought to be possible (p. 17, italics added).
Psycho-analysis as Science
The philosopher Collingwood (1940, p. 4) has defined science as systematic or orderly thinking about a determinate subject-matter. One necessary element of a science is that it attempts to approach the truth about the phenomena toward which it directs its attention. It tends to try to find out about these phenomena.
It follows that psycho-analysis, in order to try and delineate this object called psychic truth, adopts an essentially scientific stance. It is the natural science of the psyche or mind.
Obviously words like truth have to be used with some care. It is used here in the sense suggested by Bion, as something that, like Kants (1783) noumenon, exists, but which we cannot know directly. Bion (1970) calls this truth or existence ultimate reality. In brief he suggests we approach knowledge of ultimate reality indirectly through the process he calls K that is the attempt to get to know about something. Through K we gain knowledge of the phenomena of existence, and form mental representations or theories about ultimate reality, which however we can not know directly.
A science is identified primarily on the basis of the kind of phenomena towards which it directs attention, rather than on the basis of specific current theories. To some extent theories come and go in all sciences. Given the interpretive nature of psycho-analysis, and the fact that it deals with ineffable subjective realities, it is particularly prone to the proliferation of theories. So psycho-analysis may generate theories but it is not defined by current theories.
To relegate theory to a secondary role is not to suggest that all theories of the mind are of equal value, so that it does not matter what theory we hold. It is, however, to suggest that in psycho-analysis, as in all science, investment in and adherence to a particular theory, or school of thinking, is likely to restrict ones capacity for observation. In the clinical context, faced with the immediacy and complexity of the psycho-analytic or psychotherapeutic encounter, when one person is trying to find out something about another, then any attempt to impose a theory or work from a theory restricts vision and experience, and if experience is restricted so is the data available to the analyst.
The analyst in the session is in the position of the scientist trying to make sense of a mass of data. What is unusual about the psycho-analysts position, and which is perhaps rather different from the usual conception of the scientist, is that the analyst-therapists data is the emotional experience of the session and associated thoughts. The analyst-therapists subjective experience of participation in the emotional relationship with the patient is an essential part of the data.
The state of mind on which the analytic work depends is one conducive to something being realised or understood. Freud (1912e, p.112), characterised this state of mind as one of listening with evenly suspended attention, and Bion (1962, p. 36) referred to it as a state of reverie. The analysts reverie is a state of mind receptive to the experience of being with the other person, and conducive to the apprehension of links between the elements of this experience. When the links between elements are apprehended there is a further experience, that of things coming together in a meaningful way; of coherence. In the session this might be the experience of apprehending a meaningful connection between a number of elements in the patients material that the analyst had not previously related together; Bions (1962, p. 72) conception of the selected fact. Of course, any such understanding, is in the nature of a provisional hypothesis which is then tested against the evolving direction and material of the session.
The task in the session is to come to an understanding which is relevant to the patient. The circumstances of the session can never be reproduced, and the experience is specific to analyst and patient. The problem with psycho-analytic investigation is that phenomena of interest exist only within the consulting room. Some attempt, more or less convincing, may be made to communicate about the events of a session to a third party, but the events themselves can never be reproduced.
Psycho-analysis as Therapy
The psycho-analysts consultation proceeds with the specific aim of fostering a psycho-analytic and psychotherapeutic process. Or at least this is what we might expect, but of course whether or not this is so ultimately depends on the person of the psycho-analyst. Similarly this process may be fostered by the psychotherapist in his consulting room, but again this will depend upon his conception of what constitutes therapy.
It is necessary to consider the relationship of the terms psychoanalysis and psychotherapy. Some or perhaps most of the people we see have some sort of idea that they have a problem and an expectation of treatment of some kind. They quite reasonably think they are coming for therapy. There is, I believe, no doubt that psycho-analysis is potentially a most potent form of psychotherapy, the reason being that the mind, as Bion has suggested, grows through the apprehension of psychic truth. Truth is food for the development of the mind. Bions (1962) model here is the nursing mother and baby. The mother, through her activity of reverie and response, provides food for the developing mind in a manner analogous to her provision of milk for the infants developing body. In the absence of reverie a mind develops in which emotional experience and thinking are compromised or absent.
I would therefore suggest that psychotherapeutic efficacy in general depends upon psycho-analytic efficacy. Effective psychotherapy as a sustained process, depends on the presence of a psycho-analytic function, as defined, and this psycho-analytic function is in fact the essential psychotherapeutic element.
At this point we must consider the paradox already alluded to: therapeutic ambition, that is the desire to cure the patient of symptoms and suffering, tends to undermine the pursuit of understanding. While the patient comes expecting some form of treatment, any investment on the part of the analyst-therapist in the therapeutic outcome is likely to distort his psycho-analytic function. Such a wish distorts the psycho-analytic lens.
Bion (1970, p.56) puts it thus: it interferes with analytic work to permit desires for the patients cure, or well-being, or future to enter the mind. Such desires erode the analysts power to analyse and lead to progressive deterioration of his intuition.
The therapist whose wish to cure his patient intrudes into the session is not in a frame of mind conducive to analytic work. He or she might, for example, seek to read phenomena within the session as signs of progress or lack of progress, rather than remaining open to deeper meanings; or a vulnerable patient might intuit, and become constrained by, the therapists hope for, or expectation of, improvement. A patient who is not free to be ill in the session, is equally not free to be cured.
Similarly an assumption on the therapists part that the patients symptoms and psychic suffering are a bad thing, would reflect a state of mind unsuited to analytic work. The analyst-therapist attempts to maintain a position of impartiality regarding any wish on the patients behalf for relief from symptoms and suffering.
It is perhaps a critical point in our development as therapists when we come to understand that to resist our own or our patients recognition of the reality and extent of his or her difficulty and disturbance, is to compromise true understanding, and to compromise true understanding is to compromise treatment. In other words the state of mind suitable for analytic work, and hence suitable for psychotherapeutic work, is one where the investment is in truth rather than cure.
The Psycho-analytic Encounter
Whatever else it is, the psycho-analytic encounter is a human emotional experience.
If, as has been suggested, psycho-analysis is inherent in the human condition, then any encounter between people may potentially realise elements of a psycho-analytic process, but again the psycho-analytic consultation is specifically designed to foster the expression of, and reflection upon, these psycho-analytic elements. The psycho-analysts position in relation to this experience is that of participant observer.
The analyst is a participant in the emotional experience created by the coming together of two people, and the encounter also proceeds, at least from the analysts point of view, as an observational investigation; an attempt to get to know about something. As suggested any therapeutic effect that flows from this might be thought of as a by-product of this process of getting to know. This process of getting to know begins afresh with each patient, and in a sense with each session. It is fostered if the analyst-therapists mind can be freed from assumptions, and this includes attachment to theories.
The need to maintain an essentially disinterested position with regard to theories, the patients and the therapists wishes and so on, has been suggested. The concept of negative capability is a rather popularised one in psycho-analytic literature at the present, but it is relevant and important. The expression is from the poet John Keats (quoted in Motion 1997, p. 217), who wrote in a letter, At once it struck me what quality went to form a Man of Achievement especially in Literature and which Shakespeare possessed so enormously I mean Negative Capability, that is when man is capable of being in uncertainties, Mysteries, doubts, without any irritable reaching after fact and reason. Understanding, like poetry, cannot be forced; we must be willing to wait for it to come. Impatience within the analyst-therapist is not a frame of mind conducive to the evolution of a psycho-analytic process.
Bion (1970) has also characterised the frame of mind conducive to analytic work as one beyond memory and desire.
These ideas may seem all very well, a sort of ideal, but of course in the immediacy of the psycho-analytic encounter there may be enormous emotional pressure from the patient, who, unlike the analyst, is free to express all feelings including impatience and aggression. Under such conditions the analysts task is to, at least survive (Winnicott, 1971), and at best to retain some capacity to think under fire (Bion, 1974). Nor is there such a thing as an infallible psycho-analyst. The only instrument of observation the therapist or analyst has is his or her mind. If the mind is a perceiving lens it is also a distorting one, and the reason personal analysis is so important in training is that it hopefully goes some way to lessening the distorting effect of the observing instrument. In _Second Thoughts _Bion (1967, p.130) wrote, I have .learned that no amount of psycho-analysis can insure the psycho-analyst against distortion of his material although his distortions may become less crude than they were before he had been psycho-analysed.
Bion further comments (1967,_ _p138), the psycho-analysts work is lonely work, that the only companion he has is his patient and his patient is by definition unreliable. The data of the psycho-analytic experience exist only in the consulting room. For this reason it is extremely difficult for the analyst-therapist to communicate about what he does.
For this same reason, as Bion (1967, p.138) also points out, reliance cannot be placed on hostile criticism. He comments: the ineffable nature of psycho-analysis makes it unlikely that so-called impartial criticism has any value beyond serving as an indication of the climate of opinion in which the psycho-analyst works.
Hatred of Psycho-analysis
The current climate of opinion is characterised by the tendency to idealise psycho-analysis on the one hand, or to denigrate it on the other. Idealisation and denigration may be thought of as emotional responses that emerge in the absence of a real relationship and of real understanding.
Hatred can be thought of as the wish to obliterate the hated object, and denigration as a form of hatred. There may be a felt antipathy, or a less conscious dismissal or denial of the hated thing. Hatred may be expressed in extreme or subtle ways. Hatred of analysis may be found within the analyst-patient couple, or outside of it, within a group or the wider society.
An attitude of hatred towards analysis, whether conscious or unconscious, seems invariably to be found to exist within the patient. But why should the patient hate psycho-analysis, the procedure from which he or she presumably expects help of one form or another? One way of conceptualising this is as hatred of the psychic pain attendant upon truth. We naturally withdraw our hand from a naked flame to avoid physical pain, and something similar may often take place in the mind in response to painful psychic reality; a psychic defence. If the patient has created a comforting delusion, the basis of the patients hatred of the truth may be understood as a wish to avoid what is feared to be unbearable psychic pain. The arrogance and omnipotence sometimes manifest by a so-called narcissistic patient offers an example of an organised defence against the recognition of psychic truth. In the therapy room, such arrogance and omnipotence invariably reveal themselves to be forms of psychic protection; a defence against awareness of a developmental experience in which the true self has gone unrecognized and unvalued.
To the extent that the patients way of understanding and experiencing the world is based upon self deception, the mind will resist knowledge of psychic truth. Such truth is felt to threaten the existing organisation of the mind, and threaten the release of feared pain into consciousness.
However clinical experience suggests a further dimension to the attitude of hatred towards psycho-analysis. It is an observable clinical fact that human beings have the capacity to render or maintain a variety of states of mind unconscious. Just as psychic pain can exist in unconscious forms, hostile states of mind; frustration, envy, anger, may exist in latent or repressed forms. In the facilitating, intense, and sometimes provocative atmosphere of the therapy relationship, resistance and repression may attenuate, and new links are formed. Hostile feelings, anger and rage, may emerge, or erupt violently into consciousness, sometimes directed towards the therapist who is felt to be frustrating and persecutory. Interpretation of the presence of such forces within the mind is often strongly resisted, especially if they are felt to be a source of shame, and the potential for the direct experience of anger and hostility within the transference is often feared and hated. At the extreme a patient may live in fear of a regressive return to an experience of infantile frustration and trauma, with the re-emergence of intense psychic pain, violent anger, or even psychotic fragmentation.
The psychic organisation which consists of an unconsciously hostile attitude towards both awareness of, and the conscious experience of, painful and hostile emotional states, is perhaps another description of an envious state of mind. Symington (2007, p.286) has described idealisation as the first stage of envy, in recognition of the way an apparently positive attitude of idealisation may conceal, and then reveal, a negative, denigrating and spoiling attitude in the course of a therapeutic analysis; a process perhaps also formulated in phrases such as the emergence of a negative transference. The psycho-analytic concept of the bad object would seem to be another formulation of the existence of a latent emotional experience involving potential aggression and hostility. The attitude of fear and hatred which maintains this experience in an unconscious form constitutes a particular obstacle to the unfolding of the psychotherapeutic process, and psycho-analytic understanding.
Fairbairn has argued that analytic technique can be conceptualised as designed to facilitate a release of repressed bad objects from the unconscious, but it is also fear of just such a release that characteristically drives the patient to seek analytical aid in the first instance. The patient is troubled by the presence of the bad object and holds a fantasy that the idealised therapist will relieve him of it, whereas the actual process of therapeutic analysis will introduce him to it in one way or another. So, adds Fairbairn, It is only when the released bad objects are beginning to lose their terror for him that he really begins to appreciate the virtues of mental immunization therapy. (1943, p.75)
And why should the analyst hate psycho-analysis? Because the analyst too is only human; perhaps sometimes the process seems too difficult for the analyst as well as the patient, perhaps he is tired, or perhaps she is worried about some other external concern. But more importantly the analyst also resists certain truths and the work of analysis remains a potential challenge to the analysts assumptions, delusions, and repudiated psychic reality. The analyst must also remain a patient if the work is to proceed.
The collective antipathy towards psycho-analysis sometimes encountered within groups, or within society, may reflect the collective resistances of the individuals within that group, but can also be understood as following from the fact that truth is subversive to the conventions of the group. That is to say the conventions of the group may be expected to reflect an investment in ensuring the survival of the group, rather than an investment in truth. The perspective of psycho-analysis offered here favours independence of thought, and as such represents a threat to the establishment mentality of the group. This will be the case even when the group is a psycho-analytic or psychotherapy training institution.
For all his outward conventionality Freud did not flinch from the recognition that conformity with any of societys codes of conduct and conventions was no measure of mental well-being; evidence as to the emotional health of a person had to be sought within. Freud was well aware of what Winnicott later came to call the false self. Freuds position is, of course, the position of the psycho-analysis described here, and it is consequently inevitable that if this psycho-analysis ventures out into the world it will be attacked. To take such a position will make no friends amongst those of a behavioural disposition when it comes to human affairs. Public policy makers are not likely to be impressed with the psycho-analysts interest in his patients state of mind, and analyses that continue for ten years or more.
Psycho-analysis is particularly likely to come into conflict with the institutions of psychological medicine and psychiatry. The psychiatric practitioner is searching for answers in the service of symptom relief, while the psycho-analytic practitioner is seeking understanding. Psychiatric practice is in the nature of an applied science; essentially goal directed, and utilitarian. Psycho-analytic practice, at least as it is being conceptualised here, is closer to that of a pure science; the analyst looks in the raw data of the session for meaning. Inherent in this search for meaning is the implication that there is something more to be understood, and such a perspective is subversive to the belief that one already possesses the knowledge and the answers to practical problems.
However, even when we look from the more utilitarian perspective of change or outcome, nothing is straightforward. Many people would wish to believe that education, suggestion, encouragement, exhortation, coercion, and bullying should suffice to change peoples so-called undesirable behaviours or states of mind. In recent times we might add psychotropic drugs to this list. Nevertheless it appears to be a fundamental truth of the human mind that none of this can substitute for understanding. The person who is in the habit of acting without thinking, is not fulfilling their potential as a human being, and nothing can be substituted for the capacity to think. It is a fact that a baby cannot make use of education, exhortation and coercion; the baby can only make use of the mothers, or parents, thoughtful attention, and the parents understanding. The individual who, for whatever reason, has not had a sufficient experience of such attention as an infant, is rendered incapable of learning from experience, to take another phrase from Wilfred Bion (1962).
At a Sydney coffee shop the tables were close together and an animated conversation was taking place between two people at the adjacent table. I managed to more or less tune out until something about depression caught my attention. One of them stated with authority, the problem was that we in the West think too much. They went on to expound the view that there are so many other options, naturopathy, acupuncture, and so on .. Depression is a chemical thing, and the body effects the mind. So if we paid attention to the body that would cure the depression. We think too much, the speaker repeated, and added, They dont think so much in Africa and Asia. Yes, that is our problem; thinking too much.
This view is a kind of caricature of the dominant paradigm of biological psychiatry, which relegates mind to an epiphenomenal position; that is a kind of side-effect of the brain. Such a paradigm is essentially inimical to thinking. The relationship between mind and brain is conceptualised within the framework of a brain which causes a mind, and the mind is then effected by means of interventions aimed at the brain. It is true that there are other paradigms within psychiatry, but it is also true that in practice, psychiatric interventions are very often based upon this assumption, explicit or implicit. Within this dominant paradigm the mind is not considered as a source of mental disturbance or as an object worthy of investigation in its own right. Depression, as the patrons in the coffee shop insisted, is a chemical thing, so what would be the point of thinking about what else it might mean? The Melbourne philosopher Tamas Pataki (1996, p.62) in an insightful and incisive paper entitled Psychoanalysis, Psychiatry, Philosophy, has commented, The ancient injunction which governs psychoanalysis is Know thyself; but modern, biological psychiatry says: dont bother.
Psychic change is much more difficult than most of us imagine, perhaps more difficult than we can imagine. One reason is that psychic truth is often so difficult or painful to face. This remains true for the analyst as for the patient. Our self importance is always a way of protecting ourselves from a more bitter reality. Before King Lear can face anything of this reality he must first lose his kingly status and second risk losing his mind.
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Paul Schimmel. PO Box 37, Roseville, Sydney, NSW 2069, Australia