2014 December

100 Years of Solitude? (Not)

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Review of 100 Years of the IPA, Edited by Peter Loewenberg and Nellie L. Thompson (Karnac/IPA books, 2011)

This book’s a must-have, gotta-read, for your bookshelf at least for psychoanalysts or historians of ideas or New Yorker readers and fans of Janet Malcolm.

Loewenberg and Thompson are two scholarly historians and psychoanalysts. After four years of recruiting, writing, editing with 56 contributors from 41 countries and societies, this book could have been a hodge-podge. It isn’t; Loewenberg and Thompson pull it off. Their angle is to grab by the horns Derrida’s derisive bull — that there is practically no “homo psychoanalyticus” in Africa, Asia or the South Seas — and rassle it to the ground by studying the history of psychoanalytic geography, the variations with culture (or consistencies across cultures). And, in this book, they answer Derrida resoundingly that we now have the birth of a fourth region of psychoanalysis — Asia. Derrida criticized psychoanalysis as Eurocentric — the chapters on China, Japan, India and, yes, Israel and Turkey, among others, speak loudly for the autonomy that our colleagues there have earned. I will speak more about this at the end.

How to review a 560 page tome? Rather than a blow-by-blow (or chapter-by-chapter) rumble in the jungle, we can give an overview and then focus on the six histories by IPA leaders of their respective terms. These histories speak in the voices of their writers, most are former IPA presidents, and gives a sense of the shifts in timbre, pitch, theme and variations of each term in office.

Part I is Europe, beginning with three histories of the Vienna Society. The Shoah cleaned the slate in Europe, wiped out many analysts and wiped away others, 90 % to the US and others to England or South America. Andre’ Green said, (personal communication, 2004) that one cannot understand French analysis without understanding that because most French analysts were eliminated by the Nazis and Vichy, including Lacan’s analyst, Lowenstein, early French analysis was based on reading texts (not on clinical exposure to senior clinicians). This close textual reading was for better — witness LaPlanche and Pontalis magisterial dictionary of psychoanalysis — and worse — the alienating word play of some of Lacan’s prestidigitations. We continue through Germany (with a masterful, painfully honest chapter by Werner Bohleber) through northern and southern Europe and a big shout-out to United Kingdom.

Part II is North America — Canada and the US.

Part III we head South to Latin America (with four chapters on Mexico alone).

Part IV is Asia and Oceania, those lands the Derrida said were devoid of this reflective “species.” In here also is stuck Israel (by Rolnik, an historian and analyst), which I believe is far more akin to Europe than any Asia (even the Middle East, which has no significant psychoanalytic presence other than Israel and Turkey).

Part V is the international survey.
Let’s dwell on Part VI, IPA leadership, written by Rangell (1969-1973), Wallerstein (1985-9), Etchegoyen and Etchegoyen (1993-7), Kernberg and Tyson (1997-200) Widlocher (2001-5) and Laks Eizirik (2005-9). Geographically, we take off from LA, and in the next forty years, pass through San Francisco, Mexico, New York, Paris and land in Brazil (but not Rio).

Moving at a slower pace through these six chapters give us a sense of how different authors flavor the history of their era and their historical challenges. I will try to capture their voices, as well as summarize their thoughts.

Rangell recounts his history focusing on the sites of the meetings and major shifts in psychoanalytic ideas. The Vienna Congress (’69) was historical for being held in Vienna since the War. Rome (‘71) coincided with the rise of self-psychology (after Rangell defeated Kohut for the IPA presidency) and the Kleinian shift to LA. He adds details of Anna Freud’s disenchantment with the IPA (and Rangell, apparently) when she could not get the Hampsted training recognized beyond a Study Group culminating in the Paris meeting (’73) and the 1975 raucous debate between Andre Green — emphasizing the shift of theory to account for severe character disorders — and Rangell, who pressed to integrate new data into evolving Freudian theory.

Wallerstein’s major achievement (1985-9) he captures in his subtitle, “organizational unity maintained.” Wallerstein, born in and a refugee from Germany like one of his heroes, Senator Robert Wagner, from New York. Like Wagner, he wanted to make a political contribution to leading an organization deeply meaningful to him. “The suit” marked his tenure, the legal incorporation of “lay analysts” into the IPA, finalized in 1988. Wallerstein recounts the history of this conflict from Freud’s 1910 “Wild Analysis”, published the same year as the Flexner Report in America recounted the dismal state of medical education and led to profound, systematic and carefully overseen reform of medical education. Differences over lay analysis grew between the IPA’s European (majority) and American (growing minority); this brewed over three decades, interrupted by WWII and emigration of many analysts to the US and elsewhere. In 1949, the IPA agreed that the American would have both complete control over training and geographical monopoly in the US. Settling the lawsuit (under the firm legal guidance of Joel Klein, later New York Mayor (2002-2013) Michael Bloomberg’s Superintendent of Education, radically changed this.
A test and demonstration of Wallerstein’s character came early in his IPA presidency: some IPA member expressed concern that Wallerstein, as a former president of the Am psa, might a serious conflict of interest visa vis the lawsuit. In response, Wallerstein resigned from all Am Psa committees and positions during his IPA tenure.
Beyond settling this acrimonious lawsuit, Wallerstein achieved three major objectives during his tenure: 1. equalization of IPA regions; 2. fostering research; 3. accepting theoretical pluralism. And yet, in the face of such “pluralism,” Wallerstein challenged himself and others in the 1987 Montreal meeting. Inviting a Kleinian (Michael Feldman), an ego psychologist (Anton Kris) and a Middle Group trained object relationist (Max Hernandez) to present cases from their perspectives, Wallersten was able to “trace out various clinical issues dealt with in comparable clinical fashion…”: he plotted their common ground.

R. Horacio Etchegoyen (1993-7) is next, writing with Laura Etchegoyen, begins as follows: “We will set out how Horacio Etchegoyen conceives of the IPA…” and they continue, “Etchegoyen is a man of strong democratic convictions.” We learn his three achievements: transparency, while decreasing the IPA’s “interventionist” philosophy with societies, and addressing the issue of analysts involved in torture in South America.
Otto Kernberg (1997-2001) and coauthor Robert Tyson (Secretary) begin with seven challenges to the IPA and analysts:
1. the negative perception of psychoanalysis in general culture;
2. improving psychoanalysis relation to society (under Eizirik);
3. Research under the guidance of Fonagy and Wallerstein;
4. Treating patients with severe psychopathology;
5. Innovation in psychoanalytic education;
6. two major organizational IPA problems;
7. Issues in individual societies addressed to the IPA, such as ethical issues in the Rio de Janiero societies.
The rest of the chapter articulates year-by-year what was accomplished. It is straight forward and clear.

Widlocher writes of his tenure (2001-5) as the axis returns to Paris (since Lebovici’s tenure). He focuses on his efforts to promote “scientific politics” along with Sandler, Joffe, Blatt, Marianne Bohleber-Leuzinger and R. Sandell’s Stockholm group. He balanced the tension between empirical research and “reflective and historical studies.” Describing how “new” societies joined the IPA, he remarks, “”separation (of battling factions) is better than a permanent state of fighting.” With the opening of the Soviet Union and its sattelites, candidates from there trained either in Germany or Paris, resulting in dueling rivalries over training standards (reminiscent over experiences in China with Lacanian versus German versus American approaches in psychoanalytic psychotherapies). He writes about the development of analysis in the Middle East (not mentioning the Israel Society) and Far East. But, in his words, the “most important step taken by my administration” was denying some Latin American societies to approve thrice weekly analyses.
The chapter closes with Claudio Laks Eizirik’s (2005-9) account. Here’s an excerpt of his deeply personal final paragraph: “I was born, grew up, and undertook all my studies and analytic training in Porto Alegre, a lovely city in the south of Brazil…..I am at the same time a Brazilian and a Jew, a psychiatrist and a psychoanalyst, a clinician and a researcher, a medical doctor and a lover of the arts.. an inhabitant of my country but often feeling at home in so many different places.”

But, the book doesn’t end here. Look at the complete list of all the IPA congresses with presidencies and themes.

To return to psychoanalysis’s organically grown response to Derrida’s critique of Eurocentrism. Asia has come into its own intellectual strength and is growing further. Japan, Korea, China, Taiwan, Australia, India, Iran, Israel, Turkey, once nurtured by European (and American colleagues) now are prepared to stand as autonomous colleagues in the IPA. Currently, Japan, Korea, China, Taiwan are under North America’s aegis. We should be proud of their coming into their own. Under Wallerstein’s presidency, Latin America was recognized as the third region of psychoanalysis. Now, some three decades later, we witness the birth of a fourth region. Hopefully, this book documents why the IPA should recognize Asia as such, as an equal region in the IPA.

Read this book. Loewenberg and Thompson have organized an historical and geographical view of our living discipline that brings pride to psychoanalysts.
PS. Hot Tip! Big discount to IPA m

The Texture of Treatment: On the Matter of Psychoanalytic Technique

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Book Review: The Texture of Treatment: On the Matter of Psychoanalytic Technique. Herbert J. Schlesinger (2003) Analytic Press.

By Nathan Szajnberg , MD and Keren Segal, BA
(Originally published in Sichot, in Hebrew; Translation, N. Szajnberg)
Bruno Bettelheim’s fairy tale book – Use of Enchantment – was to be but one chapter of his last book on parenting. While each book stands on its own, knowing that one was born from the other enriches our understanding of both.

Herb Schlesinger’s The Texture of Treatment spent five decades analyzing and writing as if to prepare for this too brief, but glistening gem: like a diamond, it captures apparently mundane light in various facets and enhances its beauty. Schlesinger refracts and reflects the mundanities of everyday inner life in the consulting room and transforms this with clarity.

“In the beginning … was technique.” A provocative first line for a psychoanalytic text. It reflects the style of his work, a book that will be a marker in the history of psychoanalytic clinical practice. The writing reflects the thinking: crisp, concise, sincere, honest, yet twinged with humor. Even if one disagrees with Schlesinger, he writes with such clarity and substance that one knows where one stands.

This book is like Strunk and White’s classic, Elements of Style (1999), a remarkably thin book on writing: a beginner’s guide; a veterans’ reference. Follow its suggestions thoughtfully, critically, then you will write well. A great writer may go beyond its technique guidelines, but, likely, never ignore them. Its style is clear, lively, like a mountain spring.

A man of words, Schlesinger, invites us to think about our argot. “Consider transference … resistance, defense and development as … processes rather than substantives … as points of view.” Psychoanalytic phenomena are not “things.” but somethings that evolve, happen, about which we mutually reflect.

He reminds us of basics; rethink impasses, distinguish endings, quittings, stoppings, finishings, stalemates, terminations and the interminable.

The psychoanalytic relationship is “instrumental,” — there to accomplish something — rather than marriage, friendship or parenthood, which exist for their own sake. If we trust transference, then we not only facilitate its development, but also its “cure,” its resolution. For termination, Schlesinger distinguishes therapeutic gains from dependency. “The relationship, the essential vehicle for treatment, can also defeat it.” (E. & B.; p. 36).

Mini-terminations occur when the analysand has accomplished a significant piece of work. Indications include: slower work pace; lack of direction; slackened engagement; vagueness; lateness, cancellations, stopping or fantasies of stopping; waning purpose; transference shifts; reluctance to disclose; and most frequently, anxiety that the analyst wants to stop treatment.

But, these can also be signs of resistance. Our task — recognize the signs; clarify meanings.

He questions? Why treatment now? What could the analysand change to not need treatment now? What are the analysand’s capacities for treatment success: sensitivity versus obliviousness; engagement versus detachment; psychological-mindedness versus concreteness; curiosity versus indifference; externalizing versus internalizing; regression tolerance versus regression seeking; free-association versus plodding; humor versus literal-mindedness; activity versus passivity; liveliness versus stolidity; realistic life possibilities versus circumscribed circumstances. We have continua of these capacities: treatment develops greater freedom.

Schlesinger is alive to paradoxes. “Whatever… led the patient to the therapist’s office, once he gets there, his immediate problem is the therapist… alone in a room with a strange…He is anxious…”(E. & B.; 81). Or, “People generally seek treatment as a last resort…” The deck is stacked against the analysand; we need deal a better hand.

What landmarks exist for termination? 1. The capacity to make and sustain attachments; 2. Tolerating regressive pulls, including home- or heteroerotic wishes and defenses; 3. Tolerating separation, loss and surrendering fantasized gratifications.

Schlesinger addresses impasse, that uncomfortable stasis that is preferred to risky movement. Impasses (Wallerstein, 1967) can range from the doldrums to “noisy” psychosis. An impasse is an (unspoken) unsettled disagreement or argument. In the analysand, signs of an approaching impasse in include attacks of helpless/hopeless rage, feeling “in a bind,” being furiously disappointed, and guilty for failing (the analyst’s) expectations. The analyst’s contribution in quiet impasse is an error of omission; in noisy impasse, an error of commission or omission. Groundwork for impasses includes a dependent sexual transference or unanalyzed attachment. The impasse can be both a collusive repetition compulsion and an occasion for productive work.

The Texture of Treatment guides the analyst’s hand to sail out of the doldrums.

He defines technique and redefines it, like a theme with variations. He does this with “psychoanalysis,” “transference,” “interpretation” and “neurosis,” at times with a touch of surprise. “Technique… (is the psychoanalyst’s) responsibility .. to conduct a rational treatment” (p. 2); to raise the level of communication, decrease tension: transference-charged speech is loaded with action potential – to get the analyst to “do something” to, for, or about the analysand. How to handle such tension? 1. allow one’s self to be molded to action, but reflect; 2. speak electively from all positions of the fantasied parties. Technique’s major goal : promote the analysand’s activity (p. 278).

“Avoid semantic errors – questioning, obliqueness, subjunctives, qualifiers, passive voice: speech reflects our thinking. Stay a half-step behind the patient, and stay where the patient is” (258).

Listen. Avoid making nouns from verbs; skip conjunctions. Watch out for topic changes, vague references, shifts in emphasis, private language, opening phrases such as “I know…” “ I see…” “To be perfectly frank…” Schlesinger is a Yehudi Menuhin of psychoanalytic master classes.

Neuroses? “Resources… defending against unrealistic and anachronistic dangers.” ( 84). Many feel that neurosis is something they have rather than something they are doing. It projects one part of a conflict outside, then struggles with the “opponent.” (199).

Transference? It is conservative, keeps things the same (57). It is enactment. He prefers “metaphor” to the Latin transference; Ubertragung, is closer to the Greek metaphor (Szajnberg, 1986), transporting an image from one time/place to another.

I would say more, but to follow the laconic model of this book, I need say enough to reveal and yet not too much to lose the reader’s interest.

To the denouement. Interpretation either reduces a complicated phenomenon to simpler components, or reveals the complexity of an apparently simple manner. Or, both.

Schlesinger’s thinking is like old Volvos: solid, reliable, good for the long- term and equipped with gadgets to make long journey both safe and fruitful. It gets you safely where you really wanted to go.

Let’s end with Schlesinger’s most recent book, Promises, Oaths and Vows. “[The psychoanalyst promises] steadfastness, selflessness, patience and devotion. This promise is one sided. We expect nothing comparable of the new patient.” This is the foundation upon which Texture of Treatment is built.

After death, what’s learned: Fisher on Bettelheim (and Ekstein)

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Bettelheim-Living-and-Dying

Jimmy Fisher wrote a poignant study of Bettelheim, interviewing him as he lay dying, and including correspondence with Rudi Ekstein, Bettelheim’s close friend.  Here is my review of Fisher’s book.  We can read such books for various motivations — some constructive, some not. In this case, I recommend the book as a humane, sensitive study to understand Bettelheim, an astute thinker, a man who cautioned us about biographies and autobiographies in his Freud and Man’s Soul. With such caution in mind, let’s see what we can learn.   (We acknowledge the journal “Psychoananalysis and History.”)

Bettelheim: Living and Dying

David James Fisher
Volume 8 of Contemporary Psychoanalytic Studies
Rodopi Press. (Amsterdam and New York, 2008)

Listen to some statements about psychoanalysis and psychoanalysts.  How do they grab you?Analysts are a suspicious bunch, asking “Why?” “Why now?” “How does this feel?”  They are even skeptical of their own theories, interpretations and techniques, thereby (hopefully, with enough hard honesty) better able not to need to be taken by their own interpretations, unlike their, at times, idealizing patients.And, while analysts are suspicious, the patient is always right (and wrong).Analysts are soul detectives.

The goals of psychoanalysis are authenticity, wholeness; autonomy (self-rule from the Greek) (p. 3).

The psychoanalytic situation is an island of serenity for dialogue, self-discovery, and affective exploration. (p. 3).

Too much theory estranges, distances, deflects from emotions.

Psychoanalysis needs humaneness, truth, compassion and courage.

The soul is what we have in common in humanity, contains our valuable traits; the soul is our essence, our spiritual core. (p. 25).

Without saying more, we sense we are in the presence of someone who has thought about the inner life and its exploration deeply, humanely, emphatically.

This someone is Bruno Bettelheim, a Ph.D. in aesthetics from Vienna, a professor of Education at the University of Chicago, a director of a school for emotionally-disturbed children.  His comments whet our appetites: we want to learn more about his thoughts and how they can enlighten us.  Jimmy Fisher — both a cultural historian and psychoanalyst at the New Center for Psychoanalysis, and Training and Supervising Analyst at the Institute of Contemporary Psychoanalysis in Los AngelesNew Center for Psychoanalysis of Los Angeles — does this and more in a serious, thoughtful account of Bettelheim’s last years.  Fisher has an advantage over other historians: he knew Bettelheim, spoke with him at length in Bettelheim’s final years.

Bettelheim was not a man to wait for fortune, good or bad, to take place — certainly not the moth-eating deterioration that precedes contemporary death. When, after his wife’s death, his multiple strokes, his swallowing dysphagia, his vision loss, he found death’s pace too piecemeal, he decisively read about the Hemlock Society and set a date to die, the anniversary of the Nazi’s entrance to Vienna. Then, he did the deed, he took his life.

Fisher interviewed Bettelheim, read his correspondence with his close friend Rudy Ekstein, then places Bettelheim’s suicide in a context as an over-determined event, not just tied to Holocaust shame and guilt. He takes up his wife, Trude’s illness and death and Bettelheim’s reactions on pages, 11, 84, 104, 111, 112 (especially),113, 117, 128, 156.  Fisher links his suicide not only to his strokes, deteriorating health and stamina, his loss of creativity, loss of colleagues, his dread of living out his last years in a nursing home, but also his sense that he had accomplished his significant missions in life. In fact, Fisher addresses these issues directly while interviewing Bettelheim, including powerful passages about how impossible it is to work through the ego shattering experiences of the camps. (Bettelheim told me that he continued to have nightmares from the camps decades later.) The suicide happened on an anniversary of his Nazi incarceration.  Anniversaries have potent psychological echoes, often lethal and fragmenting.  Bettelheim ended up in the camps because he delayed escaping from Vienna until he was certain that the soldiers in his underground command were safe. Then he made for the border, only to learn that the Czechs were quite happy to send a Jew (no longer an Austrian citizen by their reckoning) to be a guest of the Nazis.

We Americans are fine forgetters or dismissers.  We dismiss our heroes if they transgress humanly — Martin Luther King or John Kennedy’s (irresponsible and unacceptable) sexual exploits wipe out their decades of contributions (for those ready to cast the first stone).  Fisher sees this as private matters that do not bear on their legacies.  We also forget well: how much is Erik Erikson  or Thomas Szasz read in psychoanalytic institutes  or even universities today?  So too for Bettelheim.  Eight decades of work, thinking, writing comes to little or naught, when after his death (not during his life) people made allegations about spanking at the Orthogenic School. (Although Bettelheim wrote about children preferring a good spanking to an intellectual brow-beating in The Good Enough Parent (but, he did not advocate spanking.)  Bert Cohler, Professor at the University of Chicago, who died this year, was a child at the School and later a Director of the School: he pointed out that those who complained against Bettelheim were journalists and other literate, accomplished individuals, not bad outcomes for kids who once were disturbed enough to need residential treatment. (Those who complained, Bert also observed, were predominately those who were at the School when Bettelheim retired, as if their fiery fury for being abandoned fed their burning criticism.)  As Bert put it, these were the “treatment failures.”  Fisher makes similar points in his book (pp. 159-163, for example).

To all this the biographer need attend.  But, biography, as Freud and later Bettelheim stated in Freud and Man’s Soul, is suspect. If translation is traitorous, (traduttore, traditore), then biographies are refracted, bent by the lens of the biographer.  Look at three such efforts: Richard Pollock, The Creation of Dr. B. ((1997); Theron Raines, Rising to the Light (2002); and Nina Sutton, Bettelheim: Life and Legacy  (1996).  Pollock’s book is most tragic, most vicious, most misleading to the reader.  Pollock, a persuasive journalist, is the older brother of a boy once at the Orthogenic School. One summer, the parents insisted that their younger son return home for an extended visit. Bettelheim recommended against the home visit, as the boy was suicidal.  The parents insisted, took the boy home, and while both brothers were playing in a hay loft, the younger fell to his death: what happened exactly only two people know — the dead child and his brother.  The brother, Pollock, waited decades and six years after Bettelheim’s demise to take revenge (and, we hope, perhaps assuage his own guilt).  Raines, Bettelheim’s book agent, was dazzled by his genius and wisdom.  Sutton, a journalist, wrote perhaps the most balanced work, which had the misfortune of coming out just after his death. (My edited book, Educating the Emotions: Bruno Bettelheim and Psychoanalytic Development, 1992, is an intellectual biography written by experts in the various fields Bettelheim touched — residential treatment, anthropology, education, the psychology of the concentration camps and the impact of mass society on the individual’s autonomy.  This is more a variation of Selbstdarstellung, an intellectual survey, rather than a biography.)  To know the biographer, is to know the biography, not necessarily the subject of the work.

Fisher is both historian and analyst: he interviewed Bettelheim, he read his correspondence with Ekstein, then Bettelheim’s closest surviving friend, and he thought hard about what happened in the denoument of Bettelheim’s life. Fisher enriches our understanding of Bettelheim and subtly approaches the complexity and elusiveness of Bettelheim’s suicide.  The chapter entitled “The Suicide of a Survivor: Some Intimate Perceptions of Bettelheim’s Suicide” climaxes and provides an eloquent conclusion to this book.  It is moving, sad, heart-breaking, and fiercely  honest, including the author’s own subjective reactions to the death.  Fisher takes seriously Bettelheim’s intellectual productivity, while engaging in a passionate  clinical and cultural dialogue with him.  This is a way to respect his significant and lasting contributions.

 

Kid-Rearing

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Click Here to Read:  What Drives Success? By Amy Chua and Jed  Rubenfeld  in The New York Times on January. 25, 2014.

Kid-Rearing (This is like, so Un-PC… But is it useful?)
On Tiger Mom’s (and Dad’s) new book
Nathan Szajnberg, MD, Managing Editor
January 26, 2014

Amy Chua and Jed Rubenfeld, husband and wife, father of two successful daughters, law professors at Yale, write “What Drives Success,” in Sunday’s NY Times prior to their forthcoming book, “The Triple Package: How Three Unlikely Traits Explain the Rise and Fall of Cultural Groups in American.”

There message is crisp, well-documented, clearly stated and likely unpopular or at least un-PC.  On the other hand, besides the clear data they present to back their arguments, its importance for both parents and educational policy (and that their daughters were scrutinized by the popular press after Chua’s first book and they pass muster).

They begin with one (American) measure of success: earnings.  Average income is two-fold for specific ethnic groups: Indian-, Persian-, Lebanese- and Chinese-Americans. Then there are the Jews, two percent of the population, but one third of the Supreme Court, two-thirds of all Tony award winners and one third of American Nobel prize-winners.  What gives here? And specifically, what are the three  (child-rearing) elements they claim is found in each of these groups that accounts for such success?

Their terms are a 1. sense of superiority, yet 2. paradoxical “inferiority,” and 3. impulse control. Their article elaborates, but I suggest less provactive terms. 1.  A sense that one’ s groups is special in a gifted manner (not special in the sense of feeling vicatmized); a sense that one must work hard to live up to one’s promise (think of  someone like Lucien Freud, who felt that he could improve each picture or Newton, who sought elegance in his science).  Third, as we learn from early childhood research, those who can control their impulses performed better over the long term (and this was correlated with high I.Q.

See their article and their book to learn more.  Before our politicians leap to throw funds at education, they might look more closely at Chua and Rubenfeld’s ideas.

The Body Speaks: Body Image Delusions and Hypochondria By David Rosenfeld

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Book Review: The Body Speaks: Body Image Delusions and Hypochondria By David Rosenfeld. Karnac, 2014.Reviewed by Nathan Szajnberg, MD

Courage comes to mind when reading these case histories. Courage in the sense of the

word’s origin, coeur, of the heart.  “Pierre”, a six foot four psychotic twenty-year old with a violent history, enters for a first session and stands near Dr. Rosenfeld.  He becomes increasingly agitated.  Shortly thereafter, as Pierre left angrily, he punched the door, broke the lock.  Rosenfeld ran down the stairs to help him.  Pierre is in and out of hospital. We listen to Rosenfeld persistence and perceptiveness to return this fellow to sanity.  And we learn the theoretical framework that Rosenfeld found helpful to work with such patients psychoanalytically.

Psychoanalytically?  Some may question that term with such disturbed patients. What does Rosenfeld mean by that?  He answers succinctly: think in the transference, stay with the patient’s internal world, work with projective identifications (to the analyst and to the outside world).  Look at Winnicott’s definition in The Piggle, which is comparably spare.

A fundamental model Rosenfeld found useful in conceptualizing his treatment with these cases is the psychotic body image. More specifically, these patients feel their bodies like bags of blood-related fluids, or fragile-walled, leaky vessels.  He refers to Tustin’s concept of separation experienced as a tearing away of one’s lips, tongue.

The case histories make this book. Reading of a boy who believes his blood is damaged or depleted; another who feels bats flying out of his cheeks; a girl who bleeds from her lips when her analyst is away; and others as compelling.

Rosenfeld intercalates relevant theory with the case material. Of the hypochondrias (neurotic, confusional, psychotic), it can have a defensive function to prevent or delay paranoid or psychotic states.  Klein postulated that hypochondria is fear of persecution in the body due to attacks of internalized persecuting objects. H. Rosenfeld emphasizes confusional anxieties projected onto the body; these confusions are caused by failure of normative splitting or differentiation of good and bad.

One brief chapter is particularly meaningful to me, as Rosenfeld saw this young man in consultation at the Children’s Hospital where I was Head of Child Psychiatry. I had invited Rosenfeld to teach, uncertain how he would help the very pragmatic pediatricians at this large tertiary-care hospital. Quickly, the docs threw Rosenfeld a curve. An older adolescent, whose own mother died when he was one and who was now father of a one-year-old, was hospitalized with “paralysis” of his lower legs, believing he had cancer in his feet.  After admission, he also revealed that bats were flying out of his cheeks.  The neurology service found no medical basis for his paralysis and other specialists found him medically healthy.  The “bats” got our service involved and Rosenfeld stepped into the breach. Read this too-brief account. But, I recall listening to Rosenfeld rapid connection with this man, Rosenfeld’s practical suggestions to the pediatric team and ultimately this young man’s realization that he was mourning his mother’s death of lupus as his daughter turned one, the age he was when she died. And, he could recall the lesions on his mother’s cheeks — they had looked like bats in his nascent or constructed memory — connecting up with his delusion of bats flying from his own cheeks.   I hope the reader finds the chapter as moving as those who watched the consultation.

Working with severely disturbed patients is not for everyone, nor should it be. Doing this work takes specific training and ongoing supervision (and a warm family, Rosenfeld adds).  In the 1975 IPA head-to-head between Rangell and Andre Green, this was the issue:  the broadening scope of psychoanalysis. Rangell argued to keep analysis for the less disturbed; Green, citing Winnicott and Giovacchini, as well as his own experience, argued that we can develop techniques for working with more disturbed patients, including techniques for making constructive use of our reactions to the patients, that overused and too-abstract term, “countertransference.”

Rosenfeld carries us further down this difficult path, working with severely disturbed patients psychoanalytically.  We can all read about this pioneering work and some of us will try to emulate Rosenfeld’s efforts.

Laplanche: Whom and What We Have Lost

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Jean Laplanche, a man as careful with words as a surgeon with scalpel, died this week. International Psychoanalysis.net will honor his life and work with three pieces: his 1991 “Is Psychoanalysis Curable” (courtesy of Jimmy Fisher); a classic translated by Jonathan House; and an interview.

In the “Curable,” piece below, Laplanche states that overusing psychoanalytic terms leads to ridicule; further, even in 1991, psychoanalysis was considered passé.

Yet, for Laplanche, psychoanalysis — the method — leads to lucidity and freedom. These are subversive and even revolutionary activities.

Laplanche orients us, gives us our longitude and latitude, our coordinates: psychoanalysis is a method “to investigate otherwise nearly inaccessible mental processes,” per Freud. The two components of that method are free association and transference. Much of the rest, which others write, is commentary (and more of the rest superfluous or senseless as used by society and too many others).

With this method, psychoanalysis liberates thoughts, which then gravitate to points of attraction that are at first unknown to the analysand. This is free association.

Transference ultimately leads us to speak freely with a skilled and receptive listener (and ultimately to oneself).

In the wedding of free association and transference, one produces an offspring: a sense of how this human was constituted through one’s original relationships with significant others. This offspring develops, if things go well, to learn how to relate more deeply, more thoughtfully to oneself and others.

Symptoms, Laplanche reminds us, bring the analysand. But psychoanalysis has a subversive element via free association and transference: via the symptom, we are led to a new version of the self. For, psychoanalysis reveals secret desires.

Erich Fromm wrote that psychoanalysis is a true inner freedom that complements the outer political freedoms, which democratic societies purport to offer.

Laplance, in a radical stance, insists that holding psychoanalytic method accountable to third parties (rather than to the individual alone) violates its own principles: to speak freely, to breathe freely.

Listen now to Laplanche.

A Power Structure Analysis of Four Psychoanalytic Institutes

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UnFreeAssociations

Jimmy Fisher, a cultural historian and psychoanalyst based in L.A reviews Kirsner’s book, titled “Unfree Associations” and subtitled “Inside Psychoanalytic Institutes. ”  He writes as an insider from L.A. He offers two unique, timely, intriguing pieces. You can read only one on Ip.net. The other you won’t read here because the journal’s publisher insisted that the author, Fisher, pay $186 in order for Fisher to have his article — the article he wrote, the fruits of his thinking and labor — available to readers of Ip.net. Instead, we will give a PEP link to Fisher’s elegant, thoughtful review, which teaches us something about the acrimonious and destructive battles within Apsa today. We can publish Fisher’s interview of Douglas Kirsner, author of Unfree Associations, a painful detailed account of the impasses, the lack of transparency, the difficulties at four psychoanalytic Institutes: Chicago, LA, Boston and New York. We print that in full. The second piece, courtesy of the author.

Honest histories help us see ourselves more clearly, if not kindly, more honestly, if not handsomely. We know this practicing psychoanalysis, a discipline, as Fisher says succinctly, dedicated to radical questioning of subjectivity, demystification of knowledge, clarity of family dynamics and untangling character knots.

Histories of psychoanalysis help us see the tangles within our organization, what gets us into knots, twists our sheets. Or, in a more psychoanalytically true syntax, following Shafer’s action language, I would write, “Histories inform us on how we get ourselves so tangled-up, tied into knots, twist our sheets.” For instance, Kurzweil recounts the different historical courses of analysis in five different nations; Turkle and Roudinesco travel the troubled (and brilliant) paths of French psychoanalysis refracted through the lens of Lacan; Rolnik teaches how Zion and Freud mixed in the once-sparsely populated Palestine; and Arnie Richards has been charting the U.S. ship of psychoanalysis as it has been blown by the winds of Marx and socialism.   Makari takes a different tack by following the three strands of nineteenth century thinking that Freud wove together into his psychoanalysis.  The Australian Kirsner’s book is a careful case-study of four geographic centers of American psychoanalysis in New York, Boston, Chicago and L.A. Published in 2000, he describes Institutes that are undemocratic and troubled, sectarian and paranoid. He assesses theses Institutes as oligarchies (under the guise of alleged meritocracies, but without honest, transparent measures of merit such as what one finds in universities, or businesses, or even symphony orchestras). In the years since, Kirsner diagnosis the fundamental fault to be the Training Analyst system.

 

Who Took the Fairies out of Fairy Tales?

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Review of Joan Acocella’s “Once Upon a Time” New Yorker, July 23, 2012 [1]

Once upon a time, long ago and far away (but East of the Hudson), lived a brave reviewer who wrestled Grimmly with fairy tale bowdlerizers.  This is the story of her feats, and how fairy tales still survive (in children’s hearts) in spite of some adults.

Acocella bravely takes on a raft of new interpretations or new versions of fairy tales, entirely of the Grimm variety, although the Perrault tales or Scheherzade (from Persian and Arabic and even French origins) we will show also are fairy tales.  And, some of what she reviews under fairy tales are either fables (explicitly moral stories) or single-authored (such as the moving Hans Christian Anderson stories).  It’s worth keeping our apples and oranges in different peck baskets.

Let’s begin with the differences amongst these categories, but from a children’s (and developmentally psychoanalytic perspective).  Fairy tales are orally-transmitted stories told across generations, without clear single authorship. Usually the heroes/heroines are children or small animals who use their cunning (as they don’t have the strength) to overcome evil.  There are moral themes embedded within such tales — such as how children or animals, if they restrain their impulses, use their good minds, can overcome adversity — but these are not explicit.  Why not single-authored?  Because these stories are transmitted across generations of time and from parent to child, they capture the major existential themes shared by cultures. Fairy tales appeal across cultures (not only generations): children are entranced by Scheherezade’s Sinbad the Sailor, Alladin and the Genie, as they are enthralled by Grimms’ Hansel and Gretel, Puss in Boots or Jack and the Beanstalk. or Perrault’s Little Red Riding Hood.

Single-authored stories — of necessity, we know as psychoanalysts — are more significantly colored by the inner life of the author.  Would psychoanalysts be surprised that Hans Christian Anderson, writer of such tales as the Little Match Girl, who dies in the snowy cold, was plagued by severe depression?  Listen to a summary of his Little Mermaid (not the Disney version, the original), in which

“The Little Mermaid, longing for the prince and an eternal soul…visits the Sea Witch, who sells her a potion that gives her legs in exchange for her tongue …. once she becomes a human, she will never be able to return to the sea. Drinking the potion will make her feel as if a sword is being passed through her, yet when she recovers she will have two beautiful legs, and will be able to dance like no human has ever danced before. However, it will constantly feel like she is walking on sharp swords hard enough to make her bleed. In addition, she will only get a soul if she finds true love’s kiss and if the prince loves her and marries her … Otherwise, at dawn on the first day after he marries another woman, the Little Mermaid will die brokenhearted and disintegrate into sea foam.(Ital. added).

The Little Mermaid drinks the potion and meets the prince….(But) the prince’s father orders his son to marry the neighboring king’s daughter…

…The Little Mermaid’s heart breaks … thinking of the death that awaits her…before dawn, her sisters bring her a knife …. If the Little Mermaid slays the prince … and lets his blood drip on her feet, she will become a mermaid again, all her suffering will end …

The Little Mermaid cannot bring herself to kill the sleeping prince…as dawn breaks she throws herself into the sea…. “(Wikipedia)

Fairy Tale? Not.

Fables are barely disguised and generally short accounts with strong moral endings. For instance, those by Aesop, the Greek slave, who gave us the Tortoise and the Hare, or the Lion and the Mouse (who releases the lion from the hunter’s snare, The Goose that Laid the Golden Eggs; or La Fontaines’ twelve volumes of 17th century moral tales; and others such as the Fox and the (out of reach) grapes; the scorpion and the turtle who ferries him across the lake and is stung to death in return and others.  These short accounts feel different; are more explicit, almost religiously-tinged, ending with stated maxims or morals.  Not too kid-friendly.

Let’s hear what and with whom Acocella wrestles.  Zipes, a professor of comparative literature, has written some twenty books on fairy tales. In his latest, for instance, he changes the ending of Rumplestiltskin. Remember him? He will let the Princess keep her new baby if she can guess his name. She finally does so and in the original tale, Rumplestiltskin, in great frothy fury stomps himself through the floor (and into whatever lies beneath)! Zipes has the Princess instead invite Rumplestlitskin to cohabit with her and the baby and they will have such a fine time.  Yes.  Imagine children wanting to hear that ending.  Even adults like their heroes to vanquish well: Superman does in the evil doers; Batman outdoes the Joker and so on. Imagine having Batman hook arms with the Joker and stroll into the fog. That’s good for romantic Casablanca, not for Batman.  Essentially, Zipes turns a fine fairy tale into a mundane fable.

Here’s another tale teller Acocella faces down.  Angela Carter does her take on Red Riding Hood and the Wolf, entitled, “The Company of Wolves.”  She has little Red Riding Hood remove her shawl and toss it into the fireplace…then draws “her blouse over her head; her small breasts gleamed as if the snow had invaded the room.” Then she disrobes the wolf. Then cradles the wolf’s head in her lap and …. picks his lice from his wool and… eats them.  Carter ends her tale with Riding Hood sleeping “sweet and sound … in granny‘s bed, between the paws of the tender wolf.”  (I kid you not; I take this from Acocella’s review). Read that to your kid?  Not.

Okay, let’s get back to Bettelheim.  Acocella has him at bat with two strikes against him by saying he was “notorious(ly)” and a Freudian.  In fact, let’s say that Bettelheim, one of my teachers, who dedicated much of his life to caring for dispossessed kids, was a “Kidian”: about kids, he thought deeply and listened carefully and watched closely.  Kids like their fairy tales fairly unadulterated: animals or other kids (long ago and far away) are in danger. Hear what children relish.  A Snow White envied by her aging stepmother, pitied by the hunter sent to cut out her heart; saved in part by her efforts caring for seven dwarfs, learning how to care for others, until she sleeps through (adolescence) until wakened by her Prince.  Hansel and Gretel, sent off to starve in the woods by famished parents; Gretel being clever enough to trick the witch and save her brother.  Puss-n-Boots whose cleverness gains him power, wealth and wins the Princess for his beloved, but impoverished master.  Or Scheherazade who uses her courage and creativity and clever mind to cure her homicidal husband over 1001 nights.  And don’t try to change the fairy tale in the retelling: kids like them consistent, just fine, thank you.

The Princess Bride, a movie by Rob Reiner, captures cleverly how powerful is the intimacy between teller and listener. An ill perhaps nine year old is told by mother that Grandpa (Peter Falk) is coming to read him a story. The boy doesn’t want stories: he’s busy with his video game. But, Grandpa pulls out a book given to him by his father, read to him, which he read to the boy’s father.  He begins the story with beautiful girl about to kiss the handsome but lowly farm hand: the boy’s yuck interrupts the tale. Undeterred, Grandpa interrupts the kiss for the young man to set sail, then captured by pirates; the girl in turn kidnapped by evil doers; held hostage to be married by the rival king, who will kill her on her marriage bed.  Watch it again to see not only the story, but the playful back and forth between the story and Grandpa and grandson, who now can’t abide interruptions.  This is another ingredient Bettelheim noted: fairy tales are to be told by adults to children; in fact, in olden times, some adults believed in these tales perhaps as strongly as their children.  Bettelheim hits it out of the park on the third pitch, reaches for the sky.

Children — small, vulnerable, less powerful than moms and dads, often feeling less powerful than their angry impulses (towards a sibling, towards a parent) — have a residual secret ingredient to manage the bigness of the world: their imaginations.  Give them fairy tales, told with feeling, by adults with feeling. Don’t manicure the tales; expurgate them, nor elaborate them for adults‘ needs.  Let fairies be “dancey” a bit longer in children’s lives.