Shevrin addresses one crucial aspect of the recent dissatisfactions within the American Psychoanalytic: training analysis. Click Here to Read:

He states a foundational problem clearly: organizations value power. Privileged knowledge (the intimate vulnerabilities of a candidate’s personal life) when combined with official power (overseeing promotion, graduation, certification, TA status) results in a highly combustible and potentially corruptible organization, prone to alienation, revolution/rebellion or compliant identification. This power imbalance also cramps psychoanalytic knowledge, which ails from frequent newfangled fads, rather than systematic, disciplined reevaluations and progression. The nature of appointing training analysts, he argues, who oversee both education and treatment, results in coteries of fawning acolytes, adverse power dynamics in Institutes and distortion of scientific progress. His words are strong. How can we rethink our dilemma? Moreso, is there something systematic in our profession that feeds this ailment?

Shevrin’s approach is to look at the common features of any organization or institution, an approach productively used by Weber and by Goffman in his genius work, Asylums.

Yet, while organizations share common features, they also have identities that differentiate one from the other: a university, a corporation, the Department of Motor Vehicles all are organizations, but have features that differentiate them, an aspect of their identities. To some degree, knowing an organization’s identity helps guide us to how it is structured, who its members are and their relationships to each other: the university’s identity is developing and transmitting knowledge; the corporation, generating income; the DMV, licensing cars and drivers.

Let’s narrow our focus to identity. Kernberg, Richards and others have written about the question of our overall identity as an organization. For Kernberg, he looks at the range of external models: university, trade school, artistic enterprise and so forth. For Richards and Lynch, they look both historically at how psychoanalysis has evolved and systemically at how we function as a thought collective, using ideas from the sociology of science.

To keep this column need be brief, let’s laser-like focus on a peculiar feature of our identity, the (training) analysis and its inherent binds.

There are two binds in a good enough analysis: both are challenges for the analyst, one centers on the analysand, the other on the analyst (but for the analysand’s well-being). For the analysand, we build a framework to facilitate regression and temporary dependence. Freud’s early techniques — reclining on the couch, free association and related primary processes — remain fundamental despite all the changes in theory. Winnicott elaborated the idea of a state of dependency to facilitate regression (at times this went awry with some followers). But, paradoxically, an ultimate, an optimal aim of psychoanalysis is to foster autonomy: in Western life, since the Enlightenment and political revolutions, autonomy — self-rule — is highly valued. Erik Fromm described the next step in true freedom: internal self-rule (and its attendant responsibilities) in Escape from Freedom. (R. Paul’s paper presented at the Chicago IPA makes this cultural distinction from some Eastern perspectives that emphasize reverence for authority.)

The Analyst’s responsibility: to help the analysand get from here, to there, to an other there: from the initial states of mind, to temporary dependency, to autonomy. Autonomy is not abstract: the capacity for self-reflection, to self-regulate, to take a realistic sense of responsibility for one’s actions and further.

In a training analysis, psychoanalytic life gets far more complicated: a true regression makes the analysand very vulnerable; even if with no “reporting.” Further, autonomy may be limited by what the analyst or the Institute will tolerate. Too many outsiders have left because their ideas could not be tolerated within the thought collective (perhaps at times, rightly so). Not reporting training analyses is no panacea: one senior colleague (now a training analyst) recalls the following conversation when he sat in a stall of the Institute’s men’s room. Analyst One — on the progression committee – is at a urinal; Analyst Two enters, uses the facility adjacent. Analyst One, “”So-and-so” (in analysis with Analyst Two) applied for a second control case.” Analyst Two, “Really? I haven’t heard anything about this.” Both flush, leave, and the candidate’s progression goes down the tubes too.

But, what about the analyst; what’s the second bind? We expect the analyst to permit, to tolerate, to make safe the regression (in service of the ego) and dependency. But, we also hope, we should expect, that the analyst is sufficiently self-secure that (s)he will permit as full autonomy as the analysand can achieve. The analyst’s narcissistic vulnerability threatens autonomy. We recall that Kohut got his initial ideas about narcissism from watching his colleagues. One of Winnicott’s analysands, Alfred Flarsheim, remarked in supervision, “It’s O.K. for the patient to think I am god. Not good for me to believe that.”

Where’s does this leave us as an organization? External structures help: Shevrin, Richards, Kernberg make several recommendations. But, analysts value the internal, our psychic structure, the place where autonomy resides. Paradoxically, our personal and ongoing self-analyses need be sufficient enough that we feel sufficient gratification in our work, in our lives, secure within ourselves to permit analysands not only regression, but also movements toward autonomy. External structural changes, as suggested by Shevrin and others, are a safeguard; but our inner life is the stage where our analysands can play out the their scenarios and come to safe resolution. At the end of an analysis, the analyst need break his magic transference staff, like Prospero, and permit Ariel to go free.

Sex sells, still. Psychotic sex even better. And if you can screw psychoanalysis while reviewing a sex book, maybe improves the Amazon ratings. How’s this for an eyeball grabber:

“Slice them where you will, any collection of psychoanalysts is as mad as a parliament. Novelty beards, whirling eyes, twitches, deranged clothing, tics, jitters and habits you wouldn’t want to go into. But Wilhelm Reich (1897-1957) was the maddest of the lot”

That’s the opening to a review of “Adventures in the Orgasmatron:
Wilhelm Reich and the Invention of Sex,” by Turner.

Click Here to Read: Novelty Acts The sexual revolutions before the sexual revolution.by Ariel Levy in the New Yorkeron September 19, 2011.

Can you tolerate something unsexy by Reich? Or, how far can you read this piece on Reich’s classic, Character Analysis, if I don’t say “sex” hereafter (but will touch on psychosis at the end)?

A challenge reading Reich: one of my teachers, Al Flarsheim (analyzed by Gitelson and Winnicott in that order) said of his copy of Reich the following. Flarsheim tried to take a razor blade to his edition to “edit out” the psychotic sections from the gem of character analysis: couldn’t do it; the craziness imbricates with the genius.

I will select segments of the Character Analysis, not only for its historical value, this 1933 publication, but also to its relevance to contemporary psychoanalytic technique. There’s a challenge. Since this weekly column is brief, my hope is to catalyze rethinking character, possibly re-reading Reich, even without a razor blade poised above the page.

Freud set us on the path of character beginning with the 1908 anal character  (orderly, parsimonious, obstinate), then in his brief 1916 “Some character types met with in psychoanalytic work.” This is mostly a descriptive account of “The ‘Exceptions,’” “Those Wrecked by Success,” and “Criminals from a Sense of Guilt.”

But why “character,” not “personality” Emanuel Berman asked when I told him that I was teaching a course on character at the Hebrew University. Both words arise from the Greek, although “persona” migrated through Latin. In Greek, “character” means to be etched into; there is a permanence, a consistency about it. “Persona” in Greek were the masks that actors used to portray different roles; they can be slipped off, changed with the need. That is, character is something that is etched into our bones; wherever we turn (whether we are parent, child, teacher, analyst), character (if reasonably well-formed) stays recognizable. Persona (Jung’s preferred term) we can shift like our clothes — from suit to racing shorts; from high heels to Keds; from Alexander McQueen to L.L. Bean — depending on the circumstances.

For Reich, character is even embodied in how we walk, move, present ourselves physically, wordlessly: the forthright; the despondent; the proud; the humble; the self-assured; the mousey Milquetoast. Reich watches as we enter the office, how we lay on the couch.

He suggests several characteristics of character neuroses: lack of insight (versus the neurotic symptom, which is “experienced as a foreign body”); rationalizations of the character neurosis, as it is a “way of being” (as if the person were born this way; unalterably); and the character is armored, protected, against change, such as threatened by psychoanalysis. If this sounds a bit like everyone who enters analysis, then it is an example of “mission creep” that happens with other analytic schools, which may begin with treating a specific diagnosis, then extends this technique to many more, if not all diagnosis: Kohut’s initial ideas about treating narcissistic character was extended as a general approach to many other forms of adult work by Ornstein and others.

Reich introduces us to some character types: the hysterical, the compulsive, the phallic-narcissistic the masochist. The latter, masochism, is his most detailed account. He describes vividly how the form, the manner in which someone presents material is primary in grasping character; the content can be quite secondary, even distracting. He concurs with Glover and Alexander, who distinguish the symptom neurosis from the character neurosis, then suggests that most analysis involve character neurosis: the way in which one lives in, relates to the world and oneself, not simply specific symptoms.

Reich gives detailed process material to demonstrate how he judges when to interpret, what to interpret and how he works in psychic layers. In one vignette, he lays out before us five layers coexisting simultaneously in a session, in how the patient splays out his inner life. Then, Reich explains why he doesn’t speak to the deepest layers (t/he more infantile origins), rather to what he calls the character resistance — “a form of acting or reacting” — or what we may call the lively transference of the moment. Reich then shows how the infantile material unfolds once the transference (the character resistance) is interpreted. He also candidly gives a vignette where he interpreted the infantile origins of the material before speaking to the resistance — he calls this a premature interpretation — and how this resulted in an adverse shift in the analysand’s work.

We discern here, when Reich cautions against premature interpretation — that is, speaking to the infantile origins before the character resistance — a critique of Klein’s approach. While Reich does not mention her, what he says is consistent with Glover’s (Klein’s daughter’s analyst) and Schmideberg’s (Klein’s daughter) direct attacks on Klein’s style of interpretation. Perhaps Reich’s indirection and process notes are more persuasive.

By the early 1930;’s Reich’s more psychotic biophysical” approach begins to infest his character book. He begins to lay on hands in some cases (reminiscent of Freud’s early massaging of some hysteria cases). One can read the later editions of the Character book in the way that Freud read the Schreber case: it could teach us more about the development of a delusional system in a brilliant, tragic character than about treatment.

Bruno Bettelheim, a friend of Reich’s in Vienna, told me this story. After Reich was locked away in an insane asylum shortly before his death, Bettelheim went to visit. Reich said as Bettelheim entered, “So, you want to talk about the good old times or the crazy times?” Turner has written an entertaining book. He is not entirely convincing that it was Reich who imported s-x with his zinc and steel-wool lined and orgasmatron. Character is less sexy, but closer to our everyday concerns in the office.

Bragin’s recent IP.net post on combat veterans suggests a belated call for analysts to lace up their combat boots.  The Veteran’s Adminstration has the largest mental health system in the United States; psychoanalysts are a shadow presence. Prudence Gourgechon encouraged more involvement at the January American Psychoanalytic Meetings.

This contrasts sharply with psychoanalysts engagement and dedication in WWI and WWII.  Simmel in WWI saw thousands of “shell shocked” soldiers and ported that information back to Freud and colleagues, influencing our initial ideas about trauma and mourning.  In WWII, Kardiner, Grinker, Spiegel and others were officers in the US Army and joined our men at battle.  Grinker, (one of my teachers), was analyzed by Freud, and developed the first effective treatment for acute stress disorder.  Grinker and Spiegel’s Amytal interviews are an extension of Freud’s early abreaction work.  These psychoanalysts returned to the U.S. with great credibility from  their scientific discoveries, clinical acumen and earned both military and societal respect.  They saw men at the front, most with diagnosable mental ailments; some not. And the soldiers saw these psychoanalysts who ventured from behind the couch to care for them at times of great pain and need: not just “care,” but return them to functional lives.

Further, these psychoanalysts’ involvement with the military extended analysts’ commitment to society. Aichhorn ran the streets with his delinquents (and influenced the early pioneers such as Anna Freud, Peter Blos Sr., and Erik Erikson). Erikson, to learn about the Sioux and Yurok, lived among them.  Anna Freud brought Jewish orphans from Theresienstadt and cared for them.  Fraiberg set her infant-parent program amongst the most indigent communities in Michigan and later in San Francisco.  More recently, Twemlow, seeking to decrease youth violence, succeeded in the most violent schools in Jamaica; Natti Laor, during the second Lebanese War, when one million Israeli refugees fled the North, moved his staff and clinic from Tel Aviv to Haifa and surrounding bombed villages; they migrated against the stream, closer to the war, closer to those in need.

Analysts carry valuable knowledge about inner life.  We construct a refuge in our offices as part of our analytic frame so that we can ease the difficult work of our analysands.  But, this analytic frame is also a frame of mind; a manner of listening. When I interviewed Israeli elite soldiers, several expressed surprise that so many were willing to talk with me  —  even confide — and recruit buddies. We can carry this listening and absorption outside the office to engage those in other settings.  This is another way both to serve society and to strengthen our presence in society’s mind.

Meeting the soldier near the front, listening to those who are too stoic or not culturally prepared to come into an analyst’s office also increases our truer knowledge of the inner life of soldiers.  Jonathan Shay has written two compelling accounts of the mental flotsam from the wake of Viet Nam washed up on American shores: Achilles in Vietnam and Odysseus in America.   He is not an analyst He did not work in the battlefield; he interviewed those men who came to the V.A. severe PTSD program.   Yet, his accounts come closer to the soldier’s soul in distress.  Shay’s work was well-received in the U.S. Army War College and by the Secretary of the Navy.

Analysts extend our understanding of the frontiers inner life by exploring them not only in our offices but also outside; we learn more about the vicissitudes of inner pain and how to ameliorate such suffering.  In such settings, we are stripped bare: we have no office, no stance behind the couch. In some ways this work is closer to working children and adolescents: they see us face-to-face, demand, hope and also battle against their hopes.

Stepping into the public arena, into the lives and settings of soldiers, strengthens our credibility as clinicians and scientists. But, there are other ways to learn about soldiers’ inner lives, such as asking them to speak to us.  A former student at the Hebrew University, Amit Goldenberg, was a member of Special Forces. For his Bachelor’s thesis, he interviewed all the (surviving) men in his unit: none had ever spoken to a psychotherapist; none planned to. But, all spoke with him; he is one of them. His findings are heart-compelling (and earned him an honors degree). He is now a journalist and has finished his first novel. He has agreed to write something about what he has learned for IP.net.  I hope that this is the beginning of a lively dialogue between analysts and soldiers, between ourselves and society.

I presented this in San Francisco June 2011 at the American College for  Psychoanalysis with Paul Ekman. There, our work was well-received. (In fact, Dr. Ekman was invited to teach for the day.)

But this paper has been hibernating for two years. Then, I wrote what I thought was a straightforward summary of Emotions research, a field birthed by Darwin, but empirically developed by Paul Ekman and colleagues. I’ve known Paul first as colleague, then dear friend since 1996. After years of discussions both about his research and later watching his meetings with the Dalai Lama, I thought it wa time to summarize and present the implications of emotions research for psychoanalytic work.

Emotions researchers are like physicists who work on the basic laws of the universe: analysts are closer to engineers who try apply the rules of physics to improve our lives.

Or, emotions researchers are like basic scientists in medical school; analysts, the docs who apply new knowledge. Of course, sometimes, the engineers or clinical docs participate in new discoveries or question old ones.

Yet, I found that analysts were either not knowledgable or even opposed to findings of four decades of empirical work on emotions. Emotions researchers have established basic facts about discrete emotions — such as happy, sad, angry, fear, disgust, contempt: they are universal (across cultures, as Darwin hypothesized), that we have micro expressions which conceal and reveal our true inner states. These scientists have a consensus about these basics and have shown physiological (including fMRI) correlations. Further, their work is accepted and applied by the U.S. Defense of Defense in wartime, the CIA, the French and British secret services and the Mossad. Even Pixar used their work to make their characters more “human.” Yet, I found that psychoanalysts are either unacquainted or even contest their findings. This opposition does not bother emotions researchers (nor the CIA, the Mossad nor Pixar); it should bother us. If emotions are not cross-culturally universal, then we do not have a common language about them; if they are universal (as these researchers have established), then, at some level, ” Alle Menschen sind Brüder ,” we are brothers (and sisters).

 I present this here both to inform and to raise discussion about this research in a related  field — emotions research — that should be integrated into our thinking and clinical work and training on identifying emotions in practice: both one’s own and one’s analysand’s.

Nathan Szajnberg
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Emotions Concealed and Revealed: Contributions to a Common Ground in Psychoanalysis

Nathan Szajnberg, MD (Presented in San Francisco June 2011 at Am College for Psychoanalysis)

 Emotions, a core concept for psychoanalysis, has been studied avidly by Paul Ekman and colleagues for more than four decades. Yet, its empirical study was initiated by Charles Darwin (1872). I review the researchers’ fundamental contributions, particularly 1) the universal expression and interpretation of basic emotions, 2) the presence of fleeting microexpressions, and 3) non-conscious attempts to cover-up emotions. Then, I present objective assessment of emotion recognition accuracy for several basic emotions, and discuss the implications of this work for psychoanalytic training and practice, such as accurately reading both one’s own and one’s analysand’s emotions as a component of empathy. If a fundamental area of practice is along the transference/countertransference continuum, then improving candidates’ (and our) emotional accuracy within this continuum is both desirable and feasible. Improved accurate emotion recognition, like playing on-key for a musician, is one approach to a “more transparent assessment of psychoanalytic competence…” (Tuckett, 2004). This offers a bridge to an adjacent and potentially collaborative, discipline, emotions research.

Infrequently, studies at the fringes of psychoanalysis become woven into our fabric, enriching its pattern. For instance, attachment research — although founded by Bowlby, a psychoanalyst — was carried into an almost forty year productive “exile” by academic psychologists such as Ainsworth, Main, Waters and colleagues. Recently, psychoanalytic researchers recaptured and applied attachment theory to psychoanalytic thinking (Fonagy, 2001). Attachment theory may guide transference technique (Szajnberg and Crittenden, 1996).

Here, we view another such cloth woven outside of psychoanalysis: Paul Ekman and colleagues’ four decades’ work on emotions. The aim: to explore its application to training and clinical work. Emotions is one common tapestry covering psychoanalytic ground, a juncture where psychoanalytic cultures may meet (Wallerstein, 1990, Green, 1999). This is only an introduction to the idea of emotions as a common area of clinical discussion, an introduction to assay its usefulness in daily clinical work and collegial dialogue. Linking psychoanalysis to emotions’ research serves at least three functions: 1) it gives a basis for a more universal language of discourse; 2) it returns us to the more bodily experiences and origins within which emotions are embodied and from which we have been estranged (Stern, 1985; Green, 1999); 3) it offers a more objective platform for candidate training and evaluation (Tuckett, 2004).

To begin, we need a common vocabulary, a challenge as we move across the many languages of psychoanalysis.

Darwin emphasized emotion expression, focusing predominately — for humans — on the face, with which Ekman began his studies (Darwin, 1872; Ekman, 2003). Here is Ekman’s working description of emotions: ” … a(n) automatic appraisal influenced by our evolutionary and personal past, in which we sense that something important to our welfare is occurring… set of physiological changes and … behaviors … (begin to) deal with the situation …. We… use words when emotional, but we cannot reduce emotion to words.” (Ekman, 2003).

Ekman articulates six qualities of emotions’ mental state. It is
1.a signal that “lets others know what is happening inside us” (2008, p. 37); which is
2. “triggered automatically in under a quarter of a second.. (during which it is) totally opaque to consciousness ”;
3. we are typically not aware of our emotions as they occur;
4. other animals have emotions (40);
5. emotions are short-lived (as brief as a few seconds), unlike moods; 6. Each emotion has a set of sensations.

Further, emotional arousal has individual-specific profiles — onset rise, idiosyncratic duration and a refractory period — during which we “read” our environments through the lens of that emotion. In the refractory period following fury, for instance, it may be difficult to perceive affects or entreaties other than anger (p. 47 ff.) (In psychoanalytic terms, an overwhelming experiencing ego interferes with observing ego.) This “profile” — rise, duration and dissipation — has the conformation of a volcano, but with durations that vary for each phases depending upon the individual. Intriguingly, for an individual, the emotional profiles of anger, fear and anguish are similar. Profiles can vary across individuals with more rapid or gradual rise in onsets; shorter or longer durations and variable lengths for dissipation of emotions. Individuals with, for instance, more explosive onsets of negative emotion, appear to be more resistant to reconfiguration of their more impulsive emotional onsets (Ekman, personal communication), a finding with implications for clinical work and familiar to those who work with severely borderline characters (Giovacchini, 2000).

That is, emotion is a signal, an automatic quick appraisal of what is happening, that “lets others know what is happening inside of us“. One must develop the skill to gain consistent consciousness of emotional awareness (both of self and others); emotions are not unique to humans and involve physical sensations. (Dalai Lama and Ekman, 2008, p 40).

In psychoanalytic literature, we are challenged by the variegated, even contested
meanings for “emotion” terms both across languages and even within language. In German, Freud used Affekt, Empfindung, and Gefuhl (LaPlanche and Pontalis, 1973). Strachey’s confounding English translations are: Empfindung is “feeling” or “emotion”; and Gefuhl is “feeling” or “emotion,” with Affekt usually translated “affect.” Even Freud complicates: when he wrote “Obsessions and Phobias” in French (1895), he translated Affekt as the academic sounding “etat emotif,”; this is later translated into English as both “”affect” and “emotion.”

In French, Green discusses the dilemmas of translating Affekt (1999). He describes two categories of terms connected with “feelings.” First, those words close to “affect”: Affecter (to affect), affectif (emotional), affection and affectivite. Second words with progressive gradation of tone: “When dealing the emotional life, the French … usually distinguished … emotion, an acute transitory state; sentiment, a more attenuated, more durable state , and passion … violent, profound and lasting.” (Green, 1999).

LaPlanche and Pontalis (1973) ground us with psychoanalytic terminology and translations. They define “Affekt” as “any affective state, whether painful or pleasant, whether vague or well-defined and whether .. a massive discharge or … general mood. According to Freud, each instinct expresses itself in terms of affect and… ideas (Vorstellungen).”

In fact, Freud’s distinction between affect and ideas fits closely with what Ekman and colleagues were to confirm about Darwin’s theory about universal emotions and how emotions and ideas are separable: while emotions are universal, the ideas that evoke them
may be culture-specific, as Ekman comments in the re-issue of Darwin’s Expression of Emotion in Man and Animals (Darwin, 1998).

Etymologically, Emotion comes from emotionem, “to move out.” Listen to both emotion’s archaic and contemporary definitions. “1. A moving out, migration, transference from one place to another (obsolete) (author’s italics); 2. a moving … perturbation in a physical sense (obs.); 3. A political or social agitation… 4. Any agitation or disturbance of mind … any vehement or excited mental state; (b) a mental “feeling or affection” (e.g. of pleasure or pain … etc…) as distinguished from cognitive or volitional states …”

When Ekman and the Dalai Lama first approximated a common working concept of emotion (lacking a Tibetan term), it was this sense of “being moved” (for better or worse) that worked (Dalai Lama and Ekman, 2008) (3).

Here, we use “emotion” rather than “affect” for two reasons. First, “emotion” is the researchers’ term; second, “affect” has such a rich, variegated, and voluminous scientific literature; even summarizing the latter would be onerous.

Further, I focus on the discrete emotions – such as sad, happy, angry — rather than what Stern calls vitality (1985) — such as lively, phlegmatic, zest, although we will return to this in connection with some of Ekman’s early work on gesture and deceit. (4)

Emotions Revealed

Ekman made two major discoveries about human emotion. First, he demonstrated definitively that emotions are universal, as Darwin theorized. Second, he described micro-expressions (both facial and gestural) — brief, emotional displays that generally occur out of our awareness, particularly in moments of (self- and other-) deceit.
Darwin suggested that we have evolved eight emotions: happy, sad, angry, disgust, contempt, reflection, surprise and shyness (Darwin, 1998). But by the mid-twentieth century, cultural anthropologists such as Margaret Mead, argued against the idea of universal display of emotions.

Ekman took on the challenge of emotions’ universality/cultural specificity in the early 60’s. He chose and studied a remote tribe in New Guinea, who had no exposure to photos, television or film (5). Natives could identify at least six affects in the same manner as Westerners: happy, sad, disgust, anger, surprise, fear. In years of ongoing studies of facial expression alone, Ekman confirmed and revised these findings. Culture does not determine the expression nor interpretation of most emotions (6) . However, disguise or attempted suppression of certain emotions are culturally-influenced: Japanese in the presence of an observer try to suppress anger (with a tight, obicularis oris “smile”) in contrast to Americans. Yet, Japanese sitting alone (being filmed via one-way mirror), do not suppress anger or disgust.

Further, Ekman described a series of additional emotions for which we may not have words in English, but recognize emotionally: for instance, Schadenfreude (the “pleasure” we may take in someone’s downfall), or the Italian, fiero, the pleasure we take in having achieved a difficult goal, or the Yiddish, naches, the pride we have in the achievements of those we love. While we may not have simple English words, most people can identify the feeling state.

We have EEG and Galvanic Skin Response evidence of emotion, before we are conscious of it (Emotions Revealed, Ekman, 2005) While much of his early work focus on facial expression, he also pioneered work on gesture and emblems (8) (Ekman, 2005; Goffman, 1990), which are much more culturally determined –as Darwin predicted
(Darwin, 1998). The latter research is being applied to anti-terrorism efforts, precisely because facial expression (and physiology) of emotions are so rapid and more difficult to suppress.

Ekman’s second major discovery is micro-expressions of emotion and deceit. Patients who in fact were suicidal (unknown to the interviewer) and were trying to suppress the information, made gestures or had brief facial micro-expressions (lasting about 1/25th of a second) revealing an attempt at cover-up (9).

Telling Lies (Ekman,1985), gives detailed examples of facial features of micro- expressions associated with deceit (asymmetries of facial expressions; eyebrow shifts), and gestural features, including that such gestures are generally made outside our usual “frame”: that is, between the neck and waist. He disproved previously held ideas about deception-revelation, such as “neurolinguistic” gaze aversion: this doesn’t work reliably. In addition, he and colleagues demonstrated the inaccuracy of lie detectors: trained humans do better. His work is reminiscent of Erving Goffman’s The Presentation of Self in Everyday Life, but with greater detail. “Lies” or deceit are more difficult to cover when the issues are emotionally more charged. (10) One can also use this method to determine when people tell the truth (Ekman, 1997).

Recently, Ekman and colleagues have expanded work on negative emotions, working with Tibetan Lamas, celibate men who have meditated daily for several decades. They have mastered a form of internal scanning to monitor and control emotions. One finding will be presented here. During EEG and physiologically monitored experiments in a laboratory, while the Lamas were exposed to adverse experiences, they showed initial EEG evidence of negative emotions, such as anger; this was quickly squelched electroencephalographically and before the Lamas could become conscious of the emotion (Lutz et. al., 2004). Ekman, their recent book, speculates that someone who has focused on controlling (via meditation) usually-unconscious (or preconscious) act, such as breathing, walking or eating, may also be able to extend this radar-like screening for “incoming missiles” of negative emotions, thereby foreshortening the overt response. Whether this is closer to suppression or repression needs further study.
Read my lips (and my brows and my cheeks)
Even limiting our study of emotions to facial expression, matters are not simple. Professionals whom we would expect to read hidden (facial) emotions accurately, do no better than chance (psychologists, police, judges, and others, except for the C.I.A.). The research group has devised a computer program to assess, then train viewer’s accuracy on reading facial expression of emotion (Microexpression Training Tool; METT-2, 2008) (11). For instance, a senior psychoanalyst achieved 84% overall accuracy on pre-training for micro-expression of seven emotions; but, he ranged from 75% on three emotions to 100% on four. After reflecting on his inner inhibitions to more accurate perception of these three emotions, he took the 30-40 minute training session and achieved 100% accuracy on all seven emotions. That is, a trained analyst did not achieve enhanced accuracy on reading facial emotions until examining why he missed certain emotions, then training up to improve performance.

The METT-2 measures accuracy of reading only seven emotions. In analysis we deal with many more and with combinations and without reading the face. How much more challenging, how much more expertise in both reading oneself accurately (including blocks against reading certain emotions) and reading the analysand accurately; all this before we can be prepared to make an observation, let alone an effective interpretation. Imagine, for the moment combinations of emotion in the consulting room: the tears of joy or relief; the mix of anger and contempt (the only unilateral facial expression of emotion); the laughter in a moment one expects sadness.

Here are several considerations for psychoanalysts from Ekman’s findings. Why do people tend to miss certain micro-expressions, particularly deceit or negative emotion? In general, we elide, edit-out, quite simply miss these clear signals in order to maintain a sense of believing the speaker, or sustaining politesse. An extreme example of this is a study of Munchhausen’s-by-Proxy, where there is a long line of professionals who “miss” life-threatening abuse. Szajnberg et. al demonstrated that when two observers are present, with one interviewing the known perpretrating mother, the engaged observer does not believe that the mother is guilty, an as-if personality inducing countertransference confusion (Rusakow, et. al. 1993; Deutsch, 1942). But, analysts can extend this work on self-deceit, using our understanding of repressed unconscious, whether due to wishes, phantasies, fears, representations, or signifiers. Emotions research simply sharpens our ability to notice when self-deceit occurs; the analytic work then pursues the why and what is being held back.

Our work is enriched (both complicated by and enabled by) gauging emotions via gesture, body shifts, vitality emotions, vocal prosody and of course, words, including whether the content fits the tone (as in irony or sarcasm). Our personal analyses prepare us to read ourselves more accurately; evenly hovering attention, or reverie (Ogden, 2005) gives us breathing space within which to attend to both our emotions and what is evoked in us during our work. Words in particular, as Stern suggests in his developmental study of self, may distance ourselves from our earlier selves (1985, 2005).

Analysts may be concerned with patients deceiving us about emotions: however, our greater challenge is self-deceit (the analyst’s and the analysand’s), particularly if this is
unconscious. At those moments, we need be more accurate about “reading through” the self-deceit and re-presenting this to the analysand.

For example, a young mother in analysis had for some weeks complained about her intrusive, jealous and denigrating mother-in-law. The analysand recognized her anger. But, as we listened, there was a tone of quiet terror in her voice, one familiar from earlier in her long analysis. When the analyst mentioned that there seemed to be also a tone of fear, she silenced, then whispered, “She gets under my skin.” This, we both knew, referred to early molestation by a relative. The anger had been present and more conscious; but it was the terror intruding into the present that evoked past fears.

In more familiar analytic terms, one of our basic analytic tools is empathy (Einfuhlung — “feeling into”). As such, we need be as accurate as possible at identifying the patient’s feeling (Gefuhl) into which we are trying to feel.

Child work is more face-to-face. Child analysts learn to read the child’s face, body, posture, gesture, in order to understand the child’s feeling states. While E. James Anthony wrote of trying to achieve the ideal “sessile position” (Anthony, 1977) for the analyst — trying to stay seated for much of the session — most of us know the bodily feeling of tuning our physical responsiveness to the child’s cues. (Paradoxically, child work may be more challenging, in that it permits the analyst less time, less space to guage what is happening with emotions.) In this sense, reading and responding to children’s feelings brings us closer to Freud and Hoffer’s concept of the first ego as a body ego — and that body ego endures, Piaget suggests, as a framework for all earlier phases of cognitive development (Piaget and Inhelder,1969) and Stern for self development (1985).

After laying-out the apparent simplicity of Ekman’s study of the basic emotions, I have layered and imbricated the complex challenges we face: psychoanalytic work on reading,
feeling, responding and interpreting emotions — both our own and the analysands — over the course of an hour, and over an analysis.

What Does this mean for Psychoanalysis?

So what? Some analysts argue that all work done outside the consulting room, outside the frame of transference/countertransference is irrelevant to psychoanalysis (Green, 20005). But, let us think further.

When Wallerstein asked whether we could find a common ground in psychoanalysis, a meeting place, an agora, where we can join in discussion, find a common ‘language,’ he did not stop at this appeal. Rather, he proceeded, using consensus from international colleagues, to find: that we can agree that “character” is a major clinical focus in psychoanalysis; that we hope and work for change in troublesome aspects of character; that we can come to reliable agreement about seventeen aspects of character. (12) He first achieved reliable cross-cultural agreement about seventeen aspects of character. Then, Leutzinger-Bohleber and colleagues (2003), in a landmark study, demonstrated that character shifts post-psychoanalysis could be documented. That is, we have the ability, should we desire, to discuss character as a phenomenon about which there may be consensus. (13)

Here, we try to present another area of consensus: emotions and their embodiment. Emotions are the same across cultures. This we share. What differs culturally to some degree is what ignites certain emotions and, to some extent, which emotions do certain cultures try to suppress (or emphasize). In the first case, we know from Ekman’s work that specific events also universally elicit certain emotions. Shown a sad face and asked to tell a story about what might cause this expression, the New Guinea stone-age man
cites the death of a child, maybe a wife. But, other emotion elicitors are culture-specific: shown a face displaying disgust, this same man will describe coming across a rotting boar in the jungle: while we may understand the look and smell of disgust, few of us would cite spontaneously boar putrifaction as a disgust evoker. Skewered, roasted scorpions in a Beijing street market evoke lip-smacking among natives and disgust among (some) visitors. As usual in matters human, things are not so simple. This is an example of how ideas (roasted scorpions) may evoke different emotions in different cultures, an elaboration of Freud’s distinction between emotion and idea mentioned earlier.

Another significant objection: Ekman’s observations are on facial expressions; how is this relevant to adult analysis: we don’t use faces to assess emotion?

At least two responses: first, the face is perhaps our most articulate instrument of emotion expression to others (Darwin, 1998; Ekman and Rosenberg, 1997). This makes evolutionary sense: well-muscled, well-vesseled, the face is built to “tell” others what we feel, and do so rapidly, efficiently and (perhaps unfortunately) despite ourselves. Developmentally, this is certainly true: infants express basic emotions (such as happy, sad, disgust, fear, surprise) well before they have the words to say it. The face is but an expressor of the feelings within; psychoanalytic technique is built upon transforming both feelings and thoughts into words. The process of this transformation alone may be therapeutic, shifting us towards greater symbolization, literally towards better articulation. Psychoanalysts care most about the emotions, not the muscles of the face nor the blood-vessel nor the galvanic skin responses associated with the feelings. We learn from Ekman about emotions, not simply what “facial action systems” are being activated. In fact, one of his most technical books is entitled, What the Face Reveals (Ekman and Rosenberg, 1997), emphasizing that the subject here is emotions not grimaces. Put
simply, to describe Ekman’s research as only about facial expression, is like describing psychoanalysis as only about “words”: both settings — emotion research and psychoanalytic research — use the best available signs to guide us on the roads and the detours of inner life.

Second, while Ekman grasped that the face, our physiology, gesture and emblems.(14) One of Freud’s major contributions is to show the deep correspondance between our inner lives and our bodies; Erikson’s elaboration of Abraham’s ideas about development can be understood as how our psyche makes sense of the changes in our bodies, at least through adolescence (and then into pregnancy and senescence). Frankly, at some level, learning from Ekman about bodily articulation of emotions brings us back to our psychoanalytic, bodily origins. This paper does not imply that analysts need learn or use physiological measures to understand emotions: quite the contrary, Ekman’s overall aim is to permit us to read ourselves and others more honestly and accurately in vivo. Ekman’s oevre is about emotions, not simply faces, nor even gestures.

Emotions Heard and the Present Moment

Words help interpretation, how we transmit what happens in the consulting room, between analysand and analyst, within our minds. But, as Stern demonstrated (1985, 2005), prosody — the sing-song, the sine waves of our voice — underlie words. Stern demonstrated a logic of prosody with parents and infants. When a mother asks, “You hungry, tired?” she does so with uplifting half sine waves. To quiet or reassure, mothers use descending half sines, “That’s O.K. Mommy has food for you. O.K., O.K.” And when mothers recite and want to keep the baby’s attention, a serious of continuous full sine waves emit: “Yessss. We’ll get dressed, then the stroller, the with auntie Lily we’ll go the park and watch the swans….” This is early. Babies begin their “speech” before words with sing-song. So too, to some degree we hear this in our voices or our analysands. Imagine for a moment giving an interpretation in a flat monotone. Prosody too can be somewhat cultural: when we were studying affect attunement among mothers and infants, we found that the attunements tended to be more toned-down among British Isles mothers as opposed to American-Hispanic (Stern, personal communication). Or, in the U.S., a Minnesotan’s statement of fact may end in an upward cadence; this is heard as an interrogatory along the Northeast, lending a touch of ambiguity in a Manhattan analytic office.

Prosody is connected with feeling-tone, part of what Stern called “vitality affect” — liveliness, enthusiasm, phlegmatic, calm — as opposed to the “discrete affects” about which we have a more familiar vocabulary (sad, happy, angry, etc..) and unlike mood, which has a longer-duration quality (1985). While this paper focuses on the more discrete emotions, we don’t ignore the degree to which daily speech transmits, via prosody for instance, feeling-tones that explicitly or implicitly slip into our consciousness or unconsciousness. Freud (1915, p 194) asked how the unconscious of one person reacts to that of another “without passing through consciousness.” Prosody, the feeling-tone, the emotion, let us say of the music beneath the words may be one route. Robert Pinsky described poetry writing and reading as a very physical act (Pinsky, 2008); perhaps so too there is a poetry of the soul that we call psychoanalysis. Stern, in The Present Moment (2005), painstakingly elaborates how we can construct meanings from a three to ten- second episode in the consulting room, provided we attend to the feeling tones and the content of what is said. Psychoanalysts can extend Ekman’s findings on discrete emotions with Stern’s elaboration of vitality emotions to help identify more clearly what is going on in the session — within the analyst, within the analysand and between them.
A first step — this is the intent of this paper — is that we more accurately identify the emotions hovering in the office.

Freud’s three criteria for a decent interpretation are almost Aristotilian: content, timing and delivery (1915). Delivery includes the emotional tone beneath the words, how they are borne. This vocal tone is related to Stern’s study of prosody and vitality, the sing- song beneath or even delivering our words. this sing-song is closer to the body physicality of feelings, as is true of poetry (Pinsky, 2008). We embody our words with feelings; our feelings are very much embodied.

What is true of interpretation may be true of the analysand’s own interpretations or observations. For instance, the words of this analysand following the birth of her first child, when read, may partly explain the analyst’s reaction; when heard, they are clearer: “I would not have lived long enough to become a mother without my work with you,” said by a woman some 15 years after beginning five times weekly treatment at seventeen with an extensive delusional system, self-cutting, self-burning and eating-disordered. The reader can imagine the prosodic, whispered but felt tone of the sentence that resulted in the analyst feeling a poignance, touched with inner tears. Freud, a man of science, insisted (1915, p. 168), “No physiology.. or chemistry can give us a notion of (latent states of mental life).” But, the emotions that evoke the physiology may begin to explain, particularly as we can connect them with mental content (Vorstellungen). Ekman’s work, particularly when collated with Stern’s dissection and exploration of what occurs in a consulting room in a tree-to-ten second exchange, gives us purchase on how to teach the more abstract phenomenon “empathy” in more discrete steps, such as learning how to read our universal emotions.

Here is an example of this brief “present moment” and the opportunity that evenly hovering attention offers us to read ourselves. This example will sound familiar to many analysts. At the end of a session, in which the analysand — with a long history of borderline traits — continued to talk, then spent time gathering her belongings, then folded the Matisse blanket on the couch, then fluffed the pillow. Finally, she turned to the analyst and said coldly “You hate me!” (Winnicott, 1977). The analyst realized that he felt irritated (that the patient ran over and he had a young child waiting to see him), but did not feel hatred — a different set of sensations than irritation. He could tell this woman that he was irritated that she delayed leaving, but did not feel hatred towards her.

We have a common felt vocabulary. That is, identifying discrete emotions and how we try to both suppress and reveal them facilitates our work. Because our emotions are universal — the analyst in Argentina understands fully well emotions such as joy, anger, sadness, even awe, as does the analyst in France, America or Germany, even if the word representations are different — “joy, alegria, joie, Freude“. When we listen, we also hear emotion, we even may feel it.

A Training application: a transparent assessment of clinical work
Tuckett’s article, “Does anything go?: Towards a framework for the more transparent assessment of psychoanalytic competence” (2005) is a disciplined attempt to find methods to assess candidate clinical ability in a pluralistic field. His group evolved three areas of consensus to assess ability: 1. participant-observer stance; 2. conceptual framework that is not over-intellectualized; 3. interventional frames, which include emotional tone, coherence and non-intellecutalized intervention. Tuckett’s group assessed balance of the analyst’s interpretation’s affect/intellectual illumination and “appropriate emotional tone.” Knowing that emotions are universal, means having greater agreement about reading and assessing emotions, including emotions denied or hidden.

Emotion reading is done quickly, done often. Yet, ironically — from Ekman’s work and from our rich clinical work — emotions may be missed or misinterpreted. In Telling Lies (Ekman, 1985) and “Why don’t we catch liars,” (Ekman, 1996), he showed that we often miss subtle, but present signals of “deceit”, particularly in intimate situations for various reasons: to “protect” the relationship rather than see, hear, feel the true emotions expressed. We expect psychoanalysts to be experts in reading such (self)-deceit; it is the substance of our clinical work. Yet, emotions researchers have shown the that psychologists, among others, are not so adroit at reading “deceitful” emotions. How do we help the analysand have a true reading of oneself, not continue to live with a predominately false self, rather, to be and feel as true to ourselves as humanly feasible? The psychodynamic reasons for self-deceit in particular, can be multiple; but these can be pursued only after we are better able to read the underlying emotions.

This paper leans on emotions research to suggest basic forms of clinical supervision and training closer to Stern’s method in the Present Moment (2005). But, rather than Stern’s recounting and reconstructing the internal events that occurred over a three to ten second “present moment,” we focus on identifying the emotions present in the consulting room — both those in the analysand and those evoked in the analyst. With defensive processes, we would anticipate and analyze more surface “deceits” and the underlying emotions. In a sense, this would be a form of analyzing false social and true selves, using emotions as markers (Winnicott, 1974; Giovacchini, 2000). We could use the emotional profile (for instance, reaction formation overlaying anger) as a road to identify, explore and explain the multiple false/true selves with which we live (Giovacchini, 2000). This
brings us closer to emotional empathy, that subjective phenomenon, which now can be more objectively identified.

Others — including Bion (2005), Ferro (2009) — have explored the transformation from emotions to thoughts: this goes beyond this paper, which is an appeal to begin with basic emotion recognition. We can have greater certainty about teaching the transformation from emotions to thoughts, once we have some consensus about identifying the emotions in the consulting room. Further, embodying emotion raises the further exploration of the traumatic origin of cognitions and fantasies about the reason for our suffering. This extends beyond the fundamental aims of this paper.

Returning to Tuckett’s challenge — finding consensus on judging clinical work — psychoanalysts could agree upon reading emotions accurately, one’s own and one’s analysand’s. This ability is very basic, like singing on-key for a performer. Reading emotions well should lead to clarity. This would be one among other aspects to assess the quality of clinical work, such as: those outlined by Tuckett; the consensus about character structure demonstrated by Leutzinger-Bohelber and Wallerstein et. al.; assessing the transference/countertransference via attachment (Szajnberg and Crittenden, 1995; Fonagy, 2001). Of course, accurate emotion reading is not just to assess candidates’ abilities; it is part of our daily work. Assessing, reading, feeling emotions accurately — particularly those which are hidden form ourselves or mixed with other emotions — is where we can have more grounding in the bodily origins of our emotions, and agreement across cultures, in our “body analytic,” our pluralistic psychoanalytic “cultures.”

Anthony, E. J. (1977). Nonverbal and Verbal Systems of Communication — A Study in Complementarity. Psychoanal. Study of the Child, 32: 307-25.
Bion, W. (2005). The Tavistock Seminars. London: Karnac
Boyer, L. B. (1989) Countertransference and Technique in Working with the Regressed Patient: Further Remarks. Int. J. Psychoanal., 70: 701-14.
Dalai Lama and Ekman, P. (2008). Emotional Awareness: Overcoming obstacles to Emotional Balance and Compassion. Henry Holt.
Darwin, C. (1998) The Expression of the Emotions in Man and Animals. Oxford.
Deutsch, H. (1942). Some Forms of Emotinal Disturbance and their Relationshiop to Schizophrenia. Psychoanal. Q., 11: 301-21.
Ekman P and Freisen, W. V. (1969). Nonverbal leakage and clues to deception. Psychiatry, 32, 88-105.
Ekman, P. (1985). Telling Lies: Clues to Deceit in the Marketplace, Politics and Marriage. NY: Norton.
Ekman, P. (1996) Why don’t we catch liars? Social Research, 63, 801-817.
Ekman, P. (1997) Expressive Behavior and the Recovery of a Traumatic Memory: Comments on the Videotapes of Jane Doe. Child Maltreatment 2:2 113-116.
Ekman, P. and Rosenberg, E. (1997). What the Face Reveals. Oxford.
Ekman, P. (2003) Emotions Revealed. NY: Holt.
Fonagy, P. (2001) Attachment Theory and Psychoanaysis. Guilford.
Ferro, A. (2009) Transformations in Dreaming and Characters in the Psychoanalytic Field. IJP. 90: 2; 209-30.
Freud, S. (1926). Inhibitions, Symptoms and Anxiety. SE. XX. p. 77-178
Giovacchini, P. (2000). Impact of Narcissism: The Errant Therapist on a Chaotic Quest. NJ: Aronson.
Goffman, E. (1990). The Presentation of Self in Everyday Life. Penguin
Green, A. (1999) The Fabric of Affect in the Psychoanalytic Discourse. Routledge.
Hoffer, W. (1950). Development of the Body Ego. Psychoanal. Study of the Child, 5: 18-23.
Laplanche and Pontallis (1973). The Language of Psychoanalysis.
Lasch, C. (1979) The Culture of Narcissism: American Life in an Age of Diminishing Expectations. Warner.
Leutzinger-Bohleber, M., Stuhrast, U. Ruger, B. Beutel, M. (2003). How to study the quality of psychoanalytic treatments and their long-term effects on patients’ well -being: A representative, multi-perspective follow-up study. Int. J. Psycho- anal. 84: 263-90.
Levenson, R. W., Ekman, P., & Friesen, W. V (1990) Voluntary facial action generates emotion-specific autonomic nervous system activity. Psychophysiology., 27, 363-384.
Lutz, A. Greischar, L. Rawlings, N Ricard,M and Davidson, R (2004) Long-term meditators self-induce high-amplitude gamma synchrony during mental practice PNAS Nov. 16, 2004 vol. 101 no. 46.
Ogden, T. (2005). This Art of Psychoanalysis: Dreaming Undreamt Dreams and Interrupted Cries. New Library of Psychoanalysis.
Piaget, J. and Inhelder, B. (1969) The Psychology of the Child. NY; Basic.
Pinsky, R. (2008). Memory and Modernism. J. Amer. Psychoanal. Assn., 56: 1081-7.
Rostovtzeff, M. (1963). Greece. Oxford.
Rusakow, L., Gershan, W., Bulto, M., and Szajnberg, N. (1993). Munchausen’s Syndrome Presenting as Cystic Fibrosis with Hemoptysis. Pediatric Pulmonology, Vol. 16:326-329.
Szajnberg, N. and Crittenden, C. (1997). The Transference Refracted Through the Lens of Attachment. J. Am Acad. of Psa. 25: 3, 409-438.
Tuckett, D. (2004) Does Anything go?: Toward a framework for the more transparent assessment of psychoanalytic competence. IJP 86: 31-49.
Wallerstein, R. (1990). Psychoanalysis: The Common Ground. Int. J. Psycho- Anal. 71: 3-20.
Wallerstein, R. Dewitt, K. Hartley, D. , Rosenberg, S. Zilberg, N. Scales of Psychological Capacities. Unpublished MS.
Winnicott, D.W. (1977). Maturational Processes and the Facilitating Environment. Karnac.

Footnotes
1 These emotions have specific behaviours (e.g. gaze aversion and eyelid lowering for shame) and physiologies without having universal facial expressions.
2 The latter two are mostly obsolete, but these are useful to understand the historical roots and tendency of the word. For instance, under the sixth definition is “To put on a pretense of … assume a false appearance of; to counterfeit or pretend.” We use this to describe someone with an affected air, let us say, of an aristocrat. This definition has more in common with “persona,” the mask Greek actors use to “display” a “personality” — one’s social presentation (an aspect of false self) — as opposed to “character,” something “engraved” in one’s self, which may be closer to the “true self” (Winnicott, 1974).
3 The concept of a “transference from one place to another” echoes Freud’s earlier idea of affect emanating from impulses, a concept developed by contemporary French psychoanalysts (Freud, 1926; Green, 1999).
4 Here, I will not discuss anxiety, both its position relative to affect and emotion and its position in our inner lives. In fact, anxiety has a priviileged position both in Ekman’s work and in psychoanalysis, a position not entirely within the category of affect, but not entirely outside “feelings,” as by definition, it is felt, and by extension, it has some relationship to emotions (Freud, 1926). For Ekman, anxiety has components of fear (facially and physiologically), but is not the same; unlike fear, Ekman, following both psychoanalytic and pre-psychoanalytic thinking, anxiety has no (obvious) external object; fear clearly does. However, this would take us beyond the confines of this paper’s exploration of emotion and psychoanalysis.
5 This tribe was also being studied by Gajdusek for their neurodegenerative Kuru, which he demonstrated was due to their cannibalism of their relatives who had died of this slow-virus.
6 When Mead wrote a review of Paul’s first book, she emblazened the review with the title, “THE APPALLING STATE OF THE HUMAN SCIENCES.” One doesn’t have to be a psychoanalyst to hear the “Paul” in Appalling.
7 For instance, he identifies “awe” as an infrequent, but powerful emotional experience.
8 Gesture and emblems are more culture-specific body movements. For instance, folding the arms across the chest may mean holding back information in certain cultures in certain situations (and may mean other things also). That is, these do not have the universal and rapid presentation that facial expression has in displaying emotions. On the other hand, deceit may be uncovered by catching such behaviors, among others. But, this takes us beyond this paper.
9 In an early study, a professor stressed students in individual interviews. For instance, a female student maintained outward equanimity, but unwittingly “gave the finger” to the professor. Intriguingly, when Ekman described this to them, both denied that it had happened; only when they watched the film, did they see it.
10 In this author’s experience, for instance, an attorney for a wealthy alleged child molester challenged the author in Court to assess whether the attorney was lying. He asked, “Is my middle name Roderick?” The author responded, that he could test the attorney’s truthfullness, but the question needed to be more important to the attorney, such as “Your client has molested this child, Yes or No?” The attorney refused to continue.
11 This is a computerized series of actors showing specific facial expression of emotions at various speeds. The program first tests the observers reliability reading emotions. Then, after a training period, retests.
12 These are: Hope; Zest; Attribution of responsibility; Flexibility; Persistence; Standards and Values; Relationship commitment; Empathy; Affect regulation ; Impulse regulation; Sex regulation; Self Assertion; Reciprocity; Trust; Empathy; Self assertion; Rely on self/others; Self esteem; Self coherence.
13 I use the term “character” rather than “personality,” which is more commonly used in the psychiatric terminology. Both words have ancient Greek origins. “Character” refers to something that is etched or engraved in us; Personality, from “persona” refers to the mask used by actors to portray someone. Heraclitus insisted that character was destiny (even as he also said that one could not dip one’s foot in the same river twice): that is, he suggests that character is ingrained and determines one’s fate. Psychoanalysis being psychoanalysis would be more interested in one’s character than in persona. One dilemma: while we may have consensus about assessing character, we may have greater challenges across cultures assessing what is optimal or healthy character. For instance, Lasch in his stunning assessment and critique of American society in 1974, found that there was a new prevalence of narcissism as a valued character trait (not just a psychopathology); he connected this with changes in American capitalism and bureaucratization of government and industry, associated with a weakening of the family, loss of presence of fathers and rise of valuing appearance and “getting along, over previous values associated with a meritocracy. That is, if Lasch is correct, the sudden interest and rise of Narcissistic Personality Disorder in the 1960’s may have more to do with cultural drift in American society and its values, than with a “discovery” of a previously “hidden” phenomenon. If we pursue Lasch’s challenging ideas, different cultures may value different character traits. Then, we might expect possibly different goals in psychoanalysis in different cultures. But, this takes us beyond the bounds of this paper.
14 An emblem is “a gesture that has precise meaning known to all members of a cultural group such as the A-OK emblem in the U.S” This same emblem in Sicily refers to a perverse sexual act. (Ekman, personal communication).
15 In an intriguing study, Levenson, Ekman and Friesen (1990) found that holding one’s facial muscles in the pattern of specific emotions (a sad face; a happy face, resulted after some minutes in the evocation of the emotions The researchers discovered this first on themselves, much as Harvey first explored blood flow in his own arm — or, Freud on his own dreams.

A macabre Gorey drawing initiates the NY Review of Books’ intellectual combat between Marcia Angell, former editor of the New England Journal of Medicine, and major figures in American Psychiatry: John Oldham, Richard Friedman, Andrew Nierenberg and Daniel Carlat (“The Epidemic of Mental Illness: Why?” “The Illusions of Psychiatry”;  (NYR June 23; NYR July 14; IP/net Aug 3).  A boy stretches tiptoed on a stool, reaching unsuccessfully for a squadron of bottles beyond his grasp.  We readers are like that boy, trying to get a grasp of what’s at hand here; a battle is engaged and will be formidable; how it will proceed is uncertain. But, we also know that Angell and the New York Review of Books have ignited an important rethinking of using drugs in mental illnesses: no turning back now.

In brief, Oldham, President of the APA,  says Angell should have been more balanced.  Carlat (whose book Angell reviewed), begins, “Her argument is correct in its essentials.” that psychiatrists over diagnose; are overly fixated on medication, have taken drug industry money.  Yet, he states, drugs “on the whole, work.”

Friedman and Nierenberg give no quarter, beginning with  “…Angell’s review…contains serious factual and conceptual errors…” and concluding, “she has distorted the potential adverse effects of psychotropic drugs with anecdotes and flawed data…”

Angell’s response is lengthy and detailed and crisp. She starts with “… these letters simply assume that psychoactive drugs are highly beneficial… none .. provides references … (to) substantiate that…”  Then, she lists evidence, after evidence. For instance, the U.K. agency overseeing their NHS found that antidepressants provide no  clinically significant change in the Ham-D depression index. In general, she restates, while there may be short-term effects for some drugs, there is no evidence for long-term efficacy. She condemns the quality of clinical research in psychiatry; as an expert in judging clinical studies, she is on solid ground.

And what about our kids?  Stuart Kaplan’s Newsweek article challenges the stunning rise of bipolar disorder in children and their over medication (http://www.thedailybeast.com/newsweek/2011/06/19/mommy-am-i-really-bipolar.html).  Biederman’s life’s work is discredited in part because of his dealings with pharmaceutical companies: when he claims that 1-4% of all U.S. children are bipolar; his credibility suffers further.  Kaplan argues that bipolar is a fad diagnosis; that many of the symptoms described in recent popular books, such as Brandon and the Bipolar Bear (imagine Where the Wilds Thing Are revised to sell drugs), portray either the norms of childhood, or (Kaplan argues) more parsimonious diagnoses.

Adolescents often keep us honest or at least not hypocritical: they point out that we tell them (consciously) not to use street drugs, then say that we have just the right drug for you in our cabinet.   And colleagues will try to respond to the teen, “You are trying to medicate yourself for your (fill in the diagnosis); I can do it better for you.”  But, can we? And why, in many cases, can’t we use the more sophisticated, highly individualized treatment of interacting with the teen (or adult) examining feelings, thoughts, wishes, fears, dreams: that engagement we call psychoanalysis; a treatment that our brain-imaging colleagues may some day show results in pharmacological or neuro-structural changes (If we do our treatment well.).

The New York Review of Books, Angell, Newsweek and Kaplan have provided an important public service, a breach in the wall of big pharma.   Psychoanalysts can step into that breach to promote what is in society’s better interest.

Here analysts meet a great challenge. Can we begin to initiate the careful study of adult analytic outcome as Leutzinger-Bohleber and colleagues have done in Germany, or Fonagy and Target’s courageous reexamination of the records in the Anna Freud clinic to find out what works (and doesn’t work as effectively) with children?  This kind of research takes a team; takes a discipline willing to support its teams; and takes scientific courage.

Psychoanalysts can show that we are willing to examine our practices and strut our stuff.

Book Review: David James Fisher, 2009 “Cultural Theory and Psychoanalytic Tradition.”  Written by Nathan Szajnberg, MD; NYPSI and Columbia University. Wallerstein Research Fellow in Psychoanalysis. Training Analyst, Israel Psychoanalytic Society

Too rarely, a work, like some comet, soars into our psychoanalytic ken. This work, this comet, has collected the dust, debris, remnants of psychoanalytic history, then sweeps into our vision with news about our origins, explanations of our past that cast light on our present and possibly future trajectories. And, like some bygone Hayley’s comet, if we unfortunately miss its first past through our solar system, this psychoanalytic comet may pass by again.

Such is David James Fisher’s book, Cultural Theory and Psychoanalytic Tradition, which passed this way in 1991, but fortunately for us, is reissued. The reader will benefit with greater understanding of, for instance, our French psychoanalytic cousins, who in some ways live in another universe, as well as historical figures, including Romain Rolland, whose thought has been incorporated into our framework, often with our forgetting the origins of those thoughts.

Fisher, trained as a cultural historian and later as a psychoanalyst, opens his book with a remarkably candid account of his professional life trajectory so that we may understand his viewpoint when he writes, the lens through which he sees worlds. He studied in Wisconsin, then spent two years post-graduate work in Paris at L’Ecole Practique des Hautes Etudes. He is not just fluent in French, but more significantly, appears fluent in French cultural, particularly French intellectual culture, a segment of the Parisian life in which a philosopher, such as Sartre, ruled supreme, cut a public figure. When Fisher describes the universe of our psychoanalytic and intellectual French neighbors, when he returns from orbiting those spheres to orbit in our system, he brings unique understanding of our psychoanalytic universe, helps us understand better ways of thinking and being that unite and divide us.

I will not review the entire book, but give a flavor of it. The book has three sections: The history of psychoanalysis; cultural criticism; psychoanalysis of history (including psychohistory).

In the first section, we find essays on Lacan, Romain Rolland, Jung and Fenichel. He begins the Lacan chapter ironically, quoting another Frenchman, one of Freud’s teachers, Charcot: “La theorie c’est bon, mais ca n’empeche pas d’exister,” “Theory is good, but doesn’t prevent things (facts) from existing.” Lacan commits most of his professional life turning Charcot on his head. “lacan…subordinated … technique and clinical praxis to theoretical and even literary considerations. Science.. revolved around theory building….” For more on how this attitude of French thinking influenced a different path in the physical sciences at least until the early twentieth century, see Freeman Dyson’s essay in the New York Review of Books a few years back. Lacan insisted he was returning to original Freud, thereby denying an autonomous ego, deemphasizing affects and drives and building his theory based on de Sassure’s linguistics. Lacan was a devotee of the Surrealists. Fisher describes a polar Lacan: genius and imposter. His obscurity was “willed and calculated,” and towards the end of his life he built a cult about him, acting “tyrannically and capriciously.” What can we make of a man who announces in his public lecture, “..for the moment I am not fucking, I am talking to you. Well! I can have exactly the same satisfaction as if I were fucking….” (14)?

Romain Rolland was widely known in his time, yet is now mostly forgotten. Yet, he was Freud’s inspiration for trying to grasp the sense of Oceanic feeling (and failing to do so) and ultimately, one impetus for writing “Civilization and Its Discontents.” This essay concentrates Fisher’s scholarly book-length study, Romain Rolland and the Politics of Intellectual Engagement.

In the Jung chapter, Fisher displays the man who seduced his psychotic patient, Sabina Spielrein. When Spielrein’s mother in Russia wrote to tell him to desist, Jung told her to pay her bill. (Spielrein, however, apparently shifted out of her psychosis to become a successful, thoughtful psychoanalyst, snuffed out by Stalin. See Bettelheim’s NY Review of Books review of “A Secret Symmetry for rich detail.) Jung also appropriated her original ideas and published them as his own. Jung had already seduced his own psychoanalyst, a nurse at the Burgholzli. After treating Spielrein, he descended into his lengthy psychosis, which he documented in the recently published Red Book, but also in his autobiographical writings. It is likely the Spielrein seduction that led Freud to distancing himself from Jung (possibly even explaining his fainting upon shaking his hand as they were about to embark for the U.S.). He discusses the later Jung, the Nazi sympathizer, who wrote bluntly about the shortcomings of the Jewish mind as “lack(ing) vitality, univeralism, rootedness and creative depth.”

As difficult as it may be to bookend this section with Jung — seducer, psychotic, anti-Semite — with Lacan — obfuscater, genius, entertainer — we are served up two men who were part of our history.

I promised not to review every chapter of this book. My copy is scribbled with marginalia, reflecting the book’s wealth of knowledge and ability to ignite critical thinking. Fisher’s discussion of Civilization and its Discontents is thorough and scholarly. He leads us through some of Bettelheim’s thinking — one of my more influential teachers — “a nonconforming and free thinking intellectual” who contributed to our understanding of maintaining autonomy in a mass age, building a total therapeutic milieu, seeing male ritual incisions as a form of womb envy, listening to the psychoanalytic wisdom in fairy tales.

A historian himself, he closes with surveying the life work of Peter Gay and Peter Loewenberg, the history of studying crowds, Newton’s malignant narcissism.

Best to read this book, even to savor it slowly. It voyages through the universe of psychoanalysis and collects knowledge and wisdom to help us better understand our discipline.

My father does not live in America, never did. In 1951, my father arrived in Rochester, NY, home to Kodak, home to Xerox, where he stayed to this very day. He goes nowhere without my mother. Restaurants, dinner parties, not unless they go together, with my mother. Movies, certainly not without her. Concerts, for sure not.  Baseball games, never, even with her. To shul, he drives alone.

In 1999, she died. Would he go in California, to visit me in his loneliness? “Not without your mother.” Today, a snow-packed day, my father announces he and I will go to see my mother. We must leave immediately, clean up the grave, prepare for spring planting. In Rochester! In February! In Rochester, in February, the snowdrifts rise to four feet and more. As a kid, walking to school in winter, I always wished they’d top four feet, so school would be cancelled: up to my nose, my brow, topping my head. Now, 45 years later, snows bid my boy-wishes. The Rochester Jewish cemetery is located in Irondequoit, on the banks of Lake Ontario. No Jews alive there; only dead ones are planted, never to grow. Live Jews are south, one hour away. Not one hour drive for him, though; for him, two hours. He drives local roads, not freeways, and slowly. He wants death to be cancelled or at least delayed. No rush to be reminded she’s dead and there.

The texture of the road is rock salt, ice, and grime, a slush tinted with the grayish shades of an industrial town. My father’s old rear-wheel Olds fishtails along the Genesee River. We swim upstream to the cemetery, to death locale, off an unplowed side road, off another side road, and another one, surrounded by tiny, irrelevant houses. Infuriated as he scans a sea of snow swallowing the tombstones, my father declares that no one cares – no one -, to dig a pathway into the cemetery. No one has ever cared for anyone in here. Not even the caretakers, who are nothing but careless-takers. He erupts volcanically. Never tall, stunted in Auschwitz, and now shrunken further by time, but in spite of the size, always been an active Etna, ready to blow. To the doctor of the Intensive Care Unit, where my mother laid in coma, amputated, dialyzed, intubated, respirated, just because the surgeon had suggested it might be the end, “To die?” my father exploded, “Everyone is going to die! You are going to die too, you know! Doctor? A doctor in Auschwitz you are.” Lava spewed.

He parks up a curb to let other cars slither by, gets out, pops the trunk, hands me two snow shovels, yanks a 50-pound bag of sand onto his shoulder, and says nothing. Wrapped in the shadows of pre-war Lodz, muscular and spirited, the 82 year-old man is ready to dig his way to his wife’s grave through a mountain of snow, no matter how far it will be. I see Paul Celan, soil in his eyes, excavating to meet the dead, expiring. I take point position to attack that virgin white snow impeding our visit. I dig and look back surreptitiously with shovel throws over my left shoulder. I see myself rescuing him, resuscitating him in a snowy grave. I too curse, but within. Without, I dig. I feel insignificant compare to the veteran snow digger, the Golden Shovel knight, the miniature Hercules cleaning the Aegean stables. Trained as a machinist, my father follows, correcting my path. He removes patches of snow I throw on the buried lawn and straightens the sides. His eyes plumbing ninety degrees admonish me to make the snow ramparts straighter. As meticulously as with the sheet rock he laid for our living room walls.

We reach the stone. He collapses on it. He embraces it. His face buried in his forearm, his shoulders lurching with sobs. I hear prayers. He turns to my younger sister’s neighboring pink monument, erected 10 years ago, and he weeps forever.

At the end, we did not turn our backs, but backed away with respect for the deceased, as the High Priest in the Temple did when leaving the Holy of Holies on Yom Kippur, lest he was struck dead.

The four-year-old silver Olds is in perfect shape, with 25,861 original miles. Each mile I made, he says triumphantly, is my own. The radio speaks of today, with the same radio voice, disregarding all his wishes. So he reaches from the seat box his “Chazoinem” tape with his favorite old cantors, masters of Yiddish mourning melodies and plaintive poetry. He then breathes, the deepest breath I have heard today, and drives back home. Back to Lodz. For my father does not live in America, never will. He lives in Past, Perpetual, home to memory, wailing at the Present, telling who is dead and what is dead.

He does not live in America, but in a place where Auschwitz will not happen. The Present jolts him awake from his truer dreams. My father wants to sleep.