shortessays

Prof. Donald L. Carveth

York University, Glendon College
Department of Sociology
2275 Bayview Avenue
Toronto, Canada
M4N3M6

No man remains quite what he was when he recognizes himself. --Thomas Mann

A Case for Psychoanalysis: Exploring the Scientific Evidence - YouTube

Is Psychoanalysis a Science or an Art?

Psychoanalysis cannot be reduced to a clinical method, or an applied science, or an art. Although it contains all of these elements, it has always aspired to be a true science of the mind—“science” being understood here as what the Germans call wissenschaft, disciplined scholarly study, of which they discriminate two types: naturwissenschaften (natural sciences) and geisteswissenschaften (human or social sciences). I believe psychoanalysis entails elements of both of these: it is not purely natural science, but neither can it be reduced to being a purely hermeneutic or interpretive science, let alone to a clinical method, an art, or a merely applied science..

The rejection by some of systematic theory in psychoanalysis is a form of irrationalism. I have been asked whether I think Winnicott’s failure to be systematic may have contributed to his creativity as an analyst and I think it may well have. But that is no argument against the need for systematic theory in psychoanalysis; it merely means that other thinkers must come along behind unsystematic creators like Winnicott and attempt to clean up, to systematize, to sort out what fits with what and what doesn’t fit at all and whether the latter represents new truth or something spurious and invalid. Hartmann did a good deal of that for Freud. Winnicott’s thinking is quite contradictory in places and needs to be integrated into the systematic body of psychoanalytic theory. It is a big task, but the job of integrating Freudian, Kleinian, Winnicottian, Kohutian, Mahlerian, Lacanian, etc., ideas is not, I think, impossible, merely difficult. And very worth doing.

Part of our scientific task is to figure out systematically how it is that some of our best theoretical thinkers are not good therapists, and how it is that good therapists can be good without being good thinkers. That would represent an important scientific contribution.

There are elements of both science and art in psychoanalysis, but I think we need to remember there are elements of art in science. Scientific inspiration is very like artistic inspiration:

Yes, when not discovering the key to life, and winning the Nobel Prize for it, Crick spent the 50s and 60s throwing all night parties famous for featuring that era’s favorite party favors: LSD and nudity. Crick never made it a secret that he experimented with the drug, and in 2006, the London paper The Mail on Sunday reported that Crick had told many colleagues that he was experimenting with LSD when he figured out the double helix structure.

The validation phase is another matter altogether.

I don’t at all agree that disputes between different psychoanalytic models are irresolvable by rational means, or that we can’t agree on what counts as evidence, etc. Some years ago we decided to do a ten week continuous case seminar led by two training analysts of different orientations. I was to represent Freud/Klein and a colleague Self/Relational/Intersubjective. We thought sparks would fly. They didn’t. Both of us zeroed in on the same clinical issues. We spoke of these in different languages but found ourselves in almost total agreement.

I think aspects of behaviorism, attachment theory, etc., are scientific in the broad sense that they seek to test and revise their hypotheses in light of criticism and evidence. I think that like psychoanalysis they are blends of science and art and fantasy and philosophy and prejudice ... and the task is that of over time sorting out what stands in light of logic and evidence, to separate the wheat from the chaff.

In regard to the science vs, hermeneutics debate as to the nature of psychoanalysis, my own position on the issue is to say that psychoanalysis is not one thing, but several. Clearly a large part of what we do, clinically and also in the applied psychoanalytic fields of literary and film studies, for example, is hermeneutic: geisteswissenschaft. But aspects of our theory are open to natural science verification, or rather falsification (Popper’s criterion for science). For example, the Freudian myth of development from oneness to twoness and threeness, and Mahler’s related notion of differentiation out of symbiosis, have both been scientifically disconfirmed by empirical infant research which has confirmed Melanie Klein’s view of object relations from the beginning. We now know there is no primary narcissism. Here a major tenet of Freudian psychoanalysis has been falsified by empirical research. By Popper’s standard that makes psychoanalysis, at least to a degree and in certain respects, a science.

MIND / BRAIN

People often seem to assume that those who recognize a valid distinction between mind and brain and view psychoanalysis as essentially concerned with the former rather than the latter necessarily embrace some kind of supernaturalism.

I can operate my car while knowing little or nothing about what goes on under the hood. But my ignorance with respect to the mechanics of internal combustion engines doesn't mean I think the car is guided by supernatural forces! I can psychoanalyze a mind while knowing little or nothing about the brain, while being perfectly aware that the former depends upon the latter. No brain, no mind. That's a no-brainer ... or should I say a no-minder? Never mind.

Admittedly, If I'm unhappy with the way my car is behaving, it is helpful to know enough about the engine to be able to consider the possibility that the problem might be mechanical and not just a result of my deficient driving skills. Conversely, and to vary the metaphor, if I'm unhappy with what I'm seeing on my TV it is useful to be alert to the possibility that the problem may not be with the set but with the script or the actors.

Not all, but many who work with the Three Worlds Hypothesis—World 1, lithosphere, pre-biological, inorganic; World 2, biosphere, biological, organic; World 3, nöosphere, post-biological, superorganic—do not in any way view the superorganic as supernatural, but merely as irreducible to its biological foundation.

This is is the Emergent Evolutionary hypothesis of biologist Julian Huxley who, like his grandfather, Thomas Henry Huxley, was a Darwinist, but one who, unlike his grandfather, realized that the battle to view humans as animals had been won, so that now one could afford to recognize what strange and unusual animals we are: animals possessing not just brains, but minds that, while depending upon brains, exist (ex-ist, stand out from, or emerge) on a distinctively human level of symbolic consciousness, with all (and it's plenty!) that entails.

Continuous evolutionists who emphasize only quantitative differences of degree among species rather than the qualitiative differences of kind that emerge at critical levels seem to assume that those who, like Huxley, focus upon the differences rather than the similarities between man and other species are arguing not just for the uniqueness but for the superiority of man. And they respond with vigorous criticism of the arrogance of such claims and point to the destructiveness of humanity toward other species and the planet as a whole. But in so doing they seem to fail to realize that they themselves are now arguing for the uniqueness of man. Although Freud and others mistakenly projected it upon the "beast" in us, the fact is that only humans are "beastly" while the beasts never are. It seldom occurs to such critics that those of us who focus upon man's uniqueness may do so in an attempt to better understand and limit our destructiveness.

Freud Bashers and Freud Idolaters

According to Milton H. Horowitz, "To prove the parent a fool, to prove analysis foolish and the first analyst--Freud--a dolt is a cherished wish of the the humiliated child now grown up." The very inability of the critics of psychoanalysis to stop flogging what they insist is a dead horse reveals a neurotic compulsion to repeat. They are deeply attached to psychoanalysis; they kill it, only to revive it, to kill it again. This is the hate-bond maintained with the parents by the enraged child who cannot face the loneliness entailed in growing up and letting go. But while the unconscious desire for revenge against parents frequently takes the form of attacks upon the ur-father, Freud, the aggression of the Freud-bashers is matched only by that of the Freud-idolaters, who merely employ a reaction-formation against it. In this respect, both bashers and idolaters are living in the past. Fortunately, some psychoanalytic scholars do not hate their parents, and therefore Freud, so much that they have to either idealize or devalue him.

Contra Relativism

Some argue that it is the assumption that there is one truth, one reality, one 'right' viewpoint in and of psychoanalysis that has been the conceptual and philosophical foundation for the medical model that has been central in psychoanalytic thought and that leads to people being diagnosed from the perspective of the "professional expert" whose reified "reality" specifies a norm from the standpoint of which individual deviations are measured. Apart from the sweeping nature of this rejection of essential norms by means of which, for example, psychosis and sanity may be distinguished, this model is associated in the minds of its critics with the authoritarianism of the analyst who imposes his or her perspective upon the analysand's experience, pathologizing it instead of engaging in an open and validating "sustained empathic inquiry" into the unique experiential world of the individual subject. But in so resisting the authoritarianism of "one truth" such critics are often blind to the authoritarianism of "many truths" -- that is, to the irrationalist dangers and totalitarian potential of relativism and constructivism. Both Freud and Orwell understood these threats, as I indicate in the following quotations from my 1995 paper "Selfobject and Intersubjective Theory: Part 2, A Dialectical Critique of the Intersubjective Perspective," Canadian Journal of Psychoanalysis/Revue Canadienne de Psychanalyse 3, 1 (1995): 43-70; reprinted as "Self Psychology and the Intersubjective Perspective: A Dialectical Critique," Progress in Self Psychology, Vol. 11 (Ed. A. Goldberg) (Hillsdale, NJ: The Analytic Press, 1995), pp. 3-30.

Over half a century ago, Freud (1933) recognized and rejected the philosophical relativism which, despite their disclaimers, Stolorow, Atwood, Brandchaft and their co-workers have failed to transcend:

There have certainly been intellectual nihilists of this kind in the past, but just now the relativity theory of modern physics seems to have gone to their head. They start out from science, indeed, but they contrive to force it into self-abrogation, into suicide .... According to the anarchist theory there is no such thing as truth, no assured knowledge of the external world. ... Since the criterion of truth--correspondence with the external world--is absent, it is entirely a matter of indifference what opinions we adopt. All of them are equally true and equally false. And no one has a right to accuse anyone else of error. ... All I can say is that the anarchist theory sounds wonderfully superior so long as it relates to opinions upon abstract things; it breaks down with its first step into practical life. Now the actions of men are governed by their opinions, their knowledge; and it is the same scientific spirit that speculates about the structure of atoms or the origin of man and that plans the construction of a bridge capable of bearing a load. If what we believe were really a matter of indifference, if there were no such thing as knowledge distinguished among our opinions by corresponding to reality, we might build bridges just as well out of cardboard as out of stone.... But even the intellectual anarchists would violently repudiate such practical applications of their theory (pp.175-176).

Unfortunately, epistemological relativists have not always violently repudiated practical applications of their theory, as Orwell (1938) reminds us:

I know it is the fashion to say that most of recorded history is lies anyway. I am willing to believe that history is for the most part inaccurate and biased, but what is peculiar to our own age is the abandonment of the idea that history could be truthfully written. In the past people deliberately lied, or they unconsciously coloured what they wrote, or they struggled after the truth, well knowing that they must make many mistakes; but in each case they believed that "facts" existed and were more or less discoverable. And in practice there was always a considerable body of fact which would have been agreed to by almost everyone. ... It is just this common basis of agreement, with its implication that human beings are all one species of animal, that totalitarianism destroys. Nazi theory indeed specifically denies that such a thing as "the truth" exists. There is, for instance, no such thing as "Science". There is only "German Science", "Jewish Science", etc. The implied objective of this line of thought is a nightmare world in which the Leader, or some ruling clique, controls not only the future but the past. If the Leader says of such and such an event, "It never happened"--well, it never happened. If he says that two and two are five--well, two and two are five. This prospect frightens me much more than bombs -- and after our experiences of the last few years that is not a frivolous statement (p.236).

"The 'too-pat' defense ... is frequent. However, there is another defense against simple truths:

the fantasy that analytic causes have to be mysterious and complex, or at least obscure."

--M.H. Horowitz

On the Difference Between Conflict and Contradiction

"I am struck by the cheerful attitude some analysts have toward contradiction. It is as though they had an ego lacuna where rules of logic are concerned. Primary process thought has the privilege of indifference to contradiction but secondary process thought is supposed to find contradiction unacceptable. To be sure, as analysts, we work with contradictions in our patient's beliefs by treating them as indicators of psychic conflicts. And we rightly think that correcting a patient's logic will do nothing to resolve his or her conflicts. But the adoption of contradictory theoretical ideas opens the door to incoherent clinical thinking and interpretation. Analysts need to be able to entertain interpretations implied by contradictory theories in order to evaluate their respective clinical applicability. But the conclusions we reach need to be contradiction free as does our theory. Some analysts also tend to identify conflict with contradiction. Ambivalence does not involve a contradiction, it involves a conflict between feelings of love and hate. The term "contradiction" applies to sentences--the propositional content of beliefs. Conflicted feelings can cause contradictory beliefs but are not themselves contradictory any more than the turbulence caused by the confluence of two rivers is contradictory. Nor does the statement "he loves his brother" contradict the statement "he hates his brother". Given that conflicts of ambivalence occur, both statements, one affirming love and the other affirming hate, may be true at the same time. Psychoanalysis does not justify a casual attitude toward contradiction." --From "On Fictional Truth" by Charles Hanly

Object-Relations Theories

Although the founder of object-relations thinking is Freud--his work on mourning and melancholia, internalization of the ambivalently loved object, then later his work on identification in groups and in ego and superego formation--this element of his thinking was elaborated by Karl Abraham and then by Melanie Klein.

Kleinian theory has never separated object relations from what Freudians call the "drives"; but the Kleinians have implicitly, not explicitly, altered the meaning of "drive". For Kleinians there are no drives apart from objects, nor objects unrelated to drives. Whereas Freud thought of the "trieb" as a somatically-grounded (not in the brain but in a bodily zone) drive that only turned to objects because it found it to be necessary for what it wanted (drive discharge), the later Klein (the early Klein being Freudian) came to think of the drive as always oriented toward an object, not something separate from objects and turning to them for gratification (as Freud thought). Further, she came to think of the drive as, like everything else in the mind, a phantasy (ph = unconscious; f = conscious); so Eros became phantasies of loving objects and Thanatos became phantasies of hating and attacking objects (and being hated and attacked by them), and the mind or internal world became a phantasy system. Even defense mechanisms are phantasies of burying, projecting, introjecting, etc. This is the world of internal object relations.

It appears that John Bowlby played an important role in spreading the falsehood that in emphasizing the internal world Klein more or less lost the external world, embracing a kind of psychoanalytic analogue of philosophical solipsism, losing the real mother in favour of the infant and child's phantasy of the mother, thus letting mother, father, and the social environment entirely off the hook. While this may have been true of some people who called themselves Kleinian, it was never true of Mrs. Klein. For her, the real mother plays the crucial role of helping to dispel, through her loving nurturance, the infant's inevitable paranoid phantasy of her total badness. The analyst later serves the same function. The patient projects all-bad attacking objects or an attacking superego onto the analyst, but discovers through the analyst's containment and non-retaliation and reliable rationality the phantastic nature of his or her phantasies and this allows for modification of the phantasies, some critical distance from them, and superego modification as well.

On every page where she mentions the death drive, Klein also explains that in addition to becoming paranoid because of the need to project the death drive into the breast mother, the child becomes paranoid because it assumes all unpleasure is mother's fault--in fact, says Klein, an absent good breast is felt by the baby as a present bad, attacking breast. This is the cognitive basis for inevitable infantile paranoia, quite apart from any bizarre, anti-Darwinian speculations about a biologically based drive toward death (a notion I have always rejected, while accepting Klein's alternative explanation of inevitable infantile paranoia). So Klein sees inevitable pathology, a paranoid-schizoid internal world, split between all-good and all-bad object images and self images--no matter how good the mothering. This is nobody's fault. Bad early caretaking makes it worse, but it doesn't cause it. Good early caretaking helps mitigate it. This is the human condition. This is the existential aspect of Klein's thought, because this inevitable paranoia does not arise from biologically based drives in the Freudian sense (i.e., from nature), nor is it caused by bad caretaking (i.e., nurture), nor from the interaction of nature and nurture: it is existential, inevitable, a part of being human. But Klein's position doesn't ignore environmental factors: good parenting is essential to mitigate the projective and splitting processes that are inevitable at the beginning.

The epistemological break comes with Fairbairn and Winnicott who, in different ways, laid the basis for mother-bashing theories such as that of Harry Guntrip, who despite his two analyses, by the end of his life managed only a paranoid understanding of himself as a victim of a murderous mother. American self psychology and relational psychoanalysis have tended to fall into this fallacy and to lose the precarious balance and the implicit existentialism achieved by Klein.

Kleinian-Freudian Object-Relations Theory vs. Reparative Reparenting

Although object-relational thinking originates in Freud's work--his concepts of internalization and introjection and identification--this perspective was extended and deepened and made more central by Melanie Klein. Without ever attacking Freud's drive theory, in Klein's work the supposed somatic sources of drive in Freud's thinking quietly dropped out of the picture and what for Freud were the mental representatives of the drives came, in Klein's work, to be central and to be conceived as unconscious phantasy. Instead of a psychology of somatically-rooted drives and mental defenses against them--of conflict between "nature" or the supposedly "animal" in man versus culture--Klein reconceived the mind in terms of fundamental emotions of hating and loving and the phantasies of destroying and creating and repairing with which they are linked. Klein considered herself a Freudian and to this day Kleinian Freudians share with other Freudians a fundamental emphasis upon the unconscious, unconscious phantasy, and unconscious emotions--upon love, hate, envy, persecutory anxiety, guilt, etc. Whereas some types of Freudian theory are oedipally fixated, Kleinian theory extended psychoanalytic thinking back into what Freudians called the "preoedipal" period--which Klein discovered was not preoedipal at all, finding triangular conflict, envy, rivalry, hate and fear of reprisal in relation to parents and siblings active in the pregenital phases.

What Freudianism and the Kleinian type of object-relations theory have in common, despite their differences, is their focus upon the unconscious, upon powerful primitive emotions, and upon emotional conflict. Both schools believe that even with the best parenting in the world, the human condition as such contains sufficient intrinsic frustration and pain to generate powerful conflictual emotions that cause every one of us to have to struggle with love, hate, envy, fear and guilt. This is nobody's fault--though parental failure, naturally, makes matters worse.

Here is where Freudian and Kleinian object relations theory differs from other types of object relational thinking that stem from the Middle Group or Independent Group within the British Institute. Most of these analysts were significantly influenced by Fairbairn, Winnicott and Guntrip. Although a theoretically inconsistent thinker like Winnicott cannot easily be pigionholed (there is a Kleinian Winnicott, a Freudian Winnicott, in addition to the Winnicott who was a precursor of Kohut), I think it is fair to say that his concepts of good-enough and not-good-enough mothering contributed along with Fairbairn's and Guntrip's notions of parental failure to generating an approach to therapy that I regard as non-psychoanalytic: a model of pathology as deficit rather than conflict and of therapy as reparative reparenting in which the grandiose therapist is thought to repair the damage done by the original parents by filling in the gaps in the patient's psychic structure left by parental failures of various types.

I do not wish to devalue all the work of this latter group: they have contributed greatly to the field of supportive psychotherapy. But they have lost what is fundamental to psychoanalysis: the understanding of the tragic dimension of human existence in which we are sickened by the hatred and envy that, when it comes right down to it, are nobody's fault--in addition to the hatred and envy that ARE somebody's fault. As William Barrett puts it, "Nothing can be accomplished by denying that man is an essentially troubled being, except to make more trouble."

Psychiatry is Hysterical and Resistant to Psychoanalysis

I have yet to hear anyone satisfactorily refute the basic point Szasz makes in The Myth of Mental Illness: if there is scientific evidence that satisfies the scientific community that certain forms of "mental illness" have an organic (physiological, neuroanatomical or neurochemical) cause, then these, by definition, are physical, not mental, illnesses. Their symptoms may be expressed mentally, but if such proof were to exist, then their causes would be known to be physical and, hence, they would be physically-based medical conditions.

Szasz argues that the category "mental illness" is reserved for conditions people want to believe are illnesses but that we cannot prove are illnesses. Hence, calling a person mentally ill is essentially the same thing as saying the economy is sick: one is speaking metaphorically. And we know what happens with metaphors: they come to be taken literally. So we end up confusing metaphorical "illness" with real illness. But mental "illness" is not real illness--unless its causes are found to be physical--and then it isn't mental illness anymore, it is physical illness.

Since conversion hysteria entails evading painful feelings and psychological or emotional conflicts by converting these into pseudo-physical symptoms based upon mimicry (as distinct from psychosomatic disease which is real disease that has psychological causes, and from malingering which is conscious faking of physical illness or dysfunction), then organic psychiatry is hysterical insofar as it attributes emotional suffering to supposed physical causes in the absence of supporting evidence for its claims.

Freud himself was an hysteric. His famous hysterical fainting episodes provide merely one illustration. Although he often tried to conceptualize his persistent symptoms as arising from what he called an actual as distinct from a psychoneurosis, a condition of an essentially somatic order supposedly without psychological meaning, the concept of the actual neurosis was dropped by subsequent psychoanalysis because no cases of it were found. Although this notion of the actual neurosis is an early instance of the hysterical denial of agency and meaning that is typical of hysterical psychiatry, Freud himself was at other times able to acknowledge both to himself and others the hysterical and psychoneurotic nature of certain of his symptoms and, consequently, psychoanalysis, unlike psychiatry, has often seen through hysterical disavowal and somatization to the motives and meanings underlying them.

Like other forms of hysteria, psychiatry is highly resistant to a psychoanalytic cure in that it evades facing and working-through the emotional conflicts at the root of "mental illness," insisting instead that it is a physically-based condition (in the absence of any evidence to support this claim). Where such evidence does exist, it removes the condition so caused from the category of mental illness and establishes it in the category of physical illness, leaving in the category of mental illness all those emotionally-based conditions for which no physical cause has been proven but which psychiatry fervently and hysterically insists (in the absence of evidence) have physical or chemical causes.

Naturally, those who seek to evade the mental pain consequent upon recognizing the truth and the implications of the above analysis, will do so by attempting to undermine or "deconstruct" the distinction between "mental" and "physical" that it rests on. They will argue that this distinction reflects an outmoded mind/body dualism and that, in reality, these categories are inseparable: every psychological state has a physical basis or effects and every physical state has corresponding psychological and emotional manifestations. In this view, human reality is psychophysical and it makes no sense to fall back into a dualism that would separate illness into "physical" on the one hand and "mental" on the other as it is always already both. A truly modern "psychosomatic" perspective rejects such dualism, arguing that all illness (defined subjectively as suffering) is psychosomatic in this sense, manifesting in both the psyche and the soma. In this perspective, if there is no mental illness that is only because there is no physical illness either, for illness is always both, i.e., psychosomatic.

This is very clever. But when we return from fashionable rhetoric to mundane, practical reality, the fact is that some some illnesses are defined not primarily subjectively, i.e., in terms of subjective discomfort, distress or pain, or even in functional terms (as in the case, say, of paralyses of unknown origin), but objectively in terms of observable tissue pathology (as in, say, bleeding ulcers). While there is no doubt that in the latter conditions there is often psychological distress as well as physical pathology, the point is that the condition is defined by the latter, not the former. While there is no doubt that all illnesses are psychosomatic in the sense that psychological as well as somatic factors play a part in the condition, this way of defining the term "psychosomatic" represents a fundamental alteration of its former meaning: an objectively defined medical illness believed to have significant psychological or emotional causes.

Those who seek to avoid the mental pain consequent upon clear thinking in this field attempt to do so by blurring important distinctions. They expand the meaning of "illness" from objectively defined medical pathology to subjective discomfort, pain or distress. This represents a tremendous gain for the medicalization of suffering. All suffering, by definition, is now illness, hence medical. In the past, it was only that portion of human suffering caused by objectively defined medical pathology that fell within the province of medicine, strictly defined. Mental suffering--that is, suffering apparently not arising from objective medical pathology--constituted an ambiguous field shared by ministers, priests and pastoral counsellors, those interested in the "cure of souls," philosophers concerned with man's "existence" (Dasein), as well as by clinical psychology and psychiatry. The latter disciplines and practices came, over time, to colonize this area essentially through medicalizing definitions of mental suffering as illness.

Similarly, the term "psychosomatic" used to be restricted to objectively defined medical pathology thought to have significant psychological causation. In recent years its definition has been expanded to cover all pathology, whether objectively or subjectively defined. By blurring important distinctions between objective and subjective, mind and body, it is possible to medicalize almost anything, including behaviour we want to consider disease without any evidence whatever of objective physical pathology--i.e., so-called "mental illness." This blurring of distinctions is characteristically hysterical and it characterizes the hysteria called postmodernism and the hysterical psychiatry that is its handmaiden.

It is both sad and ironic that, today, one is more likely to find recognition of the psychological and emotional basis of hysterical conditions among real doctors who recognize such patients are mentally disturbed than among psychiatrists. The latter, out of their very desperation to be doctors after all, seek to affirm the non-mental (albeit as yet undemonstrable) organic basis of such conditions, resisting the very idea that they might be the outcome of psycho-emotional factors. The current fad among psychoanalysts for the new field of neuro-psychoanalysis may be a case in point. Having argued, against Szasz, that mental illness does really exist (thus providing psychiatry with its raison d'etre), today the psychiatrist, a supposed expert in mental illnesses, is busy arguing that such illnesses are not really mental at all, but neurological and best treated pharmacologically. But this deprives psychiatry of its raison d'etre and the psychiatrist of his role, for he is neither a pharmacologist nor a neurologist.

Where in all this should the psychoanalyst stand? Although Szasz is quite right that mental illness is a myth, the psychological and emotional conflict and suffering of Dasein are all too real and irreducible to supposed (albeit unproven) organic causes. Existential anxiety and guilt are intrinsic features of the emergent human psyche or soul. Although intensified by biological and environmental factors, such suffering is irreducible to these and to their interaction. Psychoanalysis is a hermeneutic dialogue through which the neurotic evasions and illusions of Dasein in flight from freedom and from death, sunk in inauthenticity, idle talk and bad faith, may recover its authenticity and its agency. This is rendered possible through the psychoanalytic process in which the analysand's core conflicts are revived and relived in the transference to the analyst and where resistances to conscious awareness of such conflicts and anxieties may be analyzed and overcome through the medium of full speech and the analyst's empathic understanding, forbearance, containment and tactful confrontation.

On Decompensation

Decompensation is a psychiatric more than a psychoanalytic term. It refers to the breakdown of defenses leading to severe regression, sometimes as a preliminary to an outbreak of psychosis. The term "overcompensate" suggests defensiveness, and "decompensate" means the breakdown of defenses.

Colleagues who employ the term decompensation in this way tend to view psychosis as a regression into a kind of primordial mental swamp from which we have evolved in development, setting up boundaries: I/not-I, ego/object, self/other, inner/outer, imaginary/real, etc. They think psychosis is a loss of such boundaries and a falling back into the unlimited and unbounded chaos and "oceanic experience" of "primary narcissism." Hence, when they sense this happening in an analysand whom they have been treating on the couch, they immediately sit him or her up, viewing the couch as encouraging a regression that has already become uncontrolled and maladaptive.

In contrast, Kleinians reject the concept of primary narcissism or unbounded oneness at the beginning of life in favor of the concept of a primitive ego engaged in archaic relations with part-objects from the start. This is the Kleinian object-relational point of view, now supported by empirical infant research. In this perspective psychosis is not viewed as a falling back into natural chaos, for there is no such chaos to fall back into. Psychosis is not seen as decompensation, but as itself a product of certain primitive defenses, especially projective identification. For when A puts so much of himself into B (in phantasy), he can no longer tell where he leaves off and B begins. Confusional states are mental accomplishments, not simple decompensations into natural chaos. As a product of primitive defenses, psychotic states are, in principle, interpretable. They are something a person is doing and, in principle, something he or she may be able to stop doing.

The Tragic Sense of Life as Masked Depression

In Janet Malcolm's book, The Impossible Profession, the analyst she names Aaron Green opines that a good analysis ends somewhat badly because while everyone wants the perfect, unconditional love of a benevolent parent, no analysis can satisfy that desire, though it can analyze the grief accompanying the awareness of the impossibility. But whether one agrees with Aaron Green or not depends on how one interprets what he is saying. If he means that as adults we cannot expect to ever fully gratify our infantile desire for unconditional, perfect love under all circumstances, then one can only agree. As adults we have to accept that there are conditions that must be met to deserve and preserve the love of our partners, let alone the good will of our analysts. On the other hand, the "sadder but wiser" school of psychoanalysis sometimes exaggerates all this in support of a "tragic sense of life" that, sometimes, rationalizes an unresolved, underlying depression. If the analyst brings such excessive pessimism to the clinical work such countertransference may link up with the patient's unresolved depression. We have then a mutual blind spot in the analysis, a shared depressiveness, that gets in the way of recognizing and reaching out for and sustaining the real possibilities of love and joy that life sometimes affords us.

Psychoanalysis vs. Cognitive-Behavioral Therapy

Psychoanalysts have tended to believe that feelings, affects, impulses and drives are somehow more fundamental or “deeper” than mere cognitions. As I argued in The Analyst's Metaphors: A Deconstructionist Perspective (1984), the cognitive dimension of psychoanalytic work has been insufficiently appreciated by psychoanalysts in their descriptions of the analytic process. Kleinian psychoanalysis is an exception to this for, like cognitive psychology, it recognizes that affects and drives exist only in the context of the phantasies or cognitions that generate them. Very often intense emotional reactions subside immediately upon recognition of the misperception upon which they were based. Bion developed this aspect of Klein's work, reformulating the unconscious not as a "seething cauldron of instinctual drives" as the later Freud viewed it, but rather as an infinite realm of preconceptions seeking to rendezvous with realizations achieving conception through such coupling. In "The agency of the letter in the unconscious or reason since Freud," Lacan arrived at a similar insight: "Yet that is what we must resign ourselves to. The unconscious is neither primordial nor instinctual; what it knows of the elementary is no more than the elements of the signifier. ... It is the abyss open up at the thought that a thought should make itself heard in the abyss that provoked resistance to psychoanalysis from the outset. And not, as is commonly said, the emphasis on man's sexuality." Despite its tendency in theory to privilege affect over cognition, in practice psychoanalysis has always worked to bring unconscious beliefs, assumptions, phantasies and narratives to consciousness where they can be subjected to reality-testing. Properly practiced, psychoanalysis is CBT Plus, while CBT is Psychoanalysis Light.

Is the Oedipus Complex Universal?

In her classic paper "Is the Oedipus Complex Universal?" psychoanalytic anthropologist Anne Parsons revisits the Malinowski/Jones debate, reviews Malinowski's data and the anthropological record in general, and comes to the conclusion that, in a slightly revised form, yes, the Oedipus is universal.

Malinowski observed that in the Trobriand Islands, a matrilineal and matrilocal culture, a boy's hostile rivalry is with his maternal uncle rather than his father. His uncle is the man responsible for raising him, for his father only visits from time to time from his own village (where he is an uncle). Although mother sleeps with father (when he visits), the boy's hostility is toward the uncle, not the father.

Certain Marxist theorists jumped on this data and, against Freud, said "See! It's not about sex, it's about authority and domination!"

In response, Jones insisted on a very literal reading of Freudian theory and argued it IS about sex, the sexual jealousy being displaced from father to uncle. If we are true believers in a theory we can find Freudian mechanisms to explain away discrepant data.

Parsons goes back to the data and says no to both the Marxists and the Freudian literalists. She finds that Malinowski's data contain all kinds of evidence of obsession with brother-sister incest themes in Trobriand culture: myths, jokes, taboo avoidances, etc. No wonder: that culture makes a woman's brother the most important man in her life. Husbands come and go; they are easily divorced. A brother, on the other hand, is the protector of his sister and her children.

Parsons concludes: no wonder the boy is rivalrous with uncle; he doesn't sleep with mother but he is the most important person in her life in many ways.

Therefore, the Oedipus Complex is not about sex in the narrow sense, it is about who is most important to whom. Oedipal desire (as for Lacan) is not primarily about sex, it is about narcissism: the desire to monopolize the love and attention, to be the apple of the eye, of the mother. In our culture the boy's rival also sleeps with Mom so we thought it was the sex, when in reality it's about being numero uno.

We shouldn't have been surprised, least of all the French. Many women and men in our culture (not just the French) can tolerate their spouses merely sleeping with other people, as long as he/she comes home to Mamma/Daddy.

The Oedipus complex is the universal desire on the part of the child to monopolize the love, look and attention of the mother and his/her hostile rivalry with anyone who takes that look, love and attention away.

The Oedipus complex, as Lacan understood, is a narcissistic project in which the desire to be the exclusive object of the mother's or father's desire, and the castration or decentering experienced when gender and generational and other realities force us to recognize its ultimate impossibility, generates narcissistic rage, despair and a range of other passions.

No doubt Jocasta mothers and Laius fathers make it worse, but it is sentimental and naive of Kohut to think anyone, even with the best, most empathic parenting imaginable, can get through this without major stürm und drang.

Many parents are such total failures as selfobjects that they actually bring other children into the world, cruelly displacing the older child from his or her position of centrality and saddling him or her with annoying rivals. How unempathic of them!

Freud's Theory of Ego Development

Stage 1: Primary Narcissism. No I/not-I distinction. Unbounded and unboundaried oneness. Oceanic experience. Buzzing, blooming confusion. No self/non-self distinction. No object relations because there is as yet no distinction between self and object. So Freud thought. We now know he was wrong. Infant research has confirmed Klein's view that there is an archaic ego or self relating to archaic objects from the beginning. This is one of the few instances in which a central tenet of psychoanalytic theory has been empirically falsified (Popper) and surrendered.

Stage 2: Secondary Narcissism, otherwise known as the purified pleasure ego. The child admits the I/not-I distinction. For Klein this is Stage 1, the paranoid-schizoid position. For Freud it is a blow to infantile omnipotence to have to acknowledge a not-me world. But the child seeks to preserve a degree of omnipotence by insisting that at least that which is not-me is bad, while everything that is good is me. This is the purified pleasure ego. In other words, the ego or self is purified of all-bad which is projected out of the self into the non-self world, while everything good is introjected from the non-self world into the self. Here we have all-good/all-bad splitting, as Klein held, but whereas for Klein both self and object are split into all-good and all-bad parts (part-selves and part-objects), for Freud the split is between self and non-self, the former being all-good and the latter all-bad.

Stage 3: Purified Pleasure Ego breaks down in the face of the reality that the not-me contains good as well as bad, and the me contains bad as well as good. Attainment of what Freud called ambivalence or what Klein called whole self and object relations. Now one can have an Oedipus complex because in the true, Freudian Oedipus complex one both loves and hates the rivals and therein lies the whole poignancy of the conflict. But even with this achievement of ambivalence, this admission of imperfection, such is the hold of omnipotence upon us that while admitting we are not perfect now, we resolve that, by god, one day we will be. Our perfectionism is booted into the future as an ideal. This is the origin of the ego ideal. People stuck in Stage 3 are not delusional; they know they aren't perfect, but they are still driven by perfectionist ideals. Since perfectionism is a "totalizing" form of thinking in which things are all-good or all-bad, it is a characteristic of the paranoid-schizoid position and a central ingredient in totalitarianism. In totalitarian thinking if the revolution fails to create perfection then it's someone's fault. Ergo death camps, gulags, etc.

Stage 4: Thoroughgoing Atheism. Here, according to Freud, one surrenders omnipotence altogether, not just booting it into the future as an ideal: one recognizes that there is no perfection, no God, never was, never will be. One grows up. This is not eliminating the ego ideal but radically modulating or modifyiing it; giving up it's omnipotent, perfectionistic elements. One may still have ideals to strive towards, all the time knowing that one will never reach perfection.

I have insisted that the ego ideal cannot serve (as Erikson had hoped it could) as a kind of positive superego or conscience (rather like Schafer's loving and beloved superego) to counter the negative, harsh and cruel superego. It cannot do this because the ego ideal remains a narcissistic structure. It involves looking at myself and measuring myself against my ideals, which is still looking at myself rather than at the needs of the other whom I have injured. Conscience calls us to attend to the other, not just improve the self. My ego ideal wants me to improve myself by being good to others. But being good to others because one wants to bask in a positive self image is not the same as being good to others because one cares about them.

Freud's Politics

I have trouble with the idea that “like Marx, Freud was a revolutionary.” At best at times he showed some liberal (welfare state) type leanings, but at other times he was an outright reactionary, like his primary non-Jewish, non-Christian mentor, Plato. Freud’s Group Psychology represents a contribution to anti-democratic theory, celebrating the strong leader, showing no appreciation (as Franz Alexander saw) of democratic groups governed by democratic principles rather than shared loyalty to a führer.

Freud shows typical 19^th century bourgeois contempt for the proletariat whom he views as stupid, lazy and oversexed, and needing to be kept in check by their “betters”, those more “civilized.” Civilization and Its Discontents reads like a current Republican tome: the need for “law and order” to keep the barbarians and the barbarian in all of us down. When Freud wrote that “America is a giant mistake,” I believe he had its experiment with democracy in mind.

We all love Freud. He was a genius. Many of his central ideas still stand—including, I believe, his structural theory of id, ego and superego (now supported to a degree by current brain research). But gimme a break—a radical? Despite the important work of the Freudo-Marxists, Freudian thought has done more to undermine radicalism than to promote it. I think we are whitewashing Freud if we try to blame the authoritarianism of the first few generations of American analysts on their (former) Marxism. They didn’t need Marx, or Lenin, or Trotsky to be authoritarian: they had Freud already.

While we need to think dialectically, as Hegel teaches us we tend to lurch, like drunkards, from thesis to antithesis, one extreme to the other, only sometimes managing eventually to reach a synthesis (I know this is more the language of Fichte than of Hegel but, scholastic quibbles aside, it captures the basic idea). The breakdown of authoritarianism in the sixties or in any period presents opportunities for progression, but also for regression. I was impressed by Occupy which did not show the same degree of narcissistic regressive trends so evident in “the Movement” in the sixties. While awareness of the potentially dangerous regression to which we are exposed when established authority breaks down can lead to conservatism, it can also lead to a more cautious radicalism, alert to and on the lookout for regression. After the Tsar comes Stalin; after 1950s conservatism comes 60s radicalism and the Manson Family. This is not an argument against progressive change, but an argument for realism and alertness to the constant regressive tendencies in human nature. Freud taught us about this. Unfortunately it’s a lesson reactionaries use as an argument against radical change, but it need not be used this way, and we cannot afford to ignore it.

While Freud may have supported people who called themselves social democrats, I think most or many of those people were liberals as, at times, was Freud. He was for a certain amount of income redistribution and supported free clinics for the underclass. He says that having once been poor himself he can sympathize. But this doesn’t alter his view of the proletariat as stupid, lazy and oversexed, or make him in any sense a Marxist. In several places Freud, the liberal, offers trenchant critique of Marxism. In other places (“Group Psychology”) Freud contributes to the kind of anti-democratic thinking that fears “the mob” might get carried away and storm the Bastille or make a revolution.

I’m less focused on Freud’s party affiliations and his personal behavior (charitable acts, etc.) than by what he wrote in “Group Psychology,” “Civilization and It’s Discontents,” the “New Introductory Lectures,” etc., where he expressed anti-Marxist views and attitudes that are typically conservative, even reactionary: civilization is a thin veneer and strong leaders and authority (superego) are necessary to keep the ever-present barbarian threat (the id, the mob) under control. Freud was a product of the Austro-Hungarian Empire and had no real experience of democracy and, like his mentor Plato, he didn’t much like it. Marx called for a dictatorship of the proletariat. Freud called for a dictatorship of the ego over the other parts of the personality, assuring us that a dictatorship of reason would, by definition, be a reasonable dictatorship. Do we know of many reasonable dictatorships?

Primary Narcissism, Merger and Mysticism

Infant research has falsified Freud's notion of primary narcissism, undifferentiation (between I and not-I, self and other), unbounded and unboundaried oneness at the beginning. The evidence supports Klein's rejection of primary narcissism in favour of the idea of object relations from the start--that is, a primitive ego relating to primitive objects from the beginning. This is a major instance supporting the scientific status of psychoanalysis because it shows that psychoanalytic theory has been forced to abandon one of its main premises on the basis of empirical findings. The romantic notion of order developing out of chaos, twoness developing out of oneness, is dead, along with Margaret Mahler's related notions of autism and symbiosis as stages after which separation-individuation takes place. The later phases of Mahler's theory (practicing, rapprochement, etc., retain some validity, but autism and symbiosis as stages of development are gone.

This does have wide implications. Freudians use to think of psychosis as the breaking down of the gradually and painfully erected boundaries between self and other, leading to a falling back into a primoridal chaos that we now know doesn't exist. The Kleinians always had a different idea of psychosis--not as a falling back into chaos and undifferentiation, but as a consequence of pathological projective identification in which I'm putting so much of my self (in phantasy) into you, and introjecting so much of you (in phantasy) into me, that the result is I no longer know what's me and what's you. This is not a falling back into primordial oneness; it is a pathological state brought about by a pathological process. It is something that a patient does and therefore can potentially stop doing.

I think mystics have fallen victim to the wrong metaphor: the metaphor of oneness. They should have used the metaphor of connectedness. What they express in the metaphor of oneness (which they don't realize is a metaphor) is really an awesome experience of profound connectedness--as in the "butterfly effect" (so much is everything connected that a butterfly spreading its wings in the Amazon affects the weather in Toronto).

I did a ton of acid in the 60's and lots of weed too and I've had plenty of experiences of awesome connectedness, though nowadays I prefer to experience this with my wife rather than with substances.

At the beginning of his work on narcissistic disorders (later called self disorders) Kohut spoke of merger transferences along with idealizing and mirroring ones and called these "self-object" transferences, the hyphen indicating that the object was experienced as incompletely separated from or merged with the self. But he quickly dropped the merger transference in light of the infant research that was disconfirming oneness in favour of varieties of connectedness, and he redefined what he now printed as "selfobject" as an object not merged with the self but an object providing needed functions for the self.

Forget oneness. "Only connect." (E.M. Forster, Howards End).

Applied Psychoanalysis: Blues

"Sigmund Freud Today: What Are His Enduring Contributions?"

Lecture presented to the Oraynu Congregation for Humanistic Judaism,

October 22nd, 2006.

Freud Today

"Psychoanalysis is about a life relived with someone else; it is not about a 'story-told.'

A clinical history and a living experience are different forms of data having different potential functions."

--M.H. Horowitz