“Appreciating the digital lives of patients”

There is an increasing demand for us, as clinicians, to understand the digital lives of our patients. The framework I have come to employ in my practice is simple and, I think, not radical: to regard the patient’s relationship with the virtual world with the same curiosity, scrutiny, and compassion that one affords to their relationship with the corporeal one. This can be easier said than done, as there is substantial cultural and political noise that interferes with such a straightforward premise. Technologists, one on hand, espouse the transcendent nature of digital devices and media: how they make us better, smarter, and stronger. Conservative alarmists, alternately, decry our increased reliance on digital spaces as the decay of traditional values and an omen of society’s downfall: we are becoming antisocial, vain, and ugly — as though these qualities were new to the human condition.

As psychoanalytic psychologists it is our duty to maintain a heuristic of skepticism and see beyond the binary assertions of technology-as-savior or technology-as-destroyer, and instead focus on the paradoxical truth: digital space is both new and old, in that it provides us with novel ways to continue to be ourselves. As I have written about elsewhere (Kriss, 2016) with specific respect to videogames, the virtual world can offer a boundaried emotional experience akin to Winnicott’s (1971/2005) notion of potential space; a kind of proto-life in which experiences are simultaneously real and unreal, felt but not overwhelming. The fact of the matter is that all of our patients make some contact with this other world; we are symbiotically linked to it; parts of ourselves are uploaded to cyberspace as we curate our public personas, comment anonymously on articles and blogs, or simply play games idly on our phones. The question is no longer whether the digital is relevant to our patients but rather in what ways is it relevant.

Of course, this is not to deny that some people’s use of digital space is problematic. But understanding the nature of the problem — and therefore potentially making ourselves available to facilitate change — requires us to discard the simplistic cause-and-effect notions that technologists and alarmists propagate (technology leads to betterment or technology leads to disarray, respectively). We do this routinely with other aspects of psychic life, helping our patients to see beyond a reified sense of self. For instance, someone begins treatment with the narrative, “I am this way because my mother was cold and withholding, and as the past cannot be undone, I cannot change.” Is this any different from a mantra of “I am this way because I spend too much time looking at my phone, and as the digital world has sunk its claws into me, I cannot change”?

Much of the clinical discourse surrounding our relationships with digital selves occurs in the language of addiction theory: she is “hooked” on social media; he is “addicted” to the internet; they “can’t stop” playing this game. Crucially, the construct of addiction is centered around the idea that, while people vary in vulnerability depending on heredity and life experience, the addictive property lies within the thing itself. This is a compelling notion for substances like alcohol, nicotine, or cocaine — which chemically influence the brain to motivate future use — or even certain behaviors like gambling — which is specifically connected to the culturally valued promise of wealth acquisition.

Digital life doesn’t quite fit the bill. The internet is not a chemical you ingest, and thereby cannot exert immediate and consistent effects on the brain; nor do videogames promise material rewards that justify the amount of time so-called “addicts” put into them. The chief limitation to understanding digital addiction, then, is our use of the word “addiction.” It immediately frames the activity as a kind of infectious substance, obscuring what is really going on: compulsion. It is a small semantic change that carries a major shift in perspective. It is not the digital world which won’t release the individual from its clutches, but the individual who cannot bring herself to leave the digital world.

From a classical psychoanalytic perspective, a person engages in repetitive play as a means of recreating some trauma around which she feels “stuck,” in an unconscious effort to master the situation (Freud, 1920; Waelder, 1933). If playing fails to resolve her conflicted feelings, a compulsive loop can develop in which the person can neither abandon nor conquer the “game.” Each person has a unique reason for seeking solace in digital space, and sometimes this need is so intense that the behavior escalates to a level of pathological compulsion. But it is in understanding the internal motivation that relief can be found, not through condemning the digital world as inherently corruptive. For most people we treat, virtual space does not cause distress or play a significant role in their presenting problems; it simply occupies a portion of their psychic life, which, however big or small, should be seen as important by any empathic clinician.

WORKS CITED

Freud, S. (1920). Beyond the pleasure principle. S.E., 18, 3–64.

Kriss, A. (2016). The player and the game: Compulsion, relation, and potential space in video games. Psychoanalytic Psychology, 33(4), 571-584.

Waelder, R. (1933). The psychoanalytic theory of play. Psychoanalytic Quarterly, 2, 208–224.

Winnicott, D. W. (2005). Playing and reality. Abingdon, Oxon, England: Routledge. (Original work published 1971)

 

Reply

Karen Gilmore, M.D.

“We must make sense of our own times” (V Flanagan)

Alexander Kriss has written a timely plea for a more enlightened approach to our patients’ digital lives. He joins a number of clinicians, therapists, and psychoanalysts (including contributors such as Essig 2012, Lemma 2015 and myself (Gilmore 2017 in press; Meersand and Gilmore 2017, in press) in pointing out that the technocultural era is here to stay; indeed the daily experience of anyone living in our society is seamlessly mediated and continuous with digital space. There is no longer a distinction between virtual and actual. But like anything else, digital life can become an overwhelming focus, to the detriment of family relationships, school or employment, and physical well-being.  Kriss devotes a good part of his essay to an argument against the notion of internet/videogame addiction (which I will call IA), basing his contention on the absence of the chemical component that is the active agent in substance addictions. Like some researchers in the field (Aladwani and Almarzouq 2016), he prefers to describe excessive video gaming, social networking and the like as compulsions, distinguishing them from addictions by this designation.

Here he enters a debate that has a significant, albeit brief history in psychiatry and in the formulation of the DSM-V, where IA did not make the grade for an official addiction diagnosis. Heated controversy continues about this decision (see, for example, Pies 2009), especially as another behavioral addiction, gambling, was included among the addiction diagnoses. What is the argument in favor of the inclusion of AI? For one, in severe cases, interruption of usage can produce the array of behaviors associated with withdrawal. There is evidence that excessive users develop tolerance and that the activity has deleterious effects on schoolwork, job performance and relationships. There is also growing evidence that excessive immersion in video gaming (Han et al 2011; Ko et al 2009)), social networking (Vink et al 2015), and smartphone use (Liu et al 2016), to name a few examples, can produce brain changes consistent with other addictions. The literature from Asia has made this argument for many years, reporting smartphone addiction in infants, with characteristic brain changes (Park and Park 2014). There is no doubt that these activities produce altered mental states.

What is the advantage of calling these extreme users addicts? In my opinion, there is a considerable difference in the conceptualization and the treatment of the problem; Kriss’s description of the individual dynamics behind compulsions and the need to understand these dynamics are important, but working on this understanding, even with an insightful and cooperative patient, is of only limited benefit if the patient is addicted; it certainly does not treat the addiction itself. Addiction is the threshold problem that must be addressed in order work on psychodynamics. To quote a beloved in-patient psychiatrist, now deceased, no therapy is as good (and as immediately effective) as a drink. This applies to any addictive behavior that creates cravings, alters mood, induces state changes, produces withdrawal, and, of course, is perpetuated by compulsion. Addiction requires behavioral treatment; the dynamics can be addressed simultaneously or afterward.

 

Aladwani, A.M., Almarzouq, M. (2016) Understanding compulsive social media use: The premise of complementing self-conceptions mismatch with technology. Computers and Human Behavior 60: 575-581

Essig, T. (2012). Psychoanalysis Lost—And Found—In Our Culture of Simulation and Enhancement. Psychoanal. Inq., 32:438-453.

Flanagan, V.(2014) Technology and identity in young adult fiction: the posthuman subject. AIAA, 1841

Gilmore, K. (2017, in press) Development in the digital age: Introduction. Psychoanalytic Study of the Child.

Han, D.H., Bolo, N., Daniels, M.A. et al. (2011). Brain activity and desire for internet video game play. Comprehensive Psychiatry 32: 88-93

Ko, C.H., Liu, G.C.,Hsaio, S. et al.(2009) Brain activities associated with gaming urge of online gaming addiction. Journal of Psychiatric Research 43: 739-747

Lemma, A. (2015). Psychoanalysis in Times of Technoculture: Some Reflections on the Fate of the Body in Virtual Space. Int. J. Psycho-Anal., 96:569-582.

Meersand, P. and Gilmore, K. (2017, in press). Play therapy in the 21 st century. American Psychiatric Press Inc.

Park, C., & Park, Y. R. (2014). The conceptual model on smart phone addiction among early childhood. International Journal of Social Science and Humanity, 4(2), 147-150.

Pies, R.(2009) Should DSM-V designate “internet addiction” a mental disorder? Psychiatry (Edgmont). 2009 Feb; 6(2): 31–3)

Vink, J. M., van Beijsterveldt, T. C. E. M., Huppertz, C., Bartels, M., and Boomsma, D. I. (2016) Heritability of compulsive Internet use in adolescents. Addiction Biology, 21: 460–468.

 

“Response to Comments by Gilmore”

Alex Kriss, Ph.D

 

While my original piece focused on theory, Karen Gilmore brings up the equally important issue of technique. I agree with her wholeheartedly that for many suffering from digital compulsions, behavioral intervention may be a necessary first step to successful treatment. As with any acute situation, serious problems in daily functioning must be remediated before more reflective understanding can develop. I disagree simply with Gilmore’s suggestion that in order to engage with behavior and symptoms on a technical level, one must favor addiction over psychodynamics on a theoretical level. My argument is not that problems with digital life should only be addressed through formal psychoanalytic techniques such as interpretation, but that regardless of technique it is essential for the clinician — and ultimately the patient — to appreciate the problem’s point of origin.

 

About the Authors

Alexander Kriss, Ph.D. is a clinical psychologist and writer. He serves as an adjunct professor at Fordham University and clinical supervisor at The New School for Social Research and the City College of New York. For more information on Dr. Kriss’ private practice, visit www.alexkriss.com

Dr. Karen Gilmore is currently a Clinical Professor of Psychiatry and Senior Consultant at the Columbia University’s Center for Psychoanalytic Training and Research. She is the founder and past Director of its Child Division. She is a Training and Supervising Analyst at the Columbia institute. She is the author of a number of papers on development and co-authored two books on the topic recently published by American Psychiatric Press and Oxford University.

 

Clinicians Reading Research: Outcome Trajectories and Mediation in Treatments of Major Depression

Klug, G., Zimmerman, J., and Huber, D. (2016).  Outcome trajectories and mediation in psychotherapeutic treatments of major depression.  Journal of the American Psychoanalytic Association, 64, (2) 307-343.

 

Imagine my surprise to open the Journal of the American Psychoanalytic Association this spring and to find an article filled with numbers and comparatively little in the way of text.  Had I gotten the wrong journal by mistake?  No, I think APsA is embracing research.  This particular article by our friends in Germany, Gunther Klug, Johannes Zimmerman, and Dorothea Huber (2016) is the third report on a research study comparing patients who were randomly assigned (based on a diagnosis of moderate to severe depression without psychosis) to one of three treatments with therapists experienced in the approach – 35 in psychoanalysis (PA: defined as meeting two to three times a week and using the couch), 31 in psychodynamic psychotherapy (PD), and 34 in cognitive behavioral therapy (CBT).  While I don’t intend to mirror the JAPA article by including lots of numbers, I actually found it helpful to know that the length of treatment varied between the groups: PA lasted on average 39 months (range 3-91) with an average of 234 sessions (range 17-370), PD averaged 34 months (range 3-108) with 88 sessions (range 12-313), and CBT lasted on average 26 months (2-78) or 45 sessions (7-100 range).

I think psychoanalysts are “suddenly” interested in outcome research because we feel pressed to demonstrate that what we do is effective.  We believe – and I don’t know that it’s true – that if we have evidence that our treatments work, there will be third party payer support for those treatments.  So papers like Shedler’s “The Efficacy of Psychodynamic Psychotherapy” (2010) have been welcomed with open arms.  We want to be able to demonstrate, objectively, that what we do works.  What is less clear is that we want research to guide the way that we do treatment.  We have always relied on clinical lore, theory and intuition to guide our work – along with our native and learned communication skills.  Clinical lore and theory are built on our collective wisdom, hard won, based on closely attending to the process of treatment, hypothesizing (and asking) what the active treatment elements have been, and trying to pass along that wisdom while simultaneously expanding it.  To have a researcher, based on numbers, tell us how to engage in something as intimate, human and non-mathematical as a clinical interaction seems like anathema to some of us.

Well, this paper (and the other two papers in this series) straddles the fence – it both helps us make the case that what we do is valuable and it takes a peak under the hood to see what might be causing the good outcomes that we have.  All three treatments resulted in a dramatic reduction in symptoms during the first six months with steady, but not so dramatic reductions continuing throughout the duration of treatment.  Partly, I think, the reductions in rate of change are less dramatic after the first six months because, for instance, on the Beck Depression Inventory (BDI), symptoms have been cut in half on average in that time, and there simply aren’t enough symptoms left to continue abating at the initial rate.  In any case, it is intriguing that, post termination, the symptoms of the patients treated with PA continued to decrease, something not seen with the PD or the CBT group.  The differences were greatest with the CBT group – post termination PA patients had, on average, a 6 point lower endorsement of BDI symptoms.

OK, good.  Not only are we as good as the competition, when we look down the road, we are doing a little better (the PA results did not differ from the PD results which did not differ from the CBT results – they were in that order, but only the PA results were significantly different from the CBT results).  But this study wanted more than just to demonstrate the differences between the response to the different treatments – they wanted to demonstrate why those differences occurred – a loftier goal.  We might opine that the post treatment results occur because of the internalization of the analytic process as a result of the identification with the analytic functioning of the analyst – and this was indeed the hypothesis of the experimenters (in fact they cite Freud (1937), Horney (1942) and Hoffer (1950) to support this idea) – but how would we demonstrate that to have been the case?  They also point out that it could be that the patient could have learned to self-soothe or has internalized positive experiences with the analyst – rather than that it being the analyzing function that is internalized.  And, frankly, it is my guess that it is a bit of all of these and more – in different proportions for different people, which makes it hard to parse out one particular element in an experimental paradigm.

The authors tested their hypothesis indirectly – they didn’t measure internalization of analyzing function, but the level of alliance that the patient felt with the treater (and the treater with the patient) as a kind of stand in for internalization, and then measured whether there was a mediating effect of alliance.  That is, in those patients with greater alliance was there also a greater post treatment improvement?  They also included a measure of self-love vs. self-hate.  The results were tantalizing, but not significant, which was somewhat surprising as this result had been reported in three prior studies, but which was to be expected with a sample size that was this small.

Why might it be that these results are not significant?  Our interventions are manifold – the interactions with our patients include much useful and not so useful stuff.  We work to craft them, to help this particular patient with this particular problem and this particular mindset learn to be more open to themselves or to think differently – perhaps more broadly – about this particular issue.  And we come at that from various angles over the course of a treatment.  When we ask a patient or a therapist to give a global assessment of the level of alliance, that includes some sense of whether they feel that they have been on the same page as the interlocutor, but it doesn’t necessarily mean that they have “taken in” the therapists way of approaching problems and are ready to apply it on their own, but it might.  On the other hand, I’m not sure that we generally ask of our patients if they have done this – though we can sometimes see them doing it.

How is it that we might have been able to divine something clinically – from a smaller sample than 25 patients – that doesn’t show up in at least this test?  Many times I think it is our own experiences of our own analyses that inform us – perhaps more than we know – about what will be useful to our patients.  Despite that, at least in my institute, few of us talk directly about them in unguarded ways.   I think that we may attribute something to our patients that may be coming at least in part from our own experience and we need to bear in mind that our own analyses are of a particular kind – they are training analyses – and we are consciously intending to internalize the analyzing function.  We want to emulate our analysts.  This may privilege a component of the treatment process in our own minds – one that is likely present to some degree in all analyses.  For the impact of internalization to be statistically significant with a sample size of this magnitude, given that the measure is pretty indirect – the impact of internalization – or the related strains (certainly a positive experience with the therapist would have supported the mediation hypothesis in this design) – would have to be quite high.  The salience may not be as high in a group that is in treatment primarily to obtain symptom relief, not to learn to do analysis, even though the internalization of the analytic function may be occurring.

We have a result – the “most analytic” group continued to improve symptomatically post treatment.  We have a likely causal agent – the internalization of the analyzing function.  And we have a sophisticated design to test the relationship between the two.  In so far as internalization is an important element of the improvement in functioning of our patients, it is one strand in a complex tapestry and it is likely that many things are contributing even to the post treatment improvement.  It may be that we have elevated the influence on one likely factor (one that does appear from other studies and from the “promise” of this one to have some validity) and it may be that there are other sustaining factors that may not be as salient to those of us who have had a training analysis.  Another point of view is that it is in some sense surprising that we are able to divine – through clinical intuition guided by and guiding theory, or through research techniques – the manifold slender threads that are inter-related that lead to good treatment outcomes – as well as to divine those things that are less helpful – indeed toxic elements – in the treatment process.

 

Freud, S. (1937).  Analysis Terminable and Interminable.  Standard Edition 23:216-253.

Hoffer, W. (1950).  The three psychological criteria for the termination of treatment.  International Journal of Psychoanalysis  31:194-203.

Horney, K. (1942).  Self-Analysis.  New York: Norton.

Klug, G., Zimmerman, J., and Huber, D. (2016).  Outcome trajectories and mediation in psychotherapeutic treatments of major depression.  Journal of the American Psychoanalytic Association, 64, (2) 307-343.

Shedler, J. (2010).  The efficacy of psychodynamic psychotherapy.  The American Psychologist, 65(2), 98 –109.

 

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

 

 

Clinicians Reading Research: Sydney Blatt’s Developmental Theory of Depression

Blatt, S. J. (1995).  The destructiveness of perfectionism:  Implications for the treatment of depression.  The American Psychologist, 50, 1003-1020.    http://psycnet.apa.org/journals/amp/50/12/1003.pdf.

 

The intent of this space is to highlight research and its implications for clinical practice.  When we envisioned this space, I, at least, thought that we would be looking at the current research literature – and I expect that much of what we review will be from the current literature (indeed, other entries – see here and here- are).  But Sydney Blatt’s work, work that I was not exposed to during my training, is so compelling that I do think it deserves mention.  Since I was not exposed to it, I’m not sure that this paper is the best representation of it, but I do think it articulates some basic ideas that may have been fleshed out later in slightly different ways.  I also think there may have been more compelling data that he later produced that supported the importance of long term depth therapy, but I (admittedly an easy mark) am quite convinced by what he references in this paper.

Blatt’s central premise in much of his work is that there are two kinds of depression – a dependent style, which Blatt calls the anaclitic, and a self-critical style, which he calls the introjective.  Blatt articulates in this paper – and doubtless elsewhere – that these styles are empirically supported and that they grow out of a theoretical assumption about a continuity between normal reactions to inevitable life events and reactions to severe disruptions.  These events cluster around two developmental poles – building interpersonal connections (or failing to do so) and creating individual and autonomous competencies that the person has confidence in (or failing to do so).  In this developmental model, when things go well, a positive, self-reinforcing spiral takes place in which increased interpersonal competence and confidence leads to increased abilities to take on and succeed at tasks independently.  When things go poorly, a similar, but much more destructive spiral ensues, where interpersonal failure undermines the capacity function independently and vice versa.

Despite the interrelationships between the two tasks, Blatt observed that there are distinct clinical presentations depending on how the trauma has been experienced.  Anaclitic depression, the dependent style, is characterized by a profound sense of loneliness, and a consequent sense of need for connection.  The person feels, especially when unsupported, helpless and weak.  They seek others out in order that they can get their needs for support, succorance, and love met by them.

Introjective depression – the autonomous kind, on the other hand, is characterized by intense self-criticism and there is frequently, then, an intense drive for achievement to offset the internalized sense of inferiority and self-scrutiny.  These individuals can be extremely critical of others as well as themselves and can be intensely competitive, often achieving a great deal, but with little sense of satisfaction – no amount of external validation seems to satisfy the harsh and demanding person that they can be in relationship to themselves.

One reason that I like this paper in particular is that Blatt is taking what he knows and applying it more broadly.  He starts by referring to three publicly described cases of perfectionism that resulted in suicide, including Clinton’s deputy counsel, Vincent Foster, someone whom many had considered a potential future Supreme Court Justice.  Blatt makes the case, based on evidence he provides, that these individuals would likely have benefited from long term intensive treatment – and, interestingly, were not likely to have received similar benefit from either short term care or from psychopharmacological treatment.  He nicely describes these individuals, their strengths, and what they had to offer society, and then deftly weaves their perfectionism into his system of organizing pathology.

He then goes beyond this to use this system to organize a variety of pathological styles, making a case for using this dichotomy to organize our system of pathology.  The nice thing about this is that it is not an empty exercise in putting things into boxes, but it has clear clinical and treatment implications – what kind of treatment are patients in the two groups likely to best respond to?  This kind of hypothesis is then testable – and we are off to the races – including being able to justify the expense of psychoanalytic treatment in certain cases.  If we are ever to move away from people getting the treatment they need through paying for it themselves (and, fortunately, those introjectives who are reasonably successful are those who are most likely to be able to afford longer term treatments) – but his point is that this is a societal value.  We should also question whether a more supportive and action oriented treatment like DBT or more supportive psychodynamic treatments might be more successful for some of our patients – particularly, as I read it, for the more Anaclitic/Dependent patients.

While I have not yet given this paper to a client (though I may at some point), I have integrated it into my psychopathology syllabus for the current candidate class at our institute.  I hope that they profit from it.  I think that being able to use a diagnostic understanding to help us think about how best to meet the needs of a particular patient so that we can help get them back onto a developmental track makes this research clinically useful.

 

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

Neighbourly Love and the Trump Effect

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

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

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

*          *          *

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

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

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

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

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

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

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

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

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

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

FOOTNOTES:

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

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

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

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

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

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

REFERENCES:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Psychoanalysis Is Scientific

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

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

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

Healing, Science and Philosophy

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

History

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

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

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

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

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

Critical Realism

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

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

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

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

Reductive Causality vs. Emergence

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

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

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

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

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

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

Over-determination, “Multiple Function,” Parsimony

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

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

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

Free Will

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

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

Modesty, Ambition and Progress in Science

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

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

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

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

Best Evidence; Convergent validity

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

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

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

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

Epistemophilia and its Discontents

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

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

What do practitioners consider the most helpful personality taxa in understanding their patients?

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

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

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

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

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

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

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

Footnotes

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

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

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

References

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

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

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

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

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

Regarding Fundamentalism: Few Comments on the One and the Other

During an anti-US protest in Bangladesh in October 2001, the demonstrators carried large banners in support of Osama bin Laden. On some of these posters, Bert, one of the Muppets of Sesame Street, was shown peeking from behind bin Laden’s left shoulder. The connection caused some perplexity: the West’s public enemy number one was shown alongside a children’s character loved by the American media and a mouthpiece for American values.

If it is true that all types of fundamentalism share protesting and reacting against change, resisting the modernization and secularization which they regard  as a threat to the very roots of their alleged “cultural identity”, it is also true that, as the above example shows, the contamination they resist so furiously has always already happened. We see this in the weapons that the fundamentalist fighters use, in the different media technologies they employ, in the banking system where they invest their money, in the racist slogans borrowed from the very cultures they are fighting against and so on. Fundamentalists are an integral part of the world they condemn and they make ample use of its resources and customs.

Given that each fundamentalist considers himself the guardian of a certain orthodoxy bound to protect his identity, as well as the identity of his group, it is  useful to examine the topic of “cultural identity” in more details. The notion of “cultural identity” hearkens back to the historical and cultural baggage specific to a given social group, which most of the time shares the same language, and includes the traditions, experiences, rules, values, habits and know-how that are related to the way in which the group maintains and organizes itself, treats its members and behaves towards its geographical environment. The notion was at the basis of the modern concept of the nation, which went hand in hand with the assertion of the principle of popular sovereignty and the introduction of the new conception of the state. Following the 18th century revolutions, the legal adoption of natural law (the philosophical doctrine which attributes to man certain natural and inalienable rights, freedom and equality) implies an understanding of the state whose power is no longer absolute but limited. Based on an individualistic view of society, the state is now considered a function of the individual and the individual no longer considered a function of the State.

History indicates that the notion of “cultural identity” is by its very nature in flux; it is inhabited by constant transformations, which reflect the changes in the social bond and in the individuals that belong to it. Cultural identity maintains an unstable equilibrium between tradition and transformation. It is by definition an aspheric idea, as it is always the case in the domain of ‘identity’. On this matter, psychoanalysis has much to offer. It has shown that the process of identification relies on a structural alienation. As Lacan points out, the emergence of the subject of the statement necessitates a passage through an undefined subject and a reciprocal subject, which are logical agencies within the collective. Through  a specific context (symbolic, imaginary and real); through language,  lalangue and the primary affective environment where the exchange with the other inscribes jouissance in the body; through  the identifying with the expectations and fantasies of the child’s caretakers, the elements of a primary cultural identity, which is at the same time a subjective identity, are articulated. The exchange with the other is by definition a transmission, since it carries within itself, as Lacan puts it, the sound deposits (“dépôts sonores ) of “the ways in which a group handles its unconscious experience”.

What we call “culture” is a social bond infused with the subject’s libidinal and affective relationships to the collective from which the subject originates, whose resonances we will continue to carry throughout our lives. The feeling of belonging to a specific cultural identity provokes immediate affective responses: whether it is nostalgia, joy, shame or rejection. This is inevitable, given that it results from an “operation” of identification that had initially mapped out the territory of the subject’s  drives and structured his relationship to the world. However, based on these premises, the identificatory process continues to operate throughout a lifetime, depending on our social life and standing, on the historical context in which we live, on our work and studies, our health, interests and so on. Always in a state of becoming, cultural identity includes both the idea of a community of kin and the ideas of plurality and difference. In this sense, the way in which the term is used — and abused–- by all those who would like to turn it into a finite set of specific characteristics, which could be counted and determined, is quite paradoxical. It is a contradiction in terms, a hypostasis of sameness: a cult of the One that contradicts the divided nature of the subject of language and serves as a basis for nationalist, racist and segregationist claims.

In relation to this, we remark that the larger the need to adhere to a pre-established identity, the stronger the necessity to manifest this need,   the weaker  is the subject that is expressing it. This is the case, for example, with many young people during adolescence, when the need to separate oneself from one’s original environment and become independent, as well as the need to give meaning to the problems of existence, can result in one’s joining all kinds of identity formations, which are often fetishized or radicalized. The vulnerable subject finds support in identifying with a group, in which, as Freud has shown, putting a person, thing or ideology in the place of the ideal, fosters the libidinal ties among members and strengthens the feeling of belonging. The result is often a homogenization and uniformisation, a bracketing of subjective responsibility and sometimes a blind obedience to the rules dictated by the ideal. By giving the individual a sense of certainty, the group masks the subject’s own insecurity and restores a feeling of unity that is by nature fleeting. Let us note that the more the symbolic context is lacking (lack of recognition and social integration, lack of education, affective isolation, segregation, marginalization and so on), the more unstable is the subjective image and the sense of self. The ego responds to this instability with a defensive rigidity, a paranoiac turgidity, which easily leads to aggressiveness, violence and self-destruction. Hatred is triggered by the ego’s reaction to the very alienation that constitutes it. Responding to the transitivism with the other inherent in the operation of identification, hatred reacts to one of the forms of the subject’s ex-sistence.

Often, the group exploits the subject’s paranoiac tendency and legitimizes it, turning it into the substance of a collective revolt against “the other”, “the outside”, “the enemy” – whose function is to consolidate the group’s identity. Leaders take advantage of the individual weakness to reinforce the group’s cohesion, obtaining in this way the submission of its members. This submission relies on manipulating individual libidinal drives, which are allowed to roam free in the service of a common ideology, whether the individual is rewarded or gratified, thus boosting his narcissism, or by allowing him to kill, rape, dominate, humiliate and so on, thus satisfying what Freud called Murderlust.

Resorting to cultural orthodoxy as a guarantee of total identity is both a mark of weakness and a very precise attempt at manipulating the social bond. In this context, we should distinguish between the two concepts of nation and nationalism. It is interesting to note that when a people recognizes itself as a “nation” (from the Latin verb nasci, “to be born”), it does so based on the construction of a collective memory. The latter is not necessarily derived from factual elements; it can include both facts that have actually occurred and myths and legends. All of these elements make it possible to characterize a given social bond as distinct from another. Based on the meaning of the received tradition, such a construction retroactively assigns a function to what the group itself defines as its historical baggage, depending on the requirements of the present-day community. This shows how memory, by turning backwards, is constructed in a forward fashion. This is a process of identification and selection, which, by linking together factual and imaginary elements, ensures that its own history is only to be constructed in the encounter with difference.

If by “nation” we mean a cultural community of territorial relations of kinship, where the notion of kinship structurally implies the idea of difference, we must distinguish this concept from both the “state” and from the ideology we call “nationalism.” A “state” designates a structure exercising sovereignty over a given territory, through institutions that promulgate and maintain certain laws and govern the relationships between individual citizens. A nation can become a state, but a state can contain different nations; the two concepts, one cultural and the other legislative, do not overlap. On the other hand, “nationalism” denotes an ideology (and a relatively recent one, if we think of Johan Gottlieb Fichte’s 1808 Reden an die deutsche Nation), which is founded on 1) the opposition between one nation and an other (which can emerge even within the structure of a single state) and 2) the support of a single, systematic vision unable to tolerate difference. In this sense, nothing is further away from the idea of a nation — a community within kinship — than nationalism.

This is worth keeping in mind because in many cases, past or present, the appeal to nationalism destroys the nation’s cultural identity. Nazi Germany was a macroscopic example of this. The invention of the Aryan race and its mythology, the apex of an identity construction whose elements were over determined by a very precise political and economic project, tore to pieces the social fabric of between the wars Germany, destroying its pluralistic cultural identity and dismantling certain aspects that were crucial to the complexity of its history. The cult of the One leads to totalitarianism, and thus to the disintegration and abolition of the cultural specificity of its followers.  In this sense, the attempts to systematically eliminate certain elements of one’s cultural heritage show the radical bias of the vision that sustains it, the way in which the weakness of an ideology masks its true aims, which have nothing to do with a collective identity but strive instead to obtain political and economic power by oppressing the masses through sanction and terror. As an example, we can think of the many “cleansing” campaigns which have been carried out over the centuries in the name of a credo or an ideology, in different cultures and places around the world.

And yet, we must distinguish between the past and current ways of attacking the cultural heritage of a given people. If various forms of fanaticism and millenarianism existed over the centuries, fundamentalism is of a recent date. Fundamentalism is inextricably linked to the history of the modern and industrial world, to the transformation of the class structure, to colonization, to the development of science and new technologies, as well as to the rise of, precisely, a new conception of the state inspired by the Rights of Man. The term itself is derived from The Fundamentals: A Testimony to the Faith (1910-1915) of the American Baptist Church, which advocated a return to the dogmatic foundations of faith, contrary to both modernism and the Evangelical theological rationalism. In order to defend the Protestant faith against the reformed tradition, Christian fundamentalism gained a foothold by attacking other forms of Protestantism, liberal theology, “Romanism” (Catholicism), socialism, modernism, atheism, evolutionism and so on and so forth. According to their nationalistic base, the values embodied by the conservatives in small American towns and villages expressed the “authenticity” of the nation, in contrast with the alleged depravity of urban modernism — epitomized by woman, sexuality and alcohol.

As an expression of change in modern society, fundamentalism must be distinguished from other forms of pre-modern fanaticism. Here, the fetishized, literalist and absolutist return to a supposedly “sacred” text — seen as an expression of the divine word and a guarantor of a monolithic world vision — takes on the form of a paranoiac convulsion as a reaction to the hostility or the transformation of local conditions. Such conditions are part of a social reality in which the foreign has already gained control. It is impossible to ignore the fact that the present-day manifestations of fundamentalism are also expressions of globalization, the development of human rights, the free movement of ideologies, the speed of information as well as the transformation of the neoliberal economy, which has developed thanks to factors such as the supranational powers of investment.

As the vicissitudes of its name illustrate, ISIS deliberately makes a reference to the idea of the state. It has proclaimed a program of territorial conquest (following the slogan “Consolidation and expansion”) based on a totalitarian state as its preliminary condition. Its aim is to subjugate nations conquered by force, to “denationalize” them in order to align them with a law that is imposed through the systematic destruction of the specificities of the subjected groups, and of the cultural reference points underpinning their national images. Following the Wahhabi slogan revived by Abu Bakr al-Baghdadi (named ‘Caliph’ by ISIS in July 2014):Those who would not conform to this view should be killed, their wives and daughters violated, and their possessions confiscated.”

Hannah Arendt observes that totalitarianism is an expression of the mass society and a form of power that differs from both despotism and tyranny: it implies a systematic destruction of the existing social, political and legal traditions, and imposes a regime of terror, which makes ideology into a principle of action. These applied ideologies, Arendt remarks, are “-isms” which to the satisfaction of their adherents can explain everything and every occurrence by deducing it from a single premise – a comprehensive explanation of reality, which can interpret any political act as a secret conspiracy and encourages both the acting out and the enjoyment associated to it. What is particular to the mass crimes such regimes perpetrate, is their attempt to strike at and abolish the symbolic universe of the victims; it is a will to deprive them of their cultural heritage and identity – as it was the case in the “final solution.” The cult of the One brings out the passion of hatred that aims at the other’s being, at the other’s uniqueness and history, and tries to abolish its symbolic environment – whether the target is the body, art, architecture, books or habits.

In this context, it is no accident that fundamentalists of different cultures share one common target: women. According to Lacan, hatred as a passion is what comes the closest to the ex-sistence of the speaking being [parlêtre]. It is a response to the subjective division expressed through the act of speaking in the structural discordance between knowing and being; a division manifested on the side of speech closer to the subject’s eternal exile. It is a response elicited by the encounter of the limitations of the Symbolic in face of the Real. Which brings up the irreducible aspect of the encounter with difference and its traumatic quality. It is not by accident that Freud makes the refusal of femininity (Ablehnung der Weiblichkeit) a key factor in the subject’s resistance to his or her own truth, regardless of one’s sex.  The unrelenting fight against femininity, the desire to subjugate it, to reduce it to nothingness, shows the unbearable character of the confrontation with a difference that is, in fact, an encounter with one’s own difference and division. The “love of the whole” — the belief in a phallic, imaginary, turgescent completeness — shows its fundamentalist tendencies, its terroristic implications, as a result of the denial of subjective ex-sistence.

Related to the structural exile of being, hatred aims at the irreducibility of the One within difference. The Other cannot be added to the One; the two can never be complementary – quite the contrary, the Other differentiates itself from the One, emphasizing its intrinsic discordance and undermining the dream of an ideal and satisfying complementarity.

October 2015

Paola Mieli, PhD, is a psychoanalyst in New York, President of Après Coup Psychoanalytic Association, NY.

 

Sick Bodies, Hysterical Pregnancies, ISIS Wives

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

***

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

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

 

 

The Activist Core of Psychoanalysis

Is Psychoanalysis Revolutionary?

As a feature of IPTAR’s year-long exploration of this question, the Institute held a colloquium on November 14, 2015 with a presentation by Dr. Elizabeth Ann Danto and two respondents, Dr. Martha Bragin and Elizabeth Cutter Evert. Titled “The Activist Core of Psychoanalysis,” the well-attended event was held at the New School for Social Research and honored the 10th anniversary of the publication of Dr. Danto’s book “Freud’s Free Clinics – Psychoanalysis and Social Justice.” In fact, Freud’s 1918 speech that inspired the development of at least 10 out-patient clinics throughout Europe, also marked the presentation’s start. The Berlin Poliklinik’s innovations (many of which are still discussed today) were of particular interest to practitioners because they ranged from length of treatment guidelines to fee setting, from record-keeping to time-limited analysis. Patients of all ages and social classes, ranging in occupational status from professional to unemployed, were treated gratis and, contrary to popular wisdom, men and women were treated in roughly equal numbers. A 1924 photograph of the Vienna Ambulatorium staff showed just how many of the free clinic analysts were exiled barely a decade later. Among those who later shaped American clinical practice were Richard Sterba and Editha Sterba who went to Detroit, Annie Angel-Katan who took child analysis to Cleveland, and Eduard Hitschmann who joined Eduard Bibring and Grete Bibring in Boston. In the 1920s and early 1930s, these analysts saw themselves as brokers of social change for whom psychoanalysis was a challenge to conventional political codes, a social mission more than a medical discipline. There too were Annie Pink Reich and Wilhelm Reich who, after leaving his position as assistant director of the Vienna clinic in 1927, set up his own clinical network called Sex-Pol – an abbreviation for Sexuality and Politics – in his influential belief that analysis liberates the individual from inner oppression and releases the flow of natural energies, so too the political left frees the oppressed and releases their innate capacity for self-regulation.

The end of the first generation of free psychoanalytic clinics came on March 12, 1938, as thousands of bayoneted German Wehrmacht troops marched the conquering Nazi flag into Vienna. In the great wave of intellectuals forced into exile, Anna Freud took up her father’s mantle of providing mental health care – and more – to indigent children and their families at her War Nurseries in London when World War 2 broke out. But the mantle was not only her father’s. Anna Freud had come of age during Austria’s First Republic, in the period known as Red Vienna, where the social democratic vision of creating a better society was actually carried out and social welfare the dominant ideological framework. In this context in 1927, Anna Freud along with her partner Dorothy Tiffany Burlingham, as well as Erik H. Erikson and Peter Blos, built the experimental Hietzing School and worked out some of today’s most enduring theories of human development along with a new pedagogy based on evolving ideas about childhood and psychoanalysis. As Sigmund Freud wrote in Civilization and its Discontents, “the replacement of the power of the individual by the power of a community constitutes the decisive step of civilization.” Now that is revolutionary.

 

Response from Elizabeth Cutter Evert

In the Freudian Tradition: IPTAR’s School-based Psychoanalytic Services

Hearing about Freud’s free clinics has been an experience in kinship. I recognize, with both excitement and an awareness of our responsibility to continue this work, how the psychoanalytic community has struggled with questions of social and political responsibility for generations. Dr. Danto describes the free clinics that blossomed between the world wars, as arising from the early analysts’ social and political engagement. The ultimate arc of the story is dark, however, with the rise of the Nazis, forced emigration of the analysts, the cooptation or closing of the clinics, and the marginalization of people who cross-fertilized politics, social responsibility and psychoanalysis. Fortunately, we have a “free clinic” here at the Institute for Psychoanalytic Training and Research (IPTAR) in New York City, where our on-site school programs take their place in a proudly progressive history.

The IPTAR Clinical Center, or ICC, opened in 1993 to provide high quality mental health treatment to New Yorkers who might not otherwise have access to it, and to give IPTAR candidates clinical experience. ICC offers psychoanalysis and psychotherapy on a sliding scale with a commitment to work with patients for as long as treatment takes. Over time, the ICC has become a laboratory of sorts where clinicians have experimented with a range of psychoanalytic concepts for working with patients from different backgrounds, with different struggles. In community agencies, homeless shelters, private apartments and offices, members of the Anni Bergman Parent-Infant Program extend psychoanalytic parent-infant therapy to at-risk infants and their parents who come from backgrounds of poverty, abuse, drug addiction, war, and mental illness.   In IPTAR’s Asylum Seekers program therapists of all levels of experience offer pro bono services to individuals at risk of being tortured or abused in their home country. Over the past fifteen years, IPTAR’s On-Site School Program has forged partnerships and run therapeutic programs in five schools that serve children from New York’s most socioeconomically challenged backgrounds.

To say that the programs are psychoanalytic, reminds me of Hans Loewald’s On the Therapeutic Action of Psychoanalysis (1960). He writes:

The analyst, through the objective interpretation of transference distortions, increasingly becomes available to the patient as a new object… [This] requires an objectivity and neutrality the essence of which is love and respect for the individual and for individual development. This love and respect represent that counterpart in ‘reality’, in interaction with which the organization and reorganization of ego and psychic apparatus take place.

Similarly, by offering something intensive enough to be clinically meaningful, we aim to leverage a world of new external objects in order to facilitate children’s discovery of a world of novel internal objects. In the elementary schools, individual play therapy is one to four times a week, with frequent consultation with parents and teachers. In the middle schools, we rely more on work in groups. Probably because of the gaps in emotional traction between traumatized adolescents of color and middle aged professional white women, we found interpretations made within the group from one member to another to be the most mutative.

It has been interesting to watch how, like us, the early analysts struggled with funding and statistics, donated services, and the search for public and private money. Our pro bono work has become more challenging in the last fifteen years.   Today, with mental health parity and the Affordable Healthcare Act, either IPTAR or a consortium of psychoanalytic institutes could apply for a NYS Office of Mental Health license to fund our programs in perpetuity. After all, just as Eitingon and Fenichel kept meticulous hand written charts and statistics, we could document the effectiveness of the psychoanalytic model – particularly as New York becomes more of a hub for traumatized refugees.

In closing, we cannot forget the dark part of the story. It seems to me that, at least among the New York institutes, we are still caught in the marginalization of social and political responsibility in psychoanalytic dialogue. Whether as psychoanalysts or as psychologists, we must reflect on the real dangers of abdicating moral responsibility in the public sphere. Even in the privacy of our offices, we rarely interpret the place of our patients’ denial of social or political responsibility within their suffering.

Over the past year, I have been intrigued by the stories of European and American young women, with families and excellent grades, now drawn to ISIS. How we would work with her in the schools? I hope we would dare to move with her into the complex moral, spiritual, political, and socioeconomic issues that face us all.

 

Response from Martha Bragin, PhD

Psychoanalysis as Liberation Psychology – Remarks in Appreciation of Elizabeth Danto

It is a great pleasure (and a great difficulty) to follow Dr Danto; she has made visible the liberatory and democratic aspects of work we knew to be freeing, but lacked evidence of the progressive roots of psychoanalysis. I will pick up on two points from Dr Danto’s lecture: one, that the psychoanalytic project can be seen as a liberation psychology, and two, that psychoanalytic work is at once personally and socially transformative by nature. I will draw on thinking from Latin America and Sub-Saharan Africa.

Indeed, starting two decades before the era of the free clinics and reaching through the first World War, Freud saw that the source of his patients’ difficulties lay neither in their individual impulses nor in the facts and circumstances of abuse and violent conflict (Freud, SE 1, 1896; SE 17, 1919). All too often, the forbidden thoughts and feelings evoked by social violence were left unsymbolized and cast out of conscious examination, essentially dooming the wounded to a lifetime of repressed knowledge – of exactly how terrible the world can be (Bragin, 2007, 2010). The psychoanalytic clinic would be a liberatory space in which experiences too unbearable to remember, along with the internal meaning of external events, could be evoked, shared with another, and in that process symbolized and transformed.

Alternate Journeys, Alternate Learning

While most of the analysts had to flee Germany and Austria in the 1930s, only some of the overtly “politicall” analysts could actually immigrate. One of those who could not was Marie Langer. As a participant in the Spanish Civil War’s International Medical Brigade, Langer did not expect to obtain asylum in England or the United States, and so fled with her husband to Argentina where she co-founded the Argentine Psychoanalytic Association (Hollander,1997).. Psychoanalysis was taught from a Kleinian perspective in Argentina Melanie Klein’s graphic, symbolic ideas and her acceptance of human violence resonated with a culture where European thought mixed with imagery from earlier civilizations, and where vivid depictions of their predecessors’ violent destruction adorned churches and public squares. Yet, motivated by social conviction and clinically trained in Europe, members of the new Latin American Analytic Societies practiced psychoanalysis in free and low cost clinics in working-class urban neighborhoods, and among the poorer rural populations. The associations emphasized training with a dialectical approach that balanced awareness of history and political economy with a psychoanalytic conceptualization of intrapsychic phenomena (Langer, 1989).

With the mid-20th century political repression in Argentina, Chile, Brazil and Uruguay (the Southern Cone) displacing many analysts, they nevertheless persevered in communities of fellow exiles, among those who remained behind while subjected human rights violations of the most terrifying sort, and within allied movements of political transformation. Exiled once more, Marie Langer fled when she realized that her presence in Buenos Aires threatened the lives of her children and patients. In Mexico City, she helped Nicaragua’s newly formed Sandinista government build a fully integrated health and mental health system with free and universal care (Hollander 1997). Supporting the work of the Women’s Institute in embattled El Salvador, Langer contributed her ideas to the work of those of us developing community-based psychosocial support, behind the lines and in liberated communities during the years of brutal civil war (Bragin, 2007).

From Latin America to Sub-Saharan Africa and Back to Early Freud

Meanwhile in Chile both during and after the repression, Elizabeth Kornfeld Lira, Eugenia Weinstein and David Becker sought to help people make meaning of their internal reactions to seemingly omnipresent external violence. When the conflict ended it appeared to them that society demanded a cure-that is that is that survivors forget, repress and suppress the internal violence wrought by external torture, so that they not be continuously disturbed by inconvenient truths. For this reason they decried the diagnosis of PTSD, stating that survivors will be changed forever by their experiences, and should therefore be helped to remember, and to integrate those experiences rather than being expected to forget (Becker, 1995; Kornfeld-Lira, 1995).

Like Freud’s early patients, whether suffering from sexual or conflict borne violence, today’s survivors are a living reminder of split off violence that society wants to forget, but actually enacts in public and private day by day (Bragin, 2007; 2010). To give voice to these thoughts beyond the consulting room, Becker, Kornfeld Lira and Weinstein joined with others to form ILAS, the Latin American Institute for Mental Health and Human Rights. Through the work of ILAS they made common cause with Carlinda Monteiro and Alcinda Honwana professionals charged with reintegration of former child soldiers in Angola and Mozambique. Drs. Monteiro (1996) and Honwana (2006) noted that, like the indigenous post-war ceremonies on which Freud commented in Totem and Taboo,(SE,13 1913) traditional healing included essential psychodynamic principals that could restore survivors still haunted by abuse, by torture, by their own knowledge and actions, to a sense of self that had loved and been loving (Bragin, 2005). Returning to El Salvador and invoking the words of murdered psychologist Father Ignacio Martín-Baró (1994), is this not a liberation psychology?

References

Becker, D. (1995). The deficiency of the concept of posttraumatic stress disorder when dealing with victims of human rights violations. In R. J. Kleber, C. R. Figley, & B. P. R. Gersons (Eds.), Beyond trauma: Cultural and societal dynamics (pp. 99–114). New York: Plenum Press.

Bragin, M. (2007). Knowing terrible things: Engaging survivors of extreme situations in treatment. Clinical Social Work Journal, 35(4), 229 -236.

Bragin, M. (2005).Pedrito: the blood of the ancestors. Journal of Infant Child and Adolescent Psychotherapy, 4 (1), 1-20.

Bragin, M. (2010). Can anyone here know who I am? Creating meaningful narratives among returning combat veterans, their families, and the communities in which we all live Clinical Social Work Journal, 38(3), 316–326.

Danto, E. A. (2005). Freud’s free clinics: Psychoanalysis & social justice, 1918-1938. Columbia University Press.

Freud, S. (1896). Draft K: The neuropsychology of defense (A Christmas Fairy Tale). Standard Edition, 1, 220–229. London: Hogarth Press, 1975

Freud, S. (1913). Totem and taboo. Standard Edition, 13, 1-162. London: Hogarth Press, 1974

Freud, S. (1919). Introduction to psychoanalysis and the war neuroses. Standard Edition, 17, 205-211. London: Hogarth Press, 1974

Hollander, N. (1997). Love in a time of hate: Liberation psychology in Latin America. New Brunswick: Rutgers University Press.

Kornfeld- Lira, E. (1995). “The development of treatment approaches for victims of human rights violations in Chile.” In R. Kleber, C. Figley, & B. Gersons, (Eds.), Beyond trauma: Societal and cultural dynamics (pp. 115–133). New York and London: Plenum Press.

Langer, M. (1989). From Vienna to Managua: The Journey of a Psychoanalyst. London: Free Association Books.

Loewald, H. W. (1960). On the therapeutic action of psycho-analysis. International Journal of Psychoanalysis, 41: 16-33.

Martín-Baró, I. (1994). Writings for a liberation psychology. Cambridge, MA: Harvard University Press.

Monteiro, C. (1996). Cultural issues in the treatment of trauma and loss: Honoring differences. Paper prepared for the Christian Children’s Fund, Richmond, VA, July 31, 1996.

 

 

 

 

Freud, the Aim and the End

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

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

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

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

 

1. The Choice of Death

 

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

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

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

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

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

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

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

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

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

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

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

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

 

2. Caducity and Eternal Return

 

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

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

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

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

 

3. ‘Si vis vitam, para mortem’

 

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

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

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

 

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

 

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

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

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

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

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

 

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

 

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

 

4. Eros and Thanatos

 

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

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

 

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

 

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

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

 

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

 

5. ‘Et in Arcadia Ego’

 

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

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

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

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

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

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

Freud says that this thing – the thing that makes our subject dream of his own agony – is the death drive. But, in this way, we are not too far from the famous explanations given by the doctors of Molière, ‘opium makes you sleep because it contains the virtus dormitiva’. And, even worse, this death drive that pushes us to repeating the unpleasant – even to dream it, as if it were our most intimate wish – can only be articulated as Eros! Because, as Freud himself tells us, death never manifests itself ‘in person’: on the one hand repetition is the fatal tendency of the living to die, on the other every repetition is also ‘command’, an attempt to come to terms with the event and subjectivize it. This repetition of the event or traumatic state manifests the strength of Thanatos, insofar as Eros does, in a certain sense, its duty: to make it possible to articulate the trauma (to make it possible for it to be spoken, but also connected to the rest of the life lines), to connect it and annex it to its own subjectivity, to make up the wound and ‘grey void’ of the trauma as one’s most precious asset. Because ultimately this is the command made possible by repetition: ‘enjoy the horrors you will go through!’

Bibliography

Derrida, J. :

– (1980) La carte postale, de Socrate à Freud et au-delà (Paris : Aubier-Flammarion).

– (1996) ‘Résistances’ in Résistances de la psychanalyse (Paris : Galilée).

Freud, S. :

– (1913) Das Motiv der Kästchenwahl [The Theme of the three Caskets], GW, 10, pp. 25–37 ; SE, 12, pp. 291–301.

– (1914) Trauer und Melancholie [Mourning and Melancholia], GW, 10, pp. 428–446; SE, 14, pp. 243-257..

– (1915a) Vergänglichkeit [Transience], GW, 10, pp. 358–361; SE, 14, pp. 303–307.

– (1915b) Zeitgemässes über Krieg und Tod [Thoughts for the Times on War and Death], GW, 10, pp. 324–355; SE, 14, pp. 273–300.

– (1920) Jenseits des Lusprinzips [Beyond the Pleasure Principle], GW, 13, pp. 3–65; SE, 18, pp. 7-60.

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Laplanche, J. (1976) Life and Death in Psychoanalysis, trans. by J. Mehlman (Baltimore: Johns Hopkins University Press).

Nancy, J.-L. (2009) ‘Freud – pour ainsi dire’, www.psychomedia.it/jep/jep-on-line/nancy.htm.

Panofsky, E. (1936) ‘Et in Arcadia ego’: Poussin and the Elegiac Tradition’, in Philosophy and History: Essays presented to Ernst Cassirer (Oxford: The Clarendon Press).

Pasolini, P.P. (1970) ‘Cinema impopolare’, in Empirismo eretico (Milan: Garzanti, 1972).

Ricoeur, P. (1965) De l’interprétation. Essai sur Freud (Paris : Seuil).

Vernant, J.-P. (1985) La mort dans les yeux (Paris: Hachette).

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This article originally appeared in the European Journal of Psychoanalysis, Vol. 1, Number 1, Jan. 2014