Friday, September 23, 2016

Dissociation and Trauma

One of the benefits of membership in the Tampa Bay Psychoanalytic Society is participating in its monthly discussion group. This year the group is reading Philip Bromberg's Awakening the Dreamer. In the Introduction, Bromberg reprises Standing in the Spaces: "Self-states are what the mind comprises. Dissociation is what the mind does. The relationship between self-states and dissociation is what the mind is."

Bromberg sees dissociation as normative in the structure of the mind, but also as a process by which psychological survival is preserved in the face of overwhelming threat to self-continuity. When parents disallow aspects of a child's self, these aspects are dissociated by the child in order to maintain the needed tie to the parent. As the child grows into adulthood, his sense of self includes "'his parents' child'"-- that is, he continues to dissociate these aspects. Unlike repression that disavows content which causes conflict, dissociation disavows parts of the self. Bromberg claims that this disavowal of parts of the self impairs intersubjectivity such that the self is "largely unable to see himself through the eyes of an other."

Psychoanalysis, writes Bromberg, includes an act of recognition (different from understanding) of the patient's disavowed self-states, states accessible within the intersubjective field through enactment. Repeated experience with recognition [and the welcoming in] of these disavowed self-states increases their accessibility. Once accessible, these self-states are available to symbolization and self-reflection, and to conflict [the stuff addressed by traditional psychoanalysis].

In contrast, self-states that are not recognized by the analyst thwart the patient's desire for recognition and acknowledgement, and lead to shame. "..[B]ecause it is not forthcoming, [it] supports the reality of their needs being illegitimate."  But "when the therapist is able to relate to each aspect...[t]his linking of self-states increases a person's sense of wholeness..." allowing one to live a fuller life.

Saturday, September 17, 2016

In Passing


The great American playwright Edward Albee died yesterday, September 16, 2016 at the age of 88. The theatre seems to me more than any other medium to reveal the human condition pointedly and in condensed fashion. Like so many great playwrights—Miller, Williams, Chekov, of course Shakespeare – before him, these artists show us a mirror of ourselves that we sometimes wish were left unrevealed (as when Albee’s 1962 play Who’s Afraid of Virginia Woolf, which won five Tony awards, was denied the Pulitzer by the advisory board despite being voted to receive it by the jurors.)  Freud, however, would have been proud of Albee’s explications of sex, aggression, and death.

In his first play Zoo Story (1958), Albee wrote about loneliness and miscommunication. In Woolf, he exposed the illusion of the prefect American family. [What couples therapist has not seen a George and Martha in the consulting room?] The Goat, Who is Sylvia? pushed the limits of liberal tolerance when Martin falls in love with a goat (bestiality) while being somewhat judgmental of his homosexual son. Albee received the Pulitzer Prize for Drama for A Delicate Balance (1967), Seascape (1975), and Three Tall Women (1994).

Constitution


On September 17, 1787 (two hundred, twenty-nine years ago today), the U.S. Constitution was adopted by the Constitutional Convention in Philadelphia, PA. One of its important compromises –between the Virginia Plan and the New Jersey Plan— allowed states to be represented both by population (The House of Representatives, favoring the larger states) and by same number of votes per state (The Senate, leveling the playing field for smaller states.)  The Constitution was ratified by conventions in eleven states and was adopted (went into effect) in 1789.  It is the longest living Constitution in the world.



The beauty of the U.S. Constitution is it is alive; It allows for changes of itself through amendments— for example, the abolition of slavery (13th), and prohibiting denial of women the right to vote (19th)—and it is interpreted to fit the lives of people in the present moment to allow for freedoms as yet unconceived by its writers and ratifiers. (Its freedoms are often hard won such as in Brown v. Board of Education of Topeka (1954) establishing separate public schools for black and white students to be unconstitutional; and Giddeons v FL (1961) allowing the accused to obtain a public defender.) Yale Law Professor and Constitutional scholar Akhil Amar said about the Constitution, “It is this epic, flawed, spectacular conversation” and “it’s the job of our generation to make it more perfect still.”



Psychoanalysis, too, is a flawed and spectacular conversation. It, too, is governed by a set of principles and procedures, and like the U.S. Constitution, is a sacred forum for struggle and negotiation where the state of the self is improved, made richer because of increased accessibility to experience and emotion, and made freer as well by being so enriched. It is through struggle and argument that our country is made better. Sometimes I think the conversation of psychoanalysis, like the voice of the vote, ought to be a basic right. But who will provide and who will pay for such a service?           

Monday, September 12, 2016

Acting Out and Passage à l'acte

On Sept 10, 2016 the Tampa Bay Psychoanalytic Society hosted Donna Bentolila at its monthly, all day seminar where she presented two riveting cases. A native of Argentina and a Lacanian by self-report, Bentolila, despite the privileging of left brain (the Symbolic) over right, and despite her reluctance to locate herself squarely in the co-creation of the experience of her patients, nonetheless, worked closely and beautifully in the lives of these two patients and their analytic relationships with her. Due perhaps to the severity of their illnesses and to complicated issues in both cases, Bentolila found herself repeatedly having to bend the frame to fit both the needs of these two very disturbed people and the limits of her capacity to endure their demands. For confidentiality sake, I will give no details, but wish you all had been there to become wholly engrossed in the presentation.

Lacan, like Freud, chose phallocentric terms to explain human experience, and I was pleased to see Bentolila try to soften Lacan’s ideas as metaphor. For example, the ‘name of the father’, Bentolila claimed, is not necessarily the biological father, but the function that transcends him. Still, this function, in addition to “constraints and proscriptions,” is to “break the fusion between mother and child." [But the idea of ‘fusion’ (or merger or symbiosis) has been reassessed since the understanding by Stern (1985) -and Benjamin- of the normal development of a sense of separateness from a very early age.]

Bentolila explained Lacan’s  distinction between acting out and passage à l'acte: Acting out is done by a subject as an attempt to communicate something to the Other which could not be heard, or said, in words. Because it remains as an attempt at communication, it thus retains the Symbolic order. Passage à l'acte (passage to [into] action), on the other hand, exits from the Symbolic Order with behavior which is not meant to communicate to the Other (the Other does not enter into consideration in the act, sometimes because there has been a dissolution of connection to the Other) for even the subject is un-situated from the scene in a desperate and irreversible attempt to resolve some unbearable anxiety (this loss of self as subject sometimes heralds psychosis), such as in the case Bentolila described.

What a wonderful reminder, as her clinical examples depicted, of how being listened to about one’s impulses makes it less likely those impulses will be acted upon. Acting out is a message to the analyst: an appeal or demand for recognition from the analyst; an attempt to communicate what the analyst had heretofore been unable to hear; an unspoken and/or unconscious invitation to dialogue about a subject that could not find a place in their discourse, perhaps because it remained dissociated (or outside the Symbolic order per Lacanians). I suppose that were the analyst to disallow space for validation, or abdicate responsibility for her own location in the fray, the patient might feel so violated and destroyed as to abandon further attempts at communication and enter instead into the real passage à l'acte.

Thursday, September 8, 2016

Comment about Homesickness and the Analytic Home

Brothers and Lewis write: “…the analyst finds ways to communicate over and over again to a patient: ‘Yes, you can come home again. No matter what happened between us during your last session, no matter how different or similar we found one another, I will be here waiting for you when it is time for us to meet again.’ "



Brothers, D., Lewis, J., (2012) Homesickness, Exile, and the Self-Psychological Language of Homecoming. International J. Psychoanalytic Self Psychol. 7:180-195.

btwHB

Monday, September 5, 2016

What is Lost

The French are terribly enamored of Lacan with his symbolic and imaginary and real, and the name of the father. Lacan leans a little too heavily on Freud for my tastes and extends the patriarchal view of things, deemphasizing contributions of our understanding of the importance of the early maternal-infant relationship. Like the homunculus, a fully formed tiny human, ‘seen’ through the microscope inside the human sperm (Hartsoeker and Leeuwenhoek), thereby giving full credit to the male of the species for the preformation of the next generation, so does Lacan disregard that it is the maternal caregiver who first imparts language and law (discipline and guidance) on the infant offspring, long before any oedipal taboos.

Donna Bentolila [who will be in Tampa on Sept 10, 2016] invokes Lacan and Freud in her paper on revisiting the Death Drive (1996). Here she notes the phenomenon that desire remains ultimately unfulfilled, thus the repetition to forever chase after what we cannot have (the lost Other) as part of the human condition. [Like Freud, I think of the death drive as partially biological as in the necessity of death to make room for new life and in the second law of thermodynamics where matter tends towards the lowest energy state—making life and any biological system a kind of miracle in its randomness and its opposition to entropy. And like Winnicott, I prefer to think of destruction as a necessary dialectic allowing the Other to come into being, and a necessity in creativity.]

But it is Bentolila’s nod to difference which brings a bittersweetness to mind. Juxtaposed with sameness— a sameness which obfuscates difference— she speaks of “Eros, the union of two beings into One." She goes on to write: “For Bataille the ultimate meaning of eroticism is a state of fusion between the partners which, insofar as it involves no separation, acts to suppress all boundaries while sustaining a perfect continuity.” Later she adds “a question of an impossible jouissance with an already lost object related to our impotence to retrieve the thing (das ding) in the real.”

Ah, the lost object. To quote Robert Frost again (Reluctance, 1913):

Ah, when to the heart of man
Was it ever less than a treason
To… bow and accept the end
Of a love, or a season?





Thursday, September 1, 2016

Homesickness and Cheever


Home is the place where, when you have to go there,
                                       They have to take you in   - Robert Frost


We long for the certainty of unquestioned acceptance and welcome, a feeling of home, the place where we belong, but then come to “the realization that one’s longing for home can never be met.” Brothers and Lewis (2012) expand the idea of homesickness— in self-psychology language—as “a longing to recover (or gain for the first time) a sense of certainty that the selfobject experiences upon which selfhood depends are unquestionably available.” 

What do we do when we are confronted with the painful realization that we can never go home again, if home indeed ever was? What do we do when confronted with “this painful sense of unfulfilled and unfulfillable longing for home”? Brothers and Lewis intimate that a compensatory ‘home’ can be created by patient and analyst when they come to know one another in predictable, reliable ways and by building together a shared unique language. “In a healing analytic relationship…patient and analyst develop a shared language—partly verbal, partly nonverbal—by means of which excruciating experiences of sameness and difference become bearable.” [Here, sameness speaks to the need for twinship (see post of August 28, 2016), belonging as one does when ‘at home,’ and “the need to experience difference…to experience oneself as unique, special…”] Treatment additionally offers the opportunity for mourning what was lost, what one never had, and/or what one can never have.

Familiarity and belonging allow for the creation of meaning. But the sense of certainty and of familiarity are shattered by trauma. Trauma, in turn, can lead to exile “when trauma brings with it a desperate need to experience the clarity of difference.”

While Brothers and Lewis utilize the John Cheever quote ‘Fifty percent of people in the world are homesick all the time’ , their points about longing for what never was are also aptly illustrated in the Cheever short story Reunion (1962) where the son, meeting his father with heightened anticipation after years of estrangement, comes to the painful realization over lunch that he will never have the relationship with his father that he had always longed for; his longings for connection will remain unfulfilled; his efforts futile. Many of the works of Cheever speak to a kind of nostalgia or ‘homesickness’ for lost culture and community experienced in the isolating and alienating suburbs. There is a deep pathos in Cheever’s works. So, too, in ours.

                                    

Brothers, D., Lewis, J., (2012) Homesickness, Exile, and the Self-Psychological Language of Homecoming. International J. Psychoanalytic Self Psychol. 7:180-195.

Cheever, J., (1978) The Stories of John Cheever, New York: Alfred A. Knopf; story originally appeared in The New Yorker magazine, October 27, 1962.

Monday, August 29, 2016

Poem: Human Family by Maya Angelou


What better describes our need for sameness and difference, and for belonging, than this beautiful poem offered as an elaboration of yesterday’s post on Twinship.  



Poem: Human Family by Maya Angelou

I note the obvious differences
in the human family.
Some of us are serious,
some thrive on comedy.

Some declare their lives are lived
as true profundity,
and others claim they really live
the real reality.

The variety of our skin tones
can confuse, bemuse, delight,
brown and pink and beige and purple,
tan and blue and white.

I’ve sailed upon the seven seas
and stopped in every land,
I’ve seen the wonders of the world
not yet one common man.

I know ten thousand women
called Jane and Mary Jane,
but I’ve not seen any two
who really were the same.

Mirror twins are different
although their features jibe,
and lovers think quite different thoughts
while lying side by side.

We love and lose in China,
we weep on England's moors,
we laugh and moan in Guinea,
and thrive on Spanish shores.

We seek success in Finland,
are born and die in Maine.
In minor ways we differ,
in major ways the same.

I note the obvious differences
between each sort and type.
But we are more alike, my friends,
than we are unalike.

We are more alike, my friends,
than we are unalike.

We are more alike, my friends,
than we are unalike.

Sunday, August 28, 2016

Twinship

Most psychoanalysts are familiar with Kohut’s mirroring and idealizing transferences. Togashi and Kottler (2012) write about the twinship transference and note Kohut’s “transformation from the psychology of the self to the psychology of being human” and from “the disorder of the self to… trauma-centered psychoanalysis.” They enumerate the many faces of twinship:

(1)    between merger and mirroring. Kohut originally conceived of the mirror transference in three forms: merger, twinship, and the narrowed mirror transference, their differences “based on the degree to which an individual” sees others as an extension of themselves or as a separate person.
(2)    as a process of mutual finding. This does not mean “recognizing…the other’s subjectivity” but rather that “two participants…regulate a sense of sameness and difference in their effort to match…their subjectivity” such as when the analyst finds aspects of herself and not-herself in her patient and the patient, likewise, can find aspects of himself and not-himself in his analyst, this mutual finding process, essential to the twinship experience.
(3)    as a sense of belonging. Later (1984), Kohut distinguished twinship from mirroring to a sense of belonging. Here twinship speaks to [authors quoting White and Weiner] ‘a similarity in interests and talents, along with the sense of being understood by someone like yourself” and [quoting Basch] ‘the need to belong and feel accepted by one’s cohort.’ [BTW, in this same volume, VanDerHyde writes a lovely paper on the importance of twinship, stating the need to belong precedes the need for mirroring or idealizing]
(4)    passing talents and skills to the next generation. Togashi and Kottler write: “For Kohut, an individual’s efforts to educate others is often based on her yearning for a person who[m] she can experience as essentially alike, or for a person in whom she can find herself.” The parent sees herself in the child and, reciprocally, the child sees himself in the parent. The child sees himself as the welcomed “successor” as the parent is “creating and finding oneself in the next generation.”
(5)    as silent communication. Twinship allows each “to share the feeling of connection without verbal communication –as with mother and infant; lovers; or analyst and patient—and to share in a “regulatory process to match (and not-match) one another.”
(6)    feeling human among other human beings. Kohut noted the necessity to feel human among other human beings. Narcissistic parents can treat the child as an extension of themselves or as a non-human thing, the latter causing the child to experience himself as non-human among non-humans.
(7)    in trauma. The authors cite Stolorow: “a need for twinship is a reaction to psychological trauma” [IMO, the authors decline to temper this statement by adding that we are hard-wired for a social network (a tribe), as well as that we can find joy in being understood and this not simply as secondary to trauma] and Brothers, noting that trauma destroys certainty and meaning. [and that we need relationship to restore the latter.]

Please see the next post for a poem by Angelou which beautifully illustrates humans’ need for a human family, same and different, but belonging.

Monday, August 22, 2016

Heritage

Cultural relics have been targeted by ISIS in northern Africa and the Middle East in alarming numbers. The first successful prosecution by the International Criminal Court for only the destruction of cultural heritage took place today at The Hague. Ahmad Al-Fagi Al-Mahdi took part in the destruction by Islamic militants of the 14th century Holy Tombs of Timbuktu in his native Mali in 2012 and today he admitted and apologized, calling for an end to these acts.

The phrase destruction of cultural heritage got me thinking about our individual specific and pointed cultural heritage, that of each of our families, and how psychoanalysts navigate the change in perspective of our unique stories. Some people come to us hoping we will undo what they have had to endure, or hoping that the painful experiences of childhood will be eradicated. But our history is part of who we are, for better or worse, forever embedded in our neuro-circuitry [unless damage occurs, such as by a stroke or traumatic brain injury] and I encourage patients to respect what has transpired, give it its due, its voice, and give it a place beside all that has made them the courageous and resourceful enough person now before me who seeks psychotherapeutic treatment.

Some patients worry, as we empathize with the relational trauma of chronic misrecognition and misattunement or with the Trauma of physical and sexual abuse of their childhoods, that their newly welcomed and understandable anger will be insurmountable to finding their way back to loving and forgiving their families of origin. It does seem remarkable that, if we persevere with recognizing, naming, and accepting anger, we will find it can be more easily lived, lived alongside the more palatable emotions and memories that are human experience.  I don’t know how forgiveness for heinous acts comes about, but it seems partially linked to learning to forgive ourselves. I know I am grateful life-long for those who have forgiven me.