Saturday, November 21, 2009

Recommended book: Identical Strangers

Identical Strangers by Elyse Schein and Paula Bernstein.

I was intrigued and fascinated by this book written by identical twins who had been separately adopted at birth for a "twin study": Their website is It presents a balanced perspective on nature-nurture contributions on behavior.

Recommended by John Lambert, LCSW

Tuesday, November 17, 2009

NPR talks about Carl Jung's Secret Book

"Jung said his 'red book,' in which he recorded his visions, was the basis of everything else he did. But it was locked away in a Swiss vault. Now it's out."

Sunday, November 15, 2009

Book Review: Literature and the Brain

In Literature and the Brain (©2009 The PsyArt Foundation, Gainesville, FL) Norman N. Holland combines his love of ideas, questions, and answers with his love for literature. Like Malcolm Gladwell's Blink or The Tipping Point, Holland’s is the perfect vacation or bedtime reading for the learned person interested in human behaviors, in this case, in thinking about literature. This is not a book that analyzes particular pieces of literature, as many of his other books do, but one that asks questions such as “Why do we feel real emotions at things we know are fictional” and what allows us to suspend disbelief, as well as explores “how the brain both enables and limits us in creating and responding to literature.”

To answer and explore some of these, Holland elucidates workings of the brain and looks at our relation to reality in general. Apparently, when our brain is cognizant that it cannot (or needs not) act or change the outcome of a situation, for example, on a work of art as when viewing a movie in a theater, then the motor cortex 'relaxes' allowing the limbic system its freer emotional expression.
He describes four changes in the brain when we are transported by reading a book or watching a play: our perception changes in relation to the body, to the environment, in reality testing, and in our emotions.

Holland provides biological and evolutionary reasons why we can lose awareness of our bodies and the world, and why we can cease to judge reality, allowing us to react emotionally toward fictional characters as if they were real. He explores why literary works engender such strong emotions by explaining the functioning of the brain, its cortical and subcortical workings. Holland says that the sole purpose of the brain is to move the body as in the four F’s learned by all medical students: feeding, fighting, fleeing, and sexual reproduction [the latter ‘F’ an example of the joy of surprise, as in a joke or well-turned phrase. ]

In explaining how the retina and the occipital brain perceive electrical physiological processes as something “out there,” he begins:

“Sensing objects as ‘out-there’ in a not-me world is useful, even essential, for survival. I have to know that somewhere beyond my skin is a mountain lion, a banana split, or Marilyn Monroe, depending on which basic need I am trying to satisfy at the moment.”

In Literature and the Brain Holland makes complex ideas accessible to the lay person. It is a rich book of neurological and psychoanalytic ideas about emotion and motivation, combined with thoughts from philosophers and poets, and peppered with humor. His avuncular writing style leads the reader into comfortable conversation with the author. Sometimes there are lovely metaphors: “A poem lies inert, like Sleeping Beauty, until we love it into life.” [Loving both poems and fairy tales, and with its allusion to sexual awakening, this one delighted me, despite the unconscious misogyny intimating that women find life from men.] Sometimes there is frank science: "...the brain stores information: not in the cells, but in the patterns of linkage between cells." But, throughout, there is the desire to read and understand more.

For the psychoanalyst, there are both ideas to fortify traditional views (about free association; the structural theory of id, ego, and superego; repression; and sublimation) and contemporary ones (cultural construction of our worlds; subjectivity; and negotiation of agreement about understanding) as well as those to support both (implicit learning and varying memory systems; how our brains are interconnected, porous to another’s person’s feelings). And when Holland writes about our enjoyment of tragedies (such as Hamlet) “…we fit them into our schemas for understanding the world. By making sense of them, we tame them.,” we think not only of Piaget, or Stolorow, or even Maurice Sendak, but we also resonate with what goes on, in part, in treatment with our patients. Later, privileging the left brain and insight, Holland notes how “Symbolization makes meaning possible,” however idiosyncratic and personal that meaning may be. But he also notes the importance of implicit connection, what Benjamin may write about as the joy of two subjects sharing a moment of like-mindedness, when he quotes the student Ellen “…this book [referring to the cartoons of Kliban] proves that someone else sees what I see.”

SEEKING behaviors and CONSUMMATORY behaviors, essential to the survival of the species, shed light on why we make meaning from and sense of literary works. Authors create a problem and we hunger for its resolution. We seek to learn the meaning of things. We seek to be reassured. Seeking satisfactions and getting them both bring us pleasure. I took pleasure in reading Literature and the Brain. In it we “discover this mysterious, magical treasure,[the] Mind.”

review by Lycia Alexander-Guerra, M.D.

Thursday, November 12, 2009

Upcoming National Convention on Trauma: American Psychoanalytic Association, Division 39 (Psychoanalytic Division)

2010 August APA Convention - Division 39 Program

Thinking Outside the Box

A major challenge to contemporary psychoanalysts is the treatment of patients who have suffered severe early trauma. Contributions from differing schools of psychoanalytic thought, and from other fields such as cognitive science and infant research, have expanded our therapeutic armamentarium and made psychoanalysis available to previously inaccessible cases. Psychoanalysis has matured to the point where we can now have meaningful discussions -- not duels -- about differing ways of working with more challenging situations.

Because early experiences of pain may be before the time of speech, feelings may not be available for discussion and interpretation. Ways in which therapists creatively connect with and help transform early experiences will be the theme of this conference.

Information for submissions is available on the APA web site,
Chairs: Sandy Shapiro, MD , and Holly McMillan,

Monday, November 9, 2009

“The Shared Labor of Relational Mourning:” Watching and Witnessing the Trauma Imposed by Germany’s Paragraph 175

Paragraph 175 is a documentary film researched and tenderly presented by Klaus Müller and directed by Rob Epstein and Jeffrey Friedman. It chronicles the experiences of the 100,000 men as well as the women who were persecuted under this criminal code. This was the third film in the Fears of Difference: Diversity of the Holocaust Experience Film Series.

Tamara Zwick, Ph.D. an Assistant Professor of European History at the University of South Florida provided the historical context in which to view the film. Paragraph 175 was the anti-sodomy ordinance with origins dating back to 1871, the year of German unification. In Berlin, the ordinance was not enforced as the liberal climate was welcoming of gays and lesbians. Berlin was considered the Gay Eden.

As political and economic instability increased in the Republic, the enforcement of heterosexual norms increased through enforcement of the code and through the protonatalist movement women's behavior was tightly regulated. Women would find it harder to have abortions and contraception and would be given prizes for procreating.

Mental Health Counselor, William Spell’s comments are below.

Audience questions and comments included the following:

One audience member was curious about the reception Dr. Zwick’s students give to the film when she screens it in class. She uses it to introduce failures in humane treatment in historical periods and some students are hostile and don’t see the importance of using such a film in an instructional context. Mr. Spell added that the film allows viewers to join with the tellers in finding solace in community.

Another audience member brought up the recent documentary Outrage illustrating the viciousness of closeted homosexuals. Mr. Spell noted that 13 states continue to have Sodomy laws. And Florida is the only state that does not allow gays to adopt. More and more states are outlawing gay marriage and the continuation of hate crimes such as the one committed against Ryan Skipper in Winter Haven, FL constitute negative trends in becoming a more inclusive nation. Yet, other audience members noted that there is a balance. With young people’s attitudes reflecting more acceptance of sexual difference and the increase in anti-discrimination laws, progress is happening.

One audience member asked about the meaning of the film for the gay movement. The audience discussed this question in regard to how education helps change attitudes. One response is to keep Foucault’s explanation in mind that educational institutions defined and made certain sexualities normative in order to pathologize some. Education should teach us to open our minds and hearts to the multiplicity within ourselves.


Tamara Zwick, Ph.D. is an Assistant Professor of European History at the University of South Florida where she offers courses in European and German social and cultural history, gender history, and Holocaust historiography. Her major research focuses largely on the intersections of kinship, gender, and class in northern Germany. She is currently at work on a manuscript titled Writing Between the Lines: Women, Kinship, and Bürgertum in Early Nineteenth-Century Hamburg. She has previously published articles on memory at the concentration camp Auschwitz-Birkenau and on bourgeois culture as a written practice.

William Spell received his B.A. in Sociology and Religion from the University of Florida. He received his Masters of Arts in Mental Health Counseling, (M.A.) from Rollins College and currently is a Licensed Mental Health Counselor in Private Practice in Winter Park, FL. From 1992-2004 William worked as a School-Based Family Counselor for the Citizen's Commission for Children, Orange County, FL. He considers his recent and ongoing study of psychoanalytic theory and practice to be an opportunity for enhancing personal and professional growth. Currently he is a member of the International Association of Relational Psychoanalysis and Psychotherapy, a Member of Florida Organization for Relational Studies (FORS), and a Corresponding Member of Tampa Bay Psychoanalytic Society. He is an Allied Professional Member of the American Psychological Association's Division of Psychoanalysis (39) and serves on the Committee on Sexualities and Gender Identities which sponsors program development at Division meetings.

Picture: Heinz Dörmer, 1928, age 18. Dörmer was 10 when he joined the German Youth Movement in 1922. He eventually became a group leader before his troop was forced by the Nazis to join the Hitler Youth.
Photo courtesy of Schwules Museum, Berlin

Trust, Contextualization, and Trauma: Documenting Holocaust Experiences of Homosexuals

Film: Paragraph 175

By William Spell
presented November 8, 2009 at the Film Series: Fear of Difference: The Diversity of Holocaust Experiences, Tampa, FL

Our presence here together unites us for a living tribute to the courageous Holocaust survivors of the documentary Paragraph 175 as well as all survivors of genocidal trauma. The seven remarkably articulate elders emerge from these interviews with a seemingly impossible grace and eloquence, putting words to unbearable experience.

I am also in awe of this achievement by the director-producers, Rob Epstein and Jeffrey Friedman, their partner in production, Michael Ehrenzweig and their many talented collaborators, who with the inspiring guidance of Klaus Muller, have set a sensitive stage and created a trusting rapport with each survivor.….for their voices to be heard and their beautiful faces to be seen with a clarifying light.

Dr. Doris Brothers, in her paper, Trust, Uncertainty and Therapeutic Alliance in Trauma-Centered Treatment suggests that “trauma does not reside in a specific event alone, but rather in the meanings of that event for the individual involved.” And she places “the focus of treatment on the trustworthiness of the relational engagement of analyst and patient.”

We see from the beginning of this project, a resistance and ongoing crisis of trust when Klaus telephones to confirm a meeting, Karl Gorath answers, “Not today” and later in person, Karl agrees to the session.

.....Pierre Seele, arriving at the train station feeling sick, not wanting to proceed, feeling hostile toward Klaus and offended by his black leather jacket, not wanting to shake hands with a German and paranoid about Klaus’ intentions.

Heinz F. speaks for the first time with another person about his 8 ¼ years in the concentration camps of Dachau, Mauthausen and Buchenwald, confined for being a homosexual. He fears using his surname for the film and initially requests that his face be seen in an anonymous silhouette of dark shadow.

From listening to the director’s added commentary on the DVD, I learned that Heinz F. upon viewing the monitor and seeing how dark his image appeared, decided that he wanted his face to be seen, since at age 93 he felt that he hadn’t much time left for the rest of his life.

There was a survivor living in Poland who ultimately declined being interviewed on film because he was battling with the fear of being publicly exposed as a homosexual.

Another German man who was castrated by the Nazis, had given consent to participate when, on the day of his filming, someone helping with the production told his landlady that he was going to be interviewed. When he found out that she knew this, he became very upset and refused to continue and Klaus spent a lot of time calming and comforting him.

The directors discuss their experience of a troubling ambivalence as they respectfully engaged Albrecht Becker, arrested for his homosexuality by the Nazis. Albrecht explains the alarming indifference and passivity of many German citizens to their widespread, word-of-mouth knowledge of the death camps.

Michael Ehrenzweig affirms that without Klaus having established relationships of safety and trust with the film’s subjects over a period of years, this ground breaking documentary would not have been possible.

Dr. Lycia Alexander-Guerra, in her presentation for the Tampa Bay Institute for Psychoanalytic Studies’ Trauma Workshop Series, discussed how, physiologically, traumatic memories are dissociated, de-contextualized from each other, and unlinked to words. In referencing the work of Dr. Jody Messler Davies and Dr. Gail Frawley, she discussed how re-enactments of experiences which lack words can become an opportunity for the therapist to lend words and help construct meanings with the survivor of previously unspeakable traumas.

Klaus encourages Heinz Dormer’s painstaking, verbal descriptions of “the singing forest”. There are haunting silences between Heinz Dormer’s words, the palpable “goosebumps” and his powerful gaze, contained by Klaus.

After approaching the abyss again, I was relieved to hear Heinz find his open-ended meanings, in his words: “inhuman” “beyond human comprehension” “inexplicable” “and much remains untold”.

Heinz F. and Klaus offered words freely and tenderly to one another. Heinz F., often tearfully sobbing, spoke of his shame. “It’s all about patiently carrying one’s burden”. When asked if there was anyone he could have spoken with, he insisted, “Never!” “Nobody wanted to hear about it” “If you would just mention one of those words…..Leave me alone with this stuff---it’s over now and done with”.

Dr. Sam Gerson's paper, When the Third is Dead: Memory, Mourning, and Witnessing in the Aftermath of the Holocaust is in press: International Journal of Psychoanalysis, 2010.

Paragraph 175 remained a law until 1968 in East Germany and 1969 in West Germany. Homosexuals continued to be classified as criminals. Heinz Dormer was re-arrested during the 1950s and 1960s.

Dr. Bruce Reis emphasizes that in the treatment of massive trauma the language of narration cannot translate away the raw pain of traumatic exposure. He recommends the work of Dr. Sue Grand in being a witness to trauma, illuminating silence and rendering it audible.

Dr. Ghislaine Boulanger represents therapeutic recognition as "when clinicians resonate to situations in their patient’s lives with which they can identify only too well; locating parallel experiences and feeling states in themselves. This often unacknowledged resonance between the patient’s and analyst’s experience signals a level of acceptance and understanding that can be transformative and promote analytic reflection.
However, when resonating to a familiar affect state is not possible, clinicians must be prepared to serve as containers and witnesses to terrifying and alienating experiences without losing their connection to the survivor. Inevitably, that connection is sometimes lost as the clinician struggles against his or her own tendency to dissociate in the face of horror."

Our hearts today contain these passages of love, hope, faith and devastating loss.

Annette Eick recounts the story of the miraculous “love letter” that saved her life, surviving only with her brother as her entire family perished in the camps.

Gad Beck remembering trying desperately to rescue and flee with his young lover, Manfred Lewin, who felt compelled to stay with and take care of his sick family, soon to go to their deaths in a camp. As Gad describes the moments of agony when he and Manfred were separated for the last time, he says, “I couldn’t think but I knew something was forever broken.”

Pierre Seele frantically beseeching Klaus, “Do you think I can talk about that?” “This is too much for my nerves, Klaus! I can’t do this anymore! I am ashamed for humanity.”

In the director’s commentary, Michael Ehrenzweig shares a story of the transformative power of Paragraph 175, the documentary.

Immediately following the film’s premiere showing in Berlin, Michael quickly joined Gad Beck and Pierre Seele in the audience and walked them slowly down the aisle to the stage, both men on each of his arms, as the fully packed theater gave them a standing ovation with thunderous applause.

Later that night Gad and Pierre sat at a café table nearby, holding hands and receiving the loving recognition and warm attention of many who had just seen their film. As a result, both men were inspired to subsequently travel extensively, speaking publicly and seeking official acknowledgement for their case and advocating support for other survivors. This reminds me of Dr. Adrienne Harris’ description of analytic process as “the shared labor of relational mourning.”

I feel this humbling work of art is an archive for all of humanity with the potential to inspire honesty and compassion for the understanding of massive traumatic experience and a caring acceptance of women desiring women and men desiring men.

-- Will Spell


Alexander-Guerra, M.D., Lycia (2009).

Boulanger, Ph.D., Ghislaine (2008). "Witnesses to Reality: Working Psychodynamically with Survivors of Terror." Psychoanalytic Dialogues, 18:638-657.

Brothers, Ph.D., Doris (2008).

Gerson, Ph.D., Samuel (2010). "When The Third is Dead: Memory, Mourning, and Witnessing in the Aftermath of the Holocaust." IN PRESS: International Journal of Psychoanalysis.

Harris, Ph.D., Adrienne (2005). "Gender as Soft Assembly." Hillsdale, NJ: The Analytic Press.

Reis, Ph.D., Bruce E. (2000). "A Review of the Reproduction of Evil: A Clinical and Cultural Perspective: Sue Grand. Hillsdale, NJ: The Analytic Press, 2000. xvi + 167 pp." Contemporary Psychoanalysis, 36:730-734.

Sunday, November 8, 2009

Narcissism Negates Subjectivity

In an early morning conversation with Daniel Shaw, LCSW, from the National Institute for the Psychotherapies (NIP), NYC, as the prelude to his presentation to the Tampa Bay Psychoanalytic Society, Inc (TBPS) on November 7, 2009 of his paper Enter Ghosts: The Loss of Intersubjectivity in Clinical Work with Adult Children of Pathological Narcissists, Shaw disclosed how he was inspired, in part, by the NY production of Eugene O’Neill’s Long Day’s Journey into Night to write about Alice and the cumulative relational trauma she suffered at the hands of her narcissistic parents. Shaw’s early training had led him to Heinz Kohut’s How Does Analysis Cure and Alice Miller’s The Drama of the Gifted Child, but he credits Alice with teaching him to ‘hang in there with’ challenging patients, and for helping him to grow as an analyst and a person. Allowing for the possibility that nobody is always right allows for growth (even in such hegemonic ideologies as classical psychoanalytic theory).

The breakdown of intersubjectivity is complementarity. Shaw expands Fairbairn’s concept of “the moral defense” to include the complementary part parents play in this relational dynamic. Recall that the moral defense, put simply, states that in order to maintain the attachment to the parents, a child of bad parents chooses to feel s/he is bad rather than acknowledge that the parents are bad. Complementary to the child, narcissistic parents see themselves as all good, perfect, and infallible, the complement to the child’s taking on the badness. As the parent disavows her/his own badness, the child is coerced into accepting the projection. The child is continually objectified, not subjectified.

Narcissism negates subjectivity. When a child is continually objectified by narcissistic parents who do not recognize the child as her/his own center of agency, the child suffers cumulative relational stress, or cumulative developmental trauma. The child grows up in a double bind, not allowed independent desire which risks abandonment and rejection, but disdained for her/his dependence, a dependence associated with shame and humiliation.

Kim Vaz, in her introduction of Shaw to TBPS, revealed his struggles with, and his compassion for, his challenging patients when she took this excerpt from another of Shaw’s papers, which received the 2001 Educator's Award for an Outstanding Scholarly Paper from NIP ( Shaw, D. (2003). On the Therapeutic Action of Analytic Love. Contemporary Psychoanalysis, 39:251-278.):

“Ari was a patient who was not easy to love, at least not at first and not for me. Ari was forty when he began to see me. His marriage was falling apart and he had been miserable for years. He felt close to becoming violent with his wife. He was burned out, always angry and always anxious, at home and at work . . . . Ari spent most of a year splenetically venting, about his wife, his son, his partners, his employees, and so forth. Feeling shut out, I often found myself shuttling between resentment, detachment, and feeling intimidated. Eventually, I understood that I was withdrawing, withholding a necessary confrontation, in retaliation for the narcissistic injury I felt about my perceived lack of effect on him. This understanding helped me to reorganize and mobilize the assertiveness I needed in order to reach Ari. One day, I finally raised my voice and said, quite loudly, ‘You know, I would like to say some things to you, but I'm afraid if you don't like what you hear, you will bite my head off, possibly literally.’
Ari looked up at me with his sharp, penetrating eyes, and I was scared. I was quite surprised and touched, though, to see Ari's eyes go moist, his face reddening. He said sadly, ‘I'm just like my father. Yes, this is what I do to everyone, my wife, my son, everyone, just like my father did.’
I said, ‘It must be awfully lonely, with everyone afraid of you like that.’ He looked up at me, silently. I added, ‘You know that song “Desperado?”’
‘Yes, I know it,’ he said, still looking intently at me.
‘You remind me of those lines, “you better let somebody love you, before it's too late.”’
Ari looked down and began to weep. I was quite moved. Right then, my very mixed feelings about Ari melted into an unexpected warmth, respect, and tenderness, and I heard myself say to myself, ‘I really love this guy.’ ”

Wednesday, November 4, 2009


Perusing the preliminary program for the American Psychoanalytic Association’s 2010 Winter meeting Jan 13-17th at the Waldorf Astoria Hotel, NYC, I noticed that Discussion Group 95 is entitled “Toward an Understanding of Loneliness and Aloneness.” The presenter Lisa A. Piazza will share about a patient who uses a busy work schedule to avoid intimate connections. The Discussion Group plans to emphasize the experience of the patient’s loneliness and how therapists might best deal with loneliness in the patient. Perhaps this Discussion Group caught my eye because recently I had read a review of The Lonely American: Drifting Apart in the Twenty-First Century by two psychiatrists, Jacqueline Olds and Richard S. Schwartz. Their book noted that increasingly more people have fewer confidants and live alone, and that many of us are too busy and irritable for friends and self reflection, causing us to feel “left-out” despite it being a situation of our own making; all of this aggravated, of course, by the mythological American ideal of independence, autonomy, and self-reliance.

Both the course title and book review struck me, I think, because in classes recently at the Tampa Bay Institute for Psychoanalytic Studies, Inc., we, students and faculty alike, often find ourselves discussing what a lonely profession solo private practice is for the psychoanalyst/psychotherapist. Professional loneliness makes classes, meetings, and conferences all the more valuable to clinicians. This experience of professional loneliness seems equally worthy of discussion, and deserves exploration as to how it affects our relationships with patients.

Relational theories of psychoanalysis have helped us understand how unrealistic autonomy is as a goal in analysis if it does not also balance the reality of the embeddedness of humans in a human community. Relational psychoanalysis, offering reconfiguration of relationship paradigms, then becomes an important antidote to loneliness and avoidance, for both analysand and analyst. In fact, if what Olds and Schwartz write is true, then therapy may be the rare haven which allows for self-reflection while in relationship, and therapists may be the sole confidant for many people, making a relational approach in treatment all the more valuable.

Sunday, November 1, 2009

Violence Against Women and Failure of Intersubjectivity

To recognize (ala Benjamin, 1988: affirm, validate, empathize, know, identify with, ) an Other and see an Other as her/his own center of subjectivity and as a separate agent with her/his own desires, denotes a capacity for intersubjectivity. When intersubjectivity breaks down, complementarity more easily ensues. Without recognition and reciprocity, one more easily falls into polarities and into the complementarity of ‘doer-done to.’

It was with horror that I listened on Friday (October 30, 2009) to National Public Radio’s story on the brutal gang rape of a fifteen year-old girl after a homecoming dance in Richmond, CA. Also horrific was the report that as many as two dozen students watched, photographed with cell phones, and even invited friends down to see the assault that lasted more than two hours.

Only ten days earlier (October 20, and 21, 2009) NPR had aired another horrific story: On September 28, 2009, at a pro-democracy rally in the west African capital of Conakry, held to speak out against Guinea’s military leader Capt. Moussa Dadis Camara, “rogue” soldiers perpetrated human rights violations, killing, by some estimates, more than a hundred demonstrators. In broad daylight the soldiers committed sexual violence against women. In a predominantly Muslim society like Guinea’s, fathers, husbands, and families may reject a woman who has been raped, making rape all the more effective as a tool of political repression. Some of the women were dragged away and held captive for days, raped repeatedly, and reportedly taunted with ‘a woman’s place is in the home, not at a political rally.’

And it was not so long ago that the decades-old crime of Roman Polanski's rape of a teen girl again occupied the media.

There may be lots of theories about why men perpetrate violence against women. In Richmond, CA a classmate of the 15 year-old victim said of the perpetrators, "They weren't raised to respect girls." One of the few universals in human experience is that we were all once helpless and dependent; the non-egalitarian distribution of childcare responsibilities makes women a likely target for the resentment of children who grew up uncomfortably dependent on, and under the thumb of, the powerful maternal figure. Children who were without the opportunity for agentic mastery as compensation for preceding helplessness, who grew up without the recognition of their own subjectivity, who did not witness the subjectivity of their mothers, are handicapped in their capacity to develop intersubjectivity.

These young men, soldiers, pedophile insist on the privilege of their own subjectivity over that of the Other. Without the capacity for intersubjectivity and to see an Other as part of the plurality of the human race, one can deny the need, or justify no need, for obligation to behave justly and ethically toward others. No where do we have a more acute failure of recognition than when the violence of rapists obliterates the humanity of women. Complicit on-lookers further aggravate and humiliate by their seemingly publically sanctioned violence against women, the unrecognized sex.