Monday, April 25, 2011

Orange on Levinas

Donna Orange, in her visit on April 9, 2011 to the Tampa Bay Psychoanalytic Society, spent most of the day discussing her take on the philosophy of Emanuelis Levinas (a student of the Talmud and a contemporary constructivist and phenomenologist , he believed in a hermeneutics of lived experience) who wrote about the "wisdom of love" (as opposed to the ‘love of wisdom’). Levinas believed that ethical responsibility is integral to the encounter with the Other, [and consequently, to intersubjectivity], a responsibility that is constitutive to our own being and interiority, that is, that subjectivity is formed, in part, through the encounter with the other. In this privileged encounter with the other, one feels both the relatedness with and the alterity of the other. Unlike what Self Psychology would purport about the confrontation with otherness, Levinas wrote: "The Other precisely reveals himself in his alterity not in a shock negating the I, but as the primordial phenomenon of gentleness."

In discussing Levinasian ethics, in particular Levinas’ idea of transcendence and the belief that one instantly recognizes the transcendence of the Other, Orange emphasized putting the other above oneself. As Orange’s form of intersubjectivity, like that of Stolorow’s/Atwood’s, with its influence from Self Psychology wherein the focus on the analyst's subjectivity is as a source of understanding, and where the need of the patient for the analyst as a selfobject is paramount, it came as no surprise that Orange would be enamored of this facet of Levinasian ethics. In fact, for me, her heavy emphasis was seen as a justification for empathic immersion and for the analyst to function predominantly as a selfobject experience for the patient.

While I agree that placing the suffering other above oneself (who would not open the door for someone struggling with crutches to get through it?) is, for those not so preoccupied with themselves as to be aware of their surroundings, a natural response, I think it is a hard philosophy to adopt when the other is not a suffering other. Orange, taking from Levinas his holding the other above self, even being responsible for the sins of others [here I am reminded both of Christ dying for the sinners’ sins and of the self blame of victims; Levinas, as a Lithuanian Jew, had survived the Holocaust but his family, sadly, did not] advocates a philosophy beyond ‘love thy neighbor as thy self’ to “love thy neighbor more than thy self.”

More than one audience member asked: how does one avoid masochism in this philosophy? Her advice to read Emmanuel Ghent’s 1990 paper on Masochism, Submission, Surrender did not suffice to further the dialogue (though his brilliant paper does). Had Orange made explicit the inference to the clinical applicability of Levinasian ethics, given that the patient is seen as the suffering other, then the attendees might have better embraced the philosophy Orange touted. Had clinical examples been supplied to illustrate the practical application of such ethics, then the audience would have been won over by her scholarly explication of Levinas’ ideas of transcendence.

Ghent, E. (1990). Masochism, Submission, Surrender—Masochism as a Perversion of Surrender. Contemp. Psychoanal., 26:108-136.

Monday, April 18, 2011

Motivation and Development

Mental health includes a sense of agency and of the subjective self in the context of relatedness and recognition by, and identification with, a subject (m)other/therapist who is a subject in her own right. Spezzano writes that human beings are motivated to share their conscious selves, regardless of other unconscious motivations, and that we can only know ourselves in light of how others know us.

Alongside the biological imperative to pass on genetic material for the survival of the species are many postulated psychological motivations. Freud’s theory of motivation was discharge of instinctual drives. Winnicott saw creativity and play as essential aspects of the true self. Bowlby and subsequent attachment theorists write about the need for safety and security. Ghent might have added “surrender.” Bach sees it as important to integrate a “sense of wholeness and aliveness” which included developing one’s own awareness and subjectivity, and learning to see oneself as one among many, with a place in the world. Maroda notes that people, to develop a full interpersonal repertoire as both subject and object, need to have their affective communications responded to, held, and returned in modified form (ala Bion).

Understanding of development is an important backdrop for the therapist when listening to and experiencing our patients. Therapy contributes to enhanced development, perhaps by recommencement of truncated development through a safe, empathic, good enough environment which facilitates reorganization of patterns of experience, as well as that co-constructing shared meaning can enhance self regulation.

Monday, April 11, 2011

More about Listening

How we organize what we hear and observe is influenced by our own subjectivity, our experiences, and our theories. Because no theory holds the ‘truth,’ we must hold our theories lightly, recognizing that each person’s reality is perspectival, and recognizing that the meaning of the material need not be fit into the procrustean bed of a theory. As I listen and muse on what is going on in the therapeutic dyad, I often think I am like a juggler, with many plates in the air at once. I must simultaneously consider whether or not I hear at this moment a familiar sigh or theme from the patient; whether or not the present narrative or relational paradigm harkens back to the patient’s childhood events; what, if any, are the transference counter-transference implications; what happened in this past moment or last session or over the months or years of analysis that contributed to this coming up or happening now; and so on; all the while being open to the unknown and to surprise in a free floating reverie with evenly hovering attention!

Listening is dialectical (you can never stand in the same river twice), which means patient and therapist influence each other and neither is ever the same again. Listening is intersubjective, containing within it both the listening and the being listened to. Listening allows space for creativity (Winnicott) and for the, as yet, unformulated and unspoken. It is a gift we give our patients, interested in every word and gesture. It is a gift our patients give us, along with the privilege of their trust. When we listen, we do not seek to confront or contradict the patient, though we may sparingly ask for clarification. Many people have never experienced such genuine attentiveness from another.

As communication is both explicit (with words and common gestures) and implicit (perhaps what Freud referred to as unconscious to unconscious communication) we must listen as well with our perceptions and unconscious perceptions. We attend to the texture of feeling and gestural communication and not just to words or content or to conscious understanding and insight. We become comfortable, not impatient, with silences when the patient may need to be with some caring other without the pressure to produce or perform. Each therapist will have a unique interest in this or that part of a story, evoking a resonance with something in the therapist’s personal history. Each therapist must find her/his own way of expressing, in a way contributory towards patient growth, what has meaningfully affected us.

Friday, April 8, 2011

Is Mutual Recognition a Foil to Empathy?

I have long struggled with attempts to integrate theories from Self Psychology with those of the varying ideas about Intersubjectivity. Self Psychology emphasizes the receiving of empathy (by patient from analyst, or, developmentally, by child from caregiver) and not the development, as Klein noted and Winnicott elaborated, of the capacity for concern, or empathy, for the other. Benjamin writes about intersubjectivity (in part, the capacity to relate subject to subject) as a developmental achievement. She also notes that it is the “mother’s recognition [that] is the basis for the baby’s sense of agency.”

Orange expands on the idea of recognition: “What we acknowledge, in relation to the other, is not primarily the other’s identity or status, but rather our own intersubjective vulnerability.” Using language (semantics) and taking literally the etymological roots of re-cognition (‘to know again’), Orange refers to Benjamin’s use of Hegel’s anerkennung, which Orange says lacks the ‘again’ and, therefore, refers to acknowledgement or appreciation and acceptance. While Benjamin emphasizes the joy of mutual recognition, Orange, expanding again, quotes the philosopher Hans-Georg Gadamer “The joy of recognition is rather the joy of knowing more than is already familiar.” Since recognition is “profoundly lopsided for a long time” Orange advocates that we do not “underestimate…trauma” [the noting by Orange of Winnicott’s being-with the patient in the co-created space (a transitional, or third, space) reminds me of the emphasis placed by relational theorist Bruce Reis on being with a patient whose traumatic experiences might be without words] of our patients, and that we not impose our own “agenda” (to be recognized as subjects) on patients. Orange “place[s] the primary responsibility for attunement and responsiveness on the analyst”.

Orange writes, “Perhaps we should give up the search for the Hegelian self-conscious subject, with the implied demand for the other to re-cognize and create it.” Orange intimates that other (not Self psychology) theorists expect the patient to meet equally the needs of the therapist. This mischaracterizes, I think, relational intersubjective emphasis. Orange is coming to Tampa Bay tomorrow (April 9) and I am eager to hear more about her foils (other theories of intersubjectivity) and how one might enter into dialogue with them.

Benjamin, J. (1990). An Outline of Intersubjectivity: The Development of Recognition. Psychoanal. Psychol., 7S:33-46.

Orange, D. (2008). Recognition As: Intersubjective Vulnerability in the Psychoanalytic Dialogue. Inter.J.of Psychoanal.Self Psychol., 3: 178-194.

Monday, April 4, 2011

Hiroshima, Mon Amour

The beautifully rendered Hiroshima, Mon Amour, directed by Alain Resnais, screenplay by Marguerite Duras, is a 1959 French film which, along with Truffaut’s 400 Blows and Godard’s Breathless ushered in French New Wave film. It is dreamily (without sequential time or cause and effect) shot and its script is poetical with its repetition of phrases. Beautiful and moving to any viewer, it may be especially so for the contemporary psychoanalyst in the way it speaks to the power of the witnessing of trauma.

We never know from the film, nor hear, the names of the two protagonists. Elle (Emmanuele Riva), a French actress (in Hiroshima to shoot a film about peace), suffered the loss of her wartime, German lover, then was ostracized by the residents of her hometown Nevers for this love; and Lui (Eiji Okuda), a Japanese architect, lost his entire family of origin and his hometown on August 6, 1945. Their personal traumas have for their backdrop the trauma of nations.

Opening the film, the two lovers entwined, the ashes of nuclear devastation on their skin transforming into perspiration, Lui responds to Elle’s narrative, telling her: you “remember nothing.” (For how could she possibly remember Hiroshima?) Later in the film, Lui says to Elle, “Tell me more.” And he is jubilant [reminiscent of the therapist’s privilege] that he is the only one who has ever heard her story. Elle’s later, second narrative includes, “One day, I’ll remember nothing,” [i.e. will be haunted no longer]. Only then does she consider returning to Nevers [facing the unknowable]. The peace march of the film within the film foreshadows Elle’s leaning toward healing. She finds Lui (He tells her that she gives him “a tremendous desire to love”) and re-finds “impossible love”. This time she does not have to bear it alone. Therapy, likewise, is not so much the ‘impossible profession’ as an ‘impossible love.’

Hiroshima, Mon Amour, shown April 3, 2001, was the ultimate film in the 2010-11 Film Series Developing Passions, cosponsored by the Tampa Bay Psychoanalytic Society, Inc and the Humanities Institute at the University of South Florida. The discussants were USF Humanities Associate Professor, Amy Rust, and local Freudian analyst, Michael Poff. Rust, in elaborating French New Wave films, also explicated components of contemporary psychoanalysis: The story [content] is subordinate to style [way of relating]; There is no omniscient viewer; Ambiguity is embraced; Subjective reality is privileged and the social history of the bombing of Hiroshima turns into the personal history of Elle and of Lui, and each’s interpretation of the world is negotiated alongside historic events.

Poff, too, saw the healing themes both between two persons (Elle and Lui) and two peoples (social historical context), but interpreted the film as “a failed attempt to resolve old trauma” referring to the Oedipus complex (both Elle and Lui deceive their respective spouses with this brief affair) and to transference, Elle’s putting of the past relationship (with the German soldier) onto the present one (with Lui), and to reconstruction (Freud)of the past. [Instead, I delighted in Lui’s capacity to ‘play’ (ala Winnicott) in the space between himself and Elle, wearing the attributions of her dead lover as part of the witnessing, and healing in relationship, which Elle requires. I found it a beautiful example, not of reconstruction, but of co-construction.]

Friday, April 1, 2011

Richard Geist replies to March 13, 2011 post

I agree with Richard that it is imperative we recognize the patient's healthy tendrils that are often embedded in their pathology because this is really the only thing we have to work with and build upon. Focusing on pathology often feels humiliating to the patient and provides little more than intellectual insight. The issue of empathizing with oneself is also crucial, but unfortunately not written about in the literature and a therapeutic goal. Carolyn and Amy, what can I say except thank you for your kind words! And being medium is pretty good for patients. Jessica, I agree completely; working from a connectedness perspective comes with its own complications and risks and requires more of the therapist/analyst than using a "technique" that keeps us somewhat distant, but safer. But, as you say, it also requires that we are very careful that what we are doing is in the service of the patient's needs not ours. Kristine, you're probably right there will be some criticism and you're right that I was enamored with my patient, but I think in the way that parents tend to over value their kids--and feeling slightly over valued as a patient is not such a bad thing. Barbara, I hadn't thought about it that way, but of course you're right that sharing the information with her was in itself an action, in this case I think in the service of welcoming what I perceived as an emerging twinship selfobject need. But again it is important as you point out to make sure we at least think we are acting in the service of the patient's needs. Steve, those patients who resist closeness require the same empathic understanding of their overwhelming fear of being close (and often the emotional traumas that have resulted from it). If we can allow them to remain distant while understanding the necessity for it, I have found eventually they will allow themselves to come a bit more connected. Christine, I think you're right (as was Pam); there were sexual undertones, but I didn't feel they were the central theme in terms of her sense of self. If they had been, I would have responded more directly to them. Ernesto, I think you're right; affect is central to connectedness and empathy as well as selfobject function. Perhaps I took this too much for granted rather than spelling it out.

Richard Geist, Ed.D.