Thursday, February 13, 2014

The Ethical, Compassion, and Complexity in Psychoanalysis

With a sense of social responsibility members of the Tampa area psychoanalytic community have developed and maintain initiatives that respond to the need of the other, supporting veterans’ families, for example. These colleagues serve without fanfare and invite us all to contribute. They may not experience it this way, but I believe their work in this regard belongs to the ethical, and suggest also that this personal inclination to the good informs and supports their psychoanalytic work.

In the larger psychoanalytic community as well, the turn to the ethical seems increasingly well established. Psychoanalysts and others, many inspired by Neil Altman’ pioneering work, are involving themselves and their writing with Palestinian-Israeli troubles, with transgender, with the undocumented, with whiteness and gross inequality, with class differences understood from below. Important voices in American relational psychoanalysis (Adrienne Harris, Eyal Rozmarin, Melanie Suchet) are now seriously engaging with the work of Emmanuel Lévinas. Likewise, in 2011 Donna Orange formally incorporated into psychoanalysis an “ethics beyond ethics”as an inherent dimension of her Hermeneutics of Trust. And the discourse of asymmetrical responsibility has appeared also in the psychoanalytic literature in the work of Adrienne Harris and Warren Poland. Also in 2011 two interdisciplinary conferences, including many psychoanalysts, took place: Psychology for the Other in Cambridge, MA, and Bystanders No More in New York City.

I have always understood Jessica Benjamin’s work, psychoanalytic and otherwise, as belonging to the ethical with her efforts to help liberate us from domination-submission forms of relatedness so we can flourish. Extending Benjamin’s and Judith Butler’s work, relational psychoanalyst, philosopher, and feminist theoretician Lisa Baraitser in London suggests that in Lévinas’ ethics, responsibility redefines recognition. After the birth of her first child, Baraitser began to ask “How do we take responsibility for the other (the infant) prior to the possibility of recognition by that other?”, and to point out that in maternal encounters (the
title of her book) the maternal subject tends to collapse in the face of the need of the fragile and developing child. As therapists we may experience something similar in the face of the need of the devastated child in our adult traumatized patients, like the ones Lauren Levine presented.

Respect for the asymmetrical responsibility to respond to the need of the other is, in part, what places our psychoanalytic work in the realm of the ethical. The clinical accounts Levine shared with us brilliantly illustrate what this looks like in practical terms.

I have suggested already that in these cases, she conducted a minimally theoretical psychoanalysis, a therapy by understanding, especially emotional understanding, that seeks to promote comprehension and to heal by participation in the emotional life of her patients. Levine is able and willing to enter the patient’s suffering and share the painful history, willing and able to “undergo the situation”with the other.

In so doing Levine’s work highlights another dimension of what makes psychoanalysis an ethical undertaking: compassion. Not pity, condescension, or mindless or inauthentic “making nice,” compassion may be experienced by the analyst as a relentless desire to accompany and to understand.

An emergent property of well-attuned relational systems just as hostility and contempt seem as if naturally to characterize others, compassion is both process and attitude. Etymologically compassion means ‘to suffer with.’ Our traumatized patients often feel crushed by a sense of futility. When we suffer with them, and struggle together to make sense of it, their suffering can begin to acquire meaning. Lévinas argues, moreover, that responding to the need of the other is precisely what brings us into subjectivity, into being.

Attention to complexity and its attendant fallibilistic attitude are other components of what one might term Levine’s compassionate psychoanalysis. “I don’t care what you think is only my opinion that counts...!”, or words to that effect roared the patient in response Levine’s spontaneous joy about the painting the patient had selected to buy. Knowing that patient and analyst are so intricately, so complexly related, even though stunned and hurt by her patient’s rebuff, in a fallibilistic spirit Levine reached out to her patient for contact. These matters are usually more complex than we have ever realized and there was more work to be
done to find out what happened.

Respectful of her patient’s suffering, Levine accompanied her patiently and without too much knowing, managing to stay engaged in dialogue with her, to good ends: in the process of transacting this rupture in the following session, perhaps in dawning recognition of Levine’s hurt, the patient said something like– “I don’t know why I feel like crying”!

A compassionate attitude may enable hitherto unknown and impossible ways of experiencing. As process, psychoanalytic compassion perhaps can be understood as a form of emotional understanding.

As emotional availability, psychoanalytic compassion may be what empowers our willingness to accompany patients to the deepest circles of their experiential hell. Not moral masochism on the part of the analyst, nor to be contrasted properly with psychoanalytic work, psychoanalytic compassion is the implicit interpretive gesture of reaching out to embrace our patient in a sustained, even relentless, struggle to find an understanding.

To state it briefly: a compassionate response to the suffering of others is an ethical imperative, and, as it brings us into subjectivity, it adds meaning to our lives; a humble life in the service of the other is our ethical vocation; psychoanalysis becomes an ethical pursuit when we learn to notice and to care for psychological fragility; the primary and fundamental task of psychoanalysis is relief of suffering; commitment to relief of suffering is our fundamental therapeutic vocation; we are called, summoned, addressed, and responsible even
when we are unsure what this address means; our work belongs to the ethical, to the vocational. For me all this is implied in the work Levine shared with us.

In her post of February 9th appended, Lycia Alexander-Guerra cogently writes: “I have read a few papers in my time, but none quite like Levine’s. Her voice is unique; it transcends theory. In a feat of lived, not
theorized, relationality and intersubjectivity, Levine’s papers are as much about her experience as about her patient’s.” Indeed. I believe Lauren Levine was as emotionally available to us, her audience, and will be to her readers later on, as she is to her patients. Such emotional availability may be what makes it possible for her to so powerfully convey her work. It may also be the reason why we established indeed a shared humanness enriching one another!

Ernesto Vasquez, M.D.

See other comments posted to the blog of the Tampa Bay Institute for Psychoanalytic Studies, Inc by this author under the February 9, 2014 post titled ‘Mutual Vulnerability’

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