Sunday, February 7, 2021

Remembering Dr. Horacio Arias

On January 23, 2021 the Tampa Bay Institute for Psychoanalytic Studies lost after a brief illness one of its emerita faculty, and the Tampa Bay Psychoanalytic Society one of its long time members and former presidents. Horacio Arias, MD was 96 years old and had, up until a few weeks before, been practicing part time his craft as psychoanalyst and psychiatrist.  At a Memorial Service (by zoom) on February 6, 2021 what stood out to most was his enduring kindness and wisdom.

I knew Horacio for more than twenty years and became accustomed to his thick accent (born in Colombia and trained in Kleinian psychoanalysis), so much so that those on first encountering him would ask me to repeat what he had said. One thing he said loudly and repeatedly to me, by his actions, was 'I'm always in your corner.' He had my back, in part, because of his Kleinian insistence to see whole objects and not just part object. A much needed skill, I think, in these times.

Saturday, November 28, 2020

How the Therapist Can Journey Toward Being an Anti-Racist

 In order to challenge oppressive cultural norms and their implicit assumptions, we need to recognize that components of identity, such as race, are not essential and biological, but, instead, are socially constructed through history, language, culture and custom. Often the designating of differences is to make those in power more comfortable.

When we ‘other’ what is different as unworthy or dangerous on the basis of race - often without even being aware that we are being racist - we are engaging in racism. We too are diminished alongside the harm we cause the othered for we limit our omni-potentiated multiple selves and truncate our capacity for varied identifications, empathy and creativity. 

I wrote in a post on February 28, 2020 about  Ibram X. Kendi’s How to Be an Anti-Racist (2019). I thought it might be interesting to consider how we might strive in our clinical practices to be ‘on the journey’ to anti-racist behavior. Our profession usually emphasizes internal factors such as defensive othering to bulwark our fragile selves; fear and its consequent hatred of difference to calm our anxieties about difference; operating in the Kleinian paranoid schizoid position instead of the depressive position; failure to reflect, in Bionian terms, to think; failure to maintain the tension required by Benjamin’s intersubjectivity. But no matter to which theoretical explanation we subscribe, we, as therapists, in order to behave as anti-racists, can, to name a few:


 - refuse to deny class differences with patients, and consider  the impact of ethnicity and culture in the clinical setting; 

- be “aware of both gender and racial difference and of the need to negotiate such differences rather than [to treat them] as fixed identities” (Kaplan,1993);  

-“acknowledge that our assumptions and beliefs … towards those who are culturally and racially different may well be over simplistic, judgemental and discriminatory” (Hawkes,1997)

We can 

-when working with any patient, keep in mind the damage to identity that racism engenders;

-think about the intergenerational transmission of trauma--from slavery; -think about how Adverse Childhood Experiences affect physical and mental health;

-not treat “race as a “content” whose symbolic meaning is already established (Leary, 1995);

-recognize that pathology is not only located within a mind but also has external origins in Society;  

-provide a thinking space, a transitional space, a third in which to deconstruct assumptions about so-called race; 

- be aware of the capacity for destruction and racist beliefs in each of us; 

- understand how binaries are used by us and by others;

- not let ‘neutrality’ mean turning a blind eye to difference; 

- reserve a % of our work hours to treat those of a different class, and at a reduced fee; 

- and serve as witness.(1)


(1) Donnell Stern writes that witnessing--an important function of therapists-- provides “metaphors for the organization of meaning.. We need a witness if we are to grasp, know, and feel what we have experienced, especially trauma. Someone else must know what we have gone through, must be able to feel it with us.”  Evans writes “Sometimes the witness's function is to break the dissociative spell and free up unformulated experience. ...we give voice in the private domain that which one day will be discourse in the public space whereas issues previously out of awareness or in denial can be confronted by the body politic as a whole and serve to inform and enlighten legislatures.” 

Hawkes, B. (1997). Race, Culture and Counselling by Colin Lago in collaboration with Joyce Thompson. Published by Open 

      University Press, Buckingham, Philadelphia 1996 British Journal of Psychotherapy, 13(3):433-435

Kaplan, E.A. (1993). The Couch Affair: Gender and Race in Hollywood Transference. Am. Imago, 50(4):481-514.

Leary, K. (1995). “Interpreting in the Dark” Race and Ethnicity in Psychoanalytic Psychotherapy. Psychoanal. Psychol., 


Tuesday, November 24, 2020

Colonization and Racialization

Psychology has made much of racism as a defensive mechanism --a projection--of, for example, asserting superiority to manage anxiety about Difference. Kleinians would say that we see the other as only part object when operating from this paranoid schizoid position. So called race is not simply about difference; historically it is also about power (Foster 2014) and about “the colonial attitude of assumed Western superiority.”  [I recommend Isabel Wilkerson’s Caste , and Frantz Fanon’s The Wretched of the Earth and Black Skin, White Masks, to learn more about “the effects of colonization on the behavior, social systems, and subjectivity of both colonialists and colonized.”]  

It is important to remember that race and ethnicity represent amalgams of real social consequences as well as fantasy (Leary, 1995). Racism appears as internal - hatred of difference - but actually reflects internalization of external racialization rationalized and justified on biological, religious and psychological grounds (Davis 2007). Racism is a socially sanctioned form of hatred; death by cop a permissible persecution; projection not only exploits Difference, but creates it. (Evans,2004). 

Dorothy Holmes (2006) contends that “our culture's attitudes and practices regarding race and social class inevitably cause significant and lasting damage to the self for all who live in this culture.” Recall that Sullivan noted that self esteem does not come from the self but from accretion of myriad interactions with others. Society, with its socially sanctioned beliefs about race, with its policing -- whether by law enforcement, segregation, Jim Crow Laws, red-lining, voter suppression or multiple, daily microaggressions -- ‘colonizes’ the mind through the learning from a myriad of cultural cues that demonstrate that one is excluded and that one’s self is experienced as inferior, dangerous, etc. 

These negative attributions take their toll. Colonized in this way by Society’s projections, one begins to believe that one is inferior, and may, of course, lead to self loathing and dysphoria. The mind has been colonized not only by the projections from those who believe themselves to be white-- who see this injustice as normal and even natural-- but from experiences of being treated as inferior or dangerously other by institutions. This is one thing that is meant by the colonized, rather than a mentalized, mind.

Evans, P. (2004). Race, Colour and the Processes of Racialization: New Perspectives from Group Analysis, Psychoanalysis and 

        Sociology Farhad Dalal Hove and New York: Brunner-Routledge 2002 251 pp. £17.99. J. Child Psychother., 30(3):376-378.

Foster, A. (2014). Thinking Space: Promoting Thinking about Race, Culture and Diversity in Psychotherapy and Beyond edited 

        by Frank Lowe. The Tavistock Clinic Series; series editor: Margot Waddell. Published by Karnac, London, 2014; 266 pp; 

        £26.99 paperback. Brit. J. Psychother., 30(4):547-550. 

Frosh, S. (2004). Aboriginal Populations in The Mind: Race and Primitivity in Psychoanalysis. By Celia Brickman. New York: 

       Columbia University PressPsychoanalytic Review, 91(3):457-460

Holmes, D.E. (2006). The Wrecking Effects of Race and Social Class on Self and Success. Psychoanal Q., 75(1):215-235.

Leary, K. (1995). “Interpreting in the Dark” Race and Ethnicity in Psychoanalytic Psychotherapy. Psychoanal. Psychol., 12(1): 


Friday, November 20, 2020

Race, Constructed and perspectival

It has been generally accepted in psychoanalytic circles that Race, like gender, is a socially constructed concept. It has been used politically to justify exclusion, marginalization, disenfranchisement, and worst: slavery. Race is used to legitimize the existing hierarchy of wealth, power and domination. (Evans, 2004) Race is an ideology. Evans writes “It is easier to exploit, torture and even exterminate people … [when] they are ‘othered’ [and] rendered less than fully human.”

Race has no genetic basis, and yet we live in a racialized society that is considered in terms of white and non-white, whereas, in the consulting room, remember these terms and meanings are to be negotiated between therapist and patient. Those who think of themselves as white also possess these categories. But race and ethnicity are not the sole domain of people of color. It is perspectival: It is not only the other who is other. 

The assumed dominant culture, ‘whiteness’ , is the assumed universalized subject (Kaplan, 1993), the default position; Whiteness goes without saying, and you may have noticed that therapists, when presenting cases, often only state race when it is other than the Euro-normative white subject. Whiteness assumes a homogeneity within race, marks clear delineations between races, and obscures and oppresses any contradictory subjects’ positions. (Layton, 1998).  The Euro-American culture is assumed normative, and stature and standard by which all others are contrasted. The Black Lives Matter movement seeks, among other things, recognition, and seeks redress of this black/white binary. 

Evans, P. (2004). Race, Colour and the Processes of Racialization: New Perspectives from Group Analysis, Psychoanalysis and Sociology Farhad Dalal Hove and New York: Brunner-Routledge 2002 251 pp. £17.99. J. Child Psychother., 30(3):376-378.

Kaplan, E.A. (1993). The Couch Affair: Gender and Race in Hollywood Transference. Am. Imago, 50(4):481-514.

Layton, L. (1998). Beyond White and Other: Relationality and Narratives of Race in Feminist Discourse: S. S. Friedman. Signs. XXI, 1995. Pp. 1-49Psychoanalytic Quarterly, 67(2):348

Tuesday, November 17, 2020

Caste by Isabel Wilkerson

The Tampa Bay Psychoanalytic Society on November 7, 2020 offered a panel on race where four panelists reviewed contemporary books. The panel: Decolonize Your Mind: Antiracist Literature, featured Aisha Abbasi, MD; Lycia Alexander-Guerra, MD; Linda Berkowitz, LMHC; and Carolyn Smith, LMHC. Aisha Abbasi reviewed Caste by Isabel Wilkerson. 

PBS Newshour, on Aug 5, 2020, spoke with Wilkerson, a Pulitzer Prize winning journalist for the New York Times, and author of Caste, the Origins of our Discontents. Wilkerson sees us [U.S.] on the “cusp of an awakening, an awakening to a part of, much of, American history that many people may not have known. The goal of this work [Black Lives Matter] is to allow us to see again the structure that we have inherited, to be able to push forward,” -[doesn’t that also sound like the work of psychoanalysis?] - Wilkerson continues: “but most importantly, to recognize that we all have a stake in it and to recognize that it will take each and every one of us to make it the strongest house possible.” 

Caste, a hierarchy, is an infrastructure. Hidden like bones, it is larger than race, the foundation, the framework for how people interact with one another. Wilkerson: “I think of caste as the bones and race as the skin...Race has been used as the cue, as the signal, as the indicator of where an individual sits in a pre-existing hierarchy ...” 

Sunday, October 18, 2020

“God Said to Abraham, Kill Me A Son.” - Bob Dylan, Highway 61

Hosted by the Tampa Bay Psychoanalytic Society (TBPS) on Saturday, October 17, 2020, John Auerbach elaborated, in a most delightful presentation, the Old Testament story of Abraham and Isaac, and linked it with Bob Dylan’s [Dylan ne Zimmerman received Nobel Prize for Literature in 2016, despite being a known assaulter of women] relationship to his own father [Abraham Zimmerman], as well as with the relationship in general of parents and children. [Thanks to Covid-19, all TBPS Speaker Program meetings are now virtual and so now almost anyone with wifi can attend presentations.] 

One very interesting part of the discussion was introduced by Peter Rudnytsky’s noting of the existentialist Kierkegaard’s ‘teleological suspension of the ethical’ [never acceptable, not even in 'the ends justify the means'] had the group examining Abraham’s dilemma-- unconditional obedience to God’s request to kill Isaac or ethical attention to God’s ‘Thou shalt not kill’ commandment. Recalling [Erich] Fromm, Rudnytsky found “profoundly troubling” any religion that teaches the acceptance of an ideology of authoritarianism and that values obedience to authority above all else. [I was reminded of the evangelical support of an unethical Donald Trump to the ends of a more conservative Supreme Court.]

Auerbach recounted that, after Isaac is spared, there exist no further Bible passages to indicate that Abraham and Isaac  ever spoke again. Imagine, said Jessica Rausch, the trauma to Isaac [ironically, ‘laughter’ in Hebrew] knowing his own father might have killed him. And what if ‘raise him up’ was not raise Isaac up as a sacrificial offering, but rather to raise him up as 'to honor 'him? Abraham’s failure (of character) to protect his son is compared to God’s character in asking Abraham to make such a sacrifice. 

While infanticide/filicide is much more prevalent than parricide, Freud chose the Greek myth of Oedipus to explain the mainstay of sexual development [recall that it is Oedipus’ father Laius who wanted to kill him first]. Auerbach mentions that Freud, in another indication of Freud’s ambivalence about Judaism -- an ambivalence shared by Dylan-- did not choose a Hebraic myth, but a Hellenic one. Anti-semitism in fin de sicle Austria put Freud, despite his success, in a marginalized group; Such groups struggle with self-love over self loathing.

Lastly, in thinking of an authoritarian and powerful God or a loving and just God, Auerbach contrasted the Freudian tripod anonymity, abstinence, and neutrality with the Rogerian triad of empathy, genuineness, and unconditional positive regard. Joseph Assouline wondered if God were not giving Abraham the opportunity to think for himself, or perhaps God had planned to stop Abraham all along, only checking to see how obedient Abraham might be? Is God seeking faith or asking Abraham to ‘wake up?’ The Judaic tradition, Linda Berkowitz reminded us, is continued discussion, a plethora of opinions [think Aron and Henik, Answering a Question with a Question].

TBPS’ next program: November 7, 2020 on Decolonizing the Mind and Anti-Racism literature.

Wednesday, October 14, 2020

On Earth We're Briefly Gorgeous: Immigration, Trauma, Recognition: "Happy Birthday, Ocean!"

Ocean Vuong, an emigrant at age two from war, is a Vietnamese American poet and novelist who debuted his first novel
On Earth We're Briefly Gorgeous (2019, Penguin Press). Voung discusses his book and his experience on Amanpour and Company (aired 10-31-19). Amanpour found it “compelling” and “a poignant ode to marginalized immigrants.” Voung’s novel is written in the form of a letter to his illiterate mother. 

Vuong’s mother cautioned him as an immigrant “to be invisible,””to go out and disappear,”  “to hide yourself in order to protect yourself,” but Vuong “wanted to be known.” He hoped “to honor [his] journey.” On Earth We're Briefly Gorgeous is semi autobiographical and a coming of age story about a gay man whose family is working its way out of poverty, Vuong was inspired and empowered by Baldwin’s Go Tell It on the Mountain

Vuong recalls being put in timeout by his elementary school teacher and being so invisible that she forgot about him. The other students had gone to lunch when she discovers him still seated in the corner. “It is so easy for a small yellow child to vanish. The hard work, the real work that requires innovation, is to be known,” says Vuong. He found that being an artist is a powerful way to be known.

A lonely boy in Hartford, CT, Vuong wrote his own poems. His teacher thought Vuong had plagiarized them. “It was terrifying to be in trouble for your imagination.” But he also had never felt so respected and feared [for] being “unfathomable.” He notes the two stereotypes of Asian Americans: the math whiz (genetic) and the musical prodigy (from “the unjust (and inhumane) parenting of tiger moms” as if not the musician’s own agency), [see Eng and Han's 2000 paper A Dialogue on Racial Melancholy on the 'model minority'] “and always in service of … European music”  To be an Asian American artist creating original works is “inconceivable” to other.

His mother and grandmother suffered with PTSD and Vuong grew up surrounded by the pervasive violence found in his mostly black and brown neighborhood, with its police brutality, and violence in his home, even toward him. He saw “that anger was the death of creativity and innovation...Anger is a force that extinguishers the wielder as well as the world....As a writer, as a thinker I am most useful to myself and my world when I ask ‘Now, what?...How do we change what happened to us into how we live better?’“

Friday, August 28, 2020

The Power of Voices

I wanted to mark the 57th anniversary of the March on Washington for Jobs and Freedom.

On August 28th, 1963, African Americans, and others, voted with their feet when 250,000 strong participated in the March. Civil rights leaders protested racial discrimination and demonstarted support for the civil rights legislation in Congress at the time. [The Civil Rights Act was signed by President Lyndon Johnson in 1964.] Martin Luther King’s “I have a Dream” speech was given on this date from the Lincoln Memorial. 

This week, in support of protestors marching for Black Lives Matter following the shooting (seven times in the back) of 29 year old Jacob Blake by a police officer in Wisconsin and the subsequent death of two and the wounding of another protestor (allegedly by a ‘Blue Lives Matter’ seventeen year old), professional athletes in soccer, football, baseball, and hockey used their voices in massive protest, unlike any heretofore, by refusing to play or by postponing games and cancelling practices. Ray Allen, former NBA player for the Milwaukee Bucks and Basketball Hall of Famer, told PBS Newshour’s John Yang yesterday August 27, “[N]ow we understand the power we possess.”

I might add from Corinthians 13:1 (Good News translation) I may be able to speak the languages of human beings and even of angels, but if I have not love, my speech is no more than a noisy gong or a clanging bell.

Monday, August 24, 2020

About the Voice

On August 18, 2020 I posted, on the 100th anniversary of the ratification of the 19th Amendment, about women having fought to obtain the voice of the vote. This led me to thinking about the voice in a more concrete way, in particular, when a patient’s voice is very loud, or productive, or seemingly pressured, patients who seem not to expect a dialogue with us or to let up ‘get a word in edgewise.’ A colleague complained to me about his patient’s very loud voice, shouting in the session such that she gave him a headache. He and I talked about the possibility that she had a great longing to be heard, having had a mother who would never listen to her. My colleague chose to ‘lean into’ her need to be heard, and even sometimes to muse aloud about this need of hers.

Another colleague of mine became annoyed with her patient with whom she had to struggle to get a word in, and to struggle to go from the patient’s complaints about external events to the patient’s internal longings. My colleague was tempted to interpret the patient’s seeming incapacity to be in dialogue with another and to let the patient know how left out from a dialogue she, the therapist, felt. Instead, my colleague decided to speak to the possible longings this behavior of the patient’s might be communicating. Perhaps the patient, like a loud patient, might have a great longing to get her story out, that is, to be heard, and had, in addition, the fear and expectation (learned from childhood experience) that a listener’s attention could not really be held for long and so the speaker better get in as much as possible before the listener 'disappeared.’ 

Childhood may teach us (and become a relational paradigm) that listeners disappear: A mother who is starting to give us attention, but then is distracted away by her other children, her own worries, or by her dissociated unresolved trauma. Caregivers may tell us to go away, that they don’t have time for us. They may teach us we are not really deserving of being listened to, or that we are boring, by pretending to listen while not really giving their full attention (e.g. while on the phone). Perhaps worse is to have had our parents dismiss our feelings and points of view such that we feel misrecognized and misunderstood, never heard.

An analytic attitude listens with heartfelt attention, allowing the patient the experience of being ‘a child of the universe [with] ... a right to be here.’ Another colleague told me how a particular patient would not stop talking at the end of a session, as if to “grab” the therapist, sometimes running over twenty minutes! I was reminded of children I have seen in play therapy who, when the parent calls for them at the end of a session, throw their arms around my legs and not want to leave. I notice aloud their attachment, let them know I will hold them in my mind, and that I will be here next time. Sometimes, because of our experience together, they know that to be true.

Tuesday, August 18, 2020

100 year anniversary of 19th Amendment’s ratification

There is no democracy without enfranchisement of all its citizens, and without the vote, there is no voice. [The voiceless are made helpless, vulnerable to depression and dissociation, and/or resentment and revenge.] The 19th Amendment enfranchised women, the right to vote giving voice to the speechless. [Psychotherapy strives to give voice, to enfranchise the speechless, empower the voiceless, to bring to fruition an individual’s potential.] This 100th anniversary is bittersweet; joy for the hard fought victory, anger that disenfranchisement lasted so long. [Our patients, too, may lament that it took so long to arrive at our offices where they work together with us to arrive at a stronger sense of themselves.] 

Woodrow Wilson had declared, “Liberty is the fundamental demand of the human spirit.” The suffragists he initially opposed replied-- with their daily picketing outside the White House,

led by Alice Paul--, “How long must women wait for liberty?” These women, demonstrating in nonviolent civil disobedience through the winter and into the fall of 1917, were jeered, called Bolsheviks by journalists, physically assaulted, attacked, arrested, jailed and beaten, [much like Black Lives Matter demonstrators are today]. When it became politically expedient, and after years of persuasion (the carrot) from the then president of the National American Woman Suffrage Association Carrie Chapman Catt, along with many months of embarrassment (the stick) by Paul and her sister demonstrators about his hypocrisy of America’s so called democracy with half its citizens unable vote, Wilson supported in November 1917 New York’s amendment to its state constitution for women’s full suffrage.

The Resolution for Amendment 19 came before the U.S. House of Representatives, gaining the required two thirds majority, and passing on May 21, 1919. One Representative left his wife’s death bed to, at her behest, vote ‘aye’ and then returned home to her funeral. The U.S. Senate passed it on June 4, 1919 by one vote over the needed two-thirds majority. Three-quarters of the states were needed to pass an amendment to the U.S. Constitution (in 1920, that was 36 out of the then 48 states).  All the southern states failed to pass, some would not even consider, the 19th amendment--black women voting would lessen their hold on white supremacy-- making ratification impossible, all except for Tennessee (its governor was a friend of Wilson’s). Tennessee was the necessary 36th state to approve, by one vote over the needed two-thirds majority, the 19th Amendment. After over 70 years* of activism, twenty million women finally won the vote, thanks, in part, to a mother who told her Tennessee State Representative son he’d better vote for women’s suffrage. The ratification of the 19th Amendment was a huge step toward realizing the United States’ potential.

*First Convention for Woman’s Rights held in 1848, in Seneca Falls, NY -- with Elizabeth Cady Stanton, Lucretia Mott and Frederick Douglas in attendance. Black women’s suffrage groups had the motto “Lifting as we climb.

The 19th amendment reads, “The right of citizens of the United States to vote shall not be denied or abridged by the United States or by any state on account of sex.”