Psychoanalysis - On the Front Lines of the Experience of Reality

It has been my experience and observation that personal pain, unexpressed and unshared, is a root cause of much malaise and suffering in the world. To the extent this can be remedied on a personal level, people can experience more freedom and become more empathic, kind and caring individuals.

To the extent that analysands can explore there own misery and suffering, share and express their pain, psychoanalysis is a tool to provide more freedom, empathy and kindness in the world.

I believe the potential collective amount of suffering in the world is boundless. It can be limitless. It is relative and thus can always improve or decline.

Thus I see psychoanalysts on the frontlines of pushing the collective experience of life in one direction or another. It's the only school of therapy I've surveyed that gives people a chance to explore deep misery and pain.

Throughout history, we have observed enormous human tragedy inflicted on humanity by it's own participants. Hitler, for example, was a person who had intense pain buried within, unshared and unaddressed (Dorpat, 2007). We all know the incredible misery he inflicted upon mankind.

Humans alone among all species (Becker, 1971) must confront their own mortality. This painful truth had led many to run from reality and lead quiet lives of misery. Projected fear of mortality has lead to all manner of collective abuse, collective denial and maladaptive behavior on a societal level.

Just as the personal experience of reality can be profoundly changed by confronting one's own deepest fears and pain, so too can the collective experience of reality be profoundly changed.

Psychoanalysis has incredible potential for humankind. Suffering is here to stay for homo sapiens. How we express it, constructively or destructively, is entirely our collective choice. As a tool for meaningful social change, psychoanalysis is the most promising frontier for mankind. Analysts and analysands alike stand at the frontlines of our collective pain and suffering.

As a tool for fighting poverty, I think psychoanalysis may be a potent tool. As a tool for alleviating social stratification and collective alienation, psychoanalysis may be the best we can offer ourselves.

All this assumes that psychoanalysis is performed with patience, respect and kindness. No school of thought has a monopoly on these traits. It also assumes that psychoanalysis can become less of a tool of, by and for those of great means, insomuch as it is just that.

Finally, I do believe psychoanalysis has an unparalleled modern voice of kindness and reason, a light that points it in the right direction. I humbly suggest this voice is that of the late Dr. Theo L. Dorpat. It is my hope that I can send as many clinicians and patients alike straight to his works. I firmly believe Dr. Dorpat shows us all the way forward to 'a more peaceful, just, and verdant society.'

-- Tim LaDuca

Relational Psychoanalysis and Community Redevelopment

At USF Day Institute on Engaged Scholarship and Community Redevelopment, University of Buffalo Professor Henry Taylor served as keynote speaker. Dr. Taylor’s emphasis on the solving of problems of “distressed urban communities” and the “sprawling urban metropolis” resonates with contemporary psychoanalytic theory. Professor Taylor noted that any one social problem can only be resolved in relation to the total environment. Underperforming inner city schools, for example, can only improve when rebuilding efforts address the unsafe neighborhoods, limited familial resources, poor nutrition that affects attention spans, bitterness, and hopelessness that form the social context of the school.

Neil Altman’s pivotal thinking about the application of psychoanalytic practice to public health clinics relies on the relational perspectives of Fairbairn, Mitchell, Greenberg, Bollas and Ogden. Though Altman’s focus is on the therapeutic setting, several issues can be extrapolated to analytic consulting work in distressed urban environments.

Psychoanalysis had long relegated the poor to the position of the “analyzable” in a way that broke down along social class values. Poor people were seen as preferring affiliativeness versus rugged individualism; as suffering from limited verbal intelligence which increased the likelihood of destructive acting out in the therapy; and as focusing on here-and-now problems of hunger and physical safety rather than on unconscious fantasy and symbolization.

Contemporary psychoanalysis had moved beyond the rigid stratifications of ego psychology that discriminated against patients based on their ability to tolerate the frustration of analytic abstinence, the eruption of anxiety from the growing awareness of the drives and drive derivatives and ego ‘defects’ such as inability to delay gratification; a profoundly class-based evaluation procedure.

Though Altman credits Fred Pine with widening the scope of ego psychology, relational psychoanalysis offers more. For Pine, (in a break from ego psychology) the relationship between the analyst and patient is mutative. When the patient has the experience of the analyst as reliable, nonjudgmental, capable of helping the patient name and distinguish feeling states cures and this is independent of the patient's use of the insight developed through therapy.

Relational analysts offer several insights that can be extrapolated to apply to community problems. Relational approaches to community trauma and despair can offer community members ways to think and be-in-relationship with each other such that they can learn to make situations less anxiety provoking. Community demands to solve concrete problems can be taken at face value and away from pathological judgment. The ensuing countertransference that develops while working in distressed communities can be a method for feeling one’s way into the community’s internal (i.e. emotional) world. Psychoanalysts can assist community groups in increasing their ability to manage anxiety provoking situations and away from a reliance on constant crises and chaotic reactions that show themselves in therapy as frequent missed appointments, coming to therapy only in times of crisis, and an over-focus on concrete, bread and butter issues. Consulting with community groups in distress affords members access to ways of thinking about bread and butter issues that promotes an understanding of what these may be symbolizing for the community.

Altman, N. (1993). Psychoanalysis and the Urban Poor, Psychoanalytic Dialogues, 3, 29-49.

Pictured are Gary Lemons, Ph.D., Department of English, USF; Nagwa Dajani, M.D., Ph.D. College of Medicine and Lycia Alexander Guerra, M.D., President, TBIPS and TBPS at the USF Day Institute.

What are the curative factors in recovery from mental illness?

Link to a very interesting article in the Washington Post on Feb. 10, by Charles Barber, a mental health worker at Yale:

http://www.washingtonpost.com/wp-dyn/content/article/2008/02/08/AR2008020803272.html?hpid=opinionsbox1

Barber describes his own journey to recovery from an incapacitating mental condition, and draws some observations from his own experience and from research into the conditions that facilitate recovery. He speaks against the "medical model" of attempting to alleviate symptoms through the use of drugs, and instead focuses on the healing effects of "social context." He notes that outcomes from even such severe mental illnesses as schizophrenia are better in developing countries, where "patients get more support from family and society." His is an argument against pharmacotherapy and "therapist as expert," and instead, an argument for immersion in a supportive social mileau.

Barber does not use the language of self psychology or relational analytic theory but, using these schools of thought as lenses, what he says becomes readily explainable. A self psychologist would recognize all of the curative factors Barber lists as sustaining selfobject relationships that lead to restoration of cohesion to the disequilibrated self. What Barber describes as curative is the restoration of the "selfobject mileau."

Near the end of his article, Barber states that "Listening to patients [the curative factor] cuts against the establishment grain." Here, he speaks of what Kohut and others have termed "empathic immersion" in the patient's experiential world. (Cf. also Donna Orange et al.)

How would other schools of psychoanalytic thought explain what Barber describes in his article? Post your thoughts, reactions, and other musings on how best to explain the important observations about what constitute the curative factors that Barber describes.

Note that Barber has a newly-published book in which he elaborates on these ideas.