After the Tide Goes Out

I take this subject very personally. For a variety of reasons, context is extraordinarily important to me; I need it to have sense of anything. I can't imagine a fish unless I also imagine either water or a frying pan. I can't imagine seeing patients without understanding our individual and shared contexts. And although I'm not so bad that I absolutely have to read the newspaper before I go to work, my experience is framed by my memory of the past and anticipation of the future. Therefore it drives me crazy when I survey our clinical literature and it seems to be written in a vacuum, oblivious to the social air we collectively breathe. Even when our conferences emphasize “culture,” I need some orientation to the location of the observer in relation to the whole landscape. It's not that I think I'm the only analyst in town who has a transference to insurance companies or has to contend with the effects on me of the devaluation of my profession or even worries about maintaining a practice—the effect of which on our clinical work is a subject in itself. From the data on intimate exchanges with analyst analysands, and supervisees, from gossip with colleagues, from joking identifications with Argentinean analysts who, as legend has it, moonlight driving taxis, and from four offers from analysts on the Upper West Side to a request posted on my institute's list serve for a referral of a difficult patient in Akron, I know I'm not alone in my anxieties. Still, it is with trepidation that I admit increasing difficulty relating to a clinical literature that seems to ignore what for me seems to be one of the most important things going on in the room until I develop a suspicion that a significant portion of that literature is an enactment of it. Thus when a symposium addresses the role of authority in the analytic encounter, I'm mystified, because my experience is that the more pertinent clinical problem is the lack of authority of psychoanalyst and psychoanalysis. When I read