According to my dictionary, an ideology is “The body of ideas reflecting the social needs and aspirations of an individual, group, class, or culture.” In response to Dr. Richards' thought-provoking paper, I provide three ways we might understand our temptation to embrace an ideology. Briefly:
Psychoanalysts, as clinicians, are confronted every session with some of life's most baffling, and most painful conundrums. Regardless of how we define our roles, it can be tempting to adhere to a set of certainties about how to proceed. The daunting clinical task might, itself, incline us toward longing for unquestionable verities.
In order to distinguish itself from a religion, or cult, psychoanalysis has traditionally “thrown out the baby with the bathwater,” so to speak. We have tried to deny having personal and professional values that profoundly affect how we work. While many in the field have cast aside some of the requirements of “neutrality” and “abstinence,” the inescapable role of values in treatment is still underplayed. As lived out in psychoanalytic institutes, this denial creates problematic situations, most especially for candidates. One outcome is that analysts' values, forced underground, may seek an acceptable expression, in the form of an ideology.
Psychoanalysis does not exist in a vacuum. It is practiced in cultures which, themselves, provide support for ideologies that equate maintaining standards with maintaining “purity,” in some sense. Put another way, regardless of widespread current efforts to assert the value of diversity, strong exclusionary trends still exist inside and outside the field of psychoanalysis. In the wider society and in the psychoanalytic world, it is not uncommon to encounter
stringent gates for admittance, which function to keep some people out, giving a special status to insiders.
While I do not agree with Janet Malcolm's (1980) characterization of our field as impossible, I do think it presents enormous challenges. No matter how our analytic education taught us to define the analyst's role, it surely includes hearing about many of life's trials and tribulations. Some of the most painful forms of suffering will appear in our offices, at unpredictable moments. Elsewhere (, chapter five) I have written about the analyst's task as including sufficient conviction in our therapeutic stance, sufficient humility, sufficient awareness of our inevitable subjectivity, and sufficient curiosity to recognize the unexpected. Given the enormous challenges we face every hour, is it any wonder we yearn for certainty about our favorite theories and methodologies, even if (or, perhaps, especially if) those certainties turn into elitist “clubs” that exclude colleagues who think and practice differently?
Put another way, the temptation to latch onto an ideology can be understood as a wish to escape the insecurity of living within the bounds of “negative capability.” Briefly, this is a concept (Keats, 1959) that lauds being capable of living with uncertainties, mysteries, and doubts, without any irritable reaching after fact and reason. Reaching, irritably or not, for an ideology might be an attempt to escape from the anxiety of constant exposure to fathomless mysteries. Which of us, feeling lost and unmoored, would not yearn for a reliable compass? But, then, to really trust my compass, wouldn't it be natural to believe that my compass is better than yours?
In 1999 I published a paper entitled “Searching for a Passionate Neutrality.” I described a two- session consultation I had recently conducted. Briefly, the patient's therapist initiated the consultation, out of concern that, after many years of treatment, the patient's severe eating disorder had not improved. Upon meeting the patient for the first time, I had a strong reaction.
Everything about her announced her reluctance to leave childhood behind. Her thin, insubstantial body, her waiflike stare and stubborn
Page 94pout made this young woman seem early adolescent. With little emotion she described more than a decade of internal warfare over eating enough to live. The struggle with her eating disorder had already taken her life, in that there was room for little else. I found myself immediately, deeply concerned. Every fiber of me wanted to wrestle with the self-destructive forces in her. I wanted the vibrant young woman I saw as her potential to emerge.
Years later, reviewing this paper for its reproduction in a book I reflected on its part in my development as an analyst. It was the start of a process of studying the place of neutrality in my clinical approach. I knew that whatever stance I took, it would have to incorporate the legacy of Erich Fromm, whose writing had made a lasting impression. Fromm's thinking also influenced me through his work with many of my analytic supervisors and training analyst, during my candidacy at the William Alanson White Institute, from 1979-1983. From Fromm I took the belief that promoting the patient's (and my own) full self-realization was part of my role as an analyst. How could I avoid imposing my own values, and respect the patient's right to an uncluttered, neutral space, but still foster (in Fromm's 1973 language) “biophilic,” or life loving forces against “necrophilic,” or death-oriented pulls?
In my first book I concluded that analysts inevitably express our values through our focus in a session. I did not suggest that we abandon the concept of neutrality, but, rather, that we hold it in a tension with these values. They include curiosity, integrity, and the ability to bear suffering (more about this below). I suggest that these values play a role in treatment regardless of the practitioner's theoretical orientation. Our focus, that is, what we hear, respond to (silently or out loud) remember, link with other impressions, and so on, is partially shaped by these values, often on a less than conscious level. I believe that they operate, however committed we may be to adherence to neutrality. There is no way to focus on everything that goes on in a session. Focus is determined by our beliefs about what is meaningful, problematic, amenable to treatment, and so on. Our only choice is whether we recognize the values that play a role in guiding our participation in sessions. I am suggesting that facing the role of values in directing our focus could ultimately free
psychoanalysis. I think it is a key aspect to its returning to its place as a vibrant, exciting field of study and treatment methodology.
Put another way, one of the greatest dangers facing psychoanalysis is an unwillingness or inability to face the values that are inherent in the psychoanalytic process, regardless of its theoretical orientation. Denial of these values contributes to the field's stultification. Psychoanalysis has always had a reluctance to come to grips with this issue. It has been afraid it will be dismissed by the public as a religion, or cult. It has worried about its standing among other professions if it admits that there are values embedded in any psychoanalytic enterprise. With good reason it has been concerned that, in the hands of a self-indulgent practitioner, it could become a method that abuses its privileged access to the minds and hearts of patients. These dangers, and others described below, are serious and worthy of our attention. But I would say that even more perilous is the position of a psychoanalysis that denies its own values, crippling its therapeutic potential, putting its candidates in the position of having to hide some of their motivations, forfeiting the possibility of inspiring clinicians and prospective patients who might otherwise be interested in psychoanalysis.
I would distinguish between areas where the analyst should refrain from expressing value judgments, where possible, from areas where expressing value judgments is inevitable (and, possibly, preferable). I do not know whether someone should live in Westchester. As H.S. Sullivan might say, that is not within my “purview.” But I do know that feeling compelled to wash one's hands two hundred times a day is problematic. If a patient described this behavior, I would tend to focus on it. I would prioritize this material, in the sense that I would be likely to respond to it (silently or out loud) and remember it. My mind would recall theories that might help me understand it. I would probably try to remember other times the patient has mentioned this pattern, and what preceded and followed these observations. I might go back to the patient's history and any dreams, as well as countertransferential responses that might shed light on the compulsion. My theoretical bent would play a role in where my mind went, but I do not think any analyst would be uninterested in the compulsion. Our focus, in a session, is an inevitable function of what we judge as relevant, meaningful, worthy of therapeutic attention. We may not even be consciously aware of this judgement. But, I
suggest, we make these evaluative assessments every hour we practice, and, even, when we read about psychoanalytic treatments.
While many practitioners have quietly admitted that Anna Freud's (1936) “evenly hovering attention” is an impossible requirement, I suggest there has been no clear replacement for it, even as an ideal. Each of us (consciously, unconsciously) distributes our attention in a session in conformity with our values, that is, what we prioritize, what we understand as a therapeutic goal, as problematic, as contributing to “therapeutic action,” as within our “purview” in H.S. Sullivan's vocabulary. When my patient tells me he beat his daughter, my subsequent attention is not evenly hovering. It is slanted toward what my training taught me to believe relevant to the problem he is presenting. I am aware that I am on a slippery slope when I label anything as problematic. I am also aware that, while evenly hovering attention is impossible, it should not be entirely dismissed as an ideal. How can I know whether my patient's next association is, or is not “relevant” to the “problem”? I can not, of course, so it would be best if my attention could hover evenly enough to register the association, along with everything else he says, without any “irritable” reaching for explanation (see “negative capability” above). Like so much else in analytic life (and life in general, I would say) we must accept “evenly hovering” as an ideal we can not reach, an ideal that might actually distract us from registering the values that are guiding our focus, and, nevertheless, an ideal we should never entirely dismiss. Comfort with the contradictory-yet-true is one of the central requirements of an analytic life, from my perspective.
All too frequently this puts the candidate in training in a problematic triangle. Pulls from the supervisor demand value free attention on the patient's material. Pressures from the patient demand attention to problems, as the patient understands them. In supervision some candidates “omit” describing their unevenly hovering moments in sessions. Elsewhere (, ) I have written about the probable costs to the candidate's sense of integrity.
But here, I am adding that I think these experiences in training can heighten the yearning for an ideology that dictates a set of priorities that are acceptable to an “establishment,” while also allowing us to meet
patients' legitimate needs. Here is where I think what is often communicated in training is unfortunate. The candidate may glean, from what the supervisor and others express, that there is a fork in the road. They either are, or are not, capable of truly analytic practice. It is implied that the analytic “way” is deeper, more profound, more intellectually challenging. It requires a capacity to withstand pressure from patients without cowardly acquiescence. It privileges long term over short term gains, showing the strength of the ability to delay gratification. It is more evolved, capable of persevering, and enduring a long, arduous process. It shows the candidate has been well analyzed. Anything other than the “analytic way” is inferior in every sense.
Faced with this “choice,” and having already committed to the training, who wouldn't want to be seen as “analytic”? Those who have been branded (however gently it might be conveyed) “not analytic” are faced with a conundrum. To protest, in any way, is often seen as proof of one's defensiveness. It can be very tempting to “hop aboard,” adopt an ideology, and find safety, approval, a sense of belonging, a professional home. How do we tend to protect our new home? As I will suggest below, by shoring up its boundaries, by keeping out non-believers.
In 2004 (Clinical Values: Emotions That Guide Psychoanalytic Treatment) I suggested that the values embedded in analytic activity include curiosity, kindness, hope, courage, integrity, emotional balance, and the capacity to bear suffering. There I offered this as a set of values that I think are essential to any analytic process. You may believe in a different set, which would be fine, from my perspective. What is not fine is the denial of having values that help shape our focus, minute to minute, not just when we face patients, or read about treatment, but, even, when we listen at conferences, read each other's books, and talk to colleagues. It is the denial of this inevitable element in psychoanalysis that is problematic, and the acknowledgment of them that can set psychoanalysis free. Since these values play roles in any treatment, regardless of its theoretical orientation they could play a role in a more inclusive vision of a future for psychoanalysis.
Jargon as Elitism: Mystifying As A Method of Exclusion
“When I use a word,” Humpty Dumpty said, in rather a scornful tone,
“it means just what I choose it to mean-neither more nor less.”
In what feels like a lifetime ago, I helped a genetics department develop a curriculum for training genetics counselors. Although my contribution was strictly confined to the “counseling” aspect, I thought I should know something about genetics for this task, so I sat in on an introductory course. It was a marvel of clarity. Our instructor, a taciturn, shy man, made the most complicated concepts crystal clear. He knew his subject so thoroughly that he was able to communicate its essence in relatively simple, concise terms. He was dedicated to helping us understand these concepts, adept at making points, uninterested in scoring points or showing off his erudition. I learned something about genetics, but much more about education (from the root “to educe, or lead forth”).
Personally, I am less worried about jargon's difficulty than I am about the message its use can convey implicitly. I think it encourages compartmentalization. Put another way, it does not encourage linking one's life experience with analytic concepts. Similarly, it inhibits cross fertilization with other fields of study. I like to bring Emily Dickinson with me when I go to a psychoanalytic lecture. I feel lost without her.
I think jargon also subtly communicates that there is a “club” that only admits its members. My genetics professor crossed over to my language, to gradually bring me to greater understanding of his. He did not require me to cross over first. Implicitly, this told me that he really wanted me to “get it,” and he would do all he could to help. His intimate knowledge of his field, his evident alive curiosity about its concepts, his sheer effort, were contagious. I got much more than I bargained for.
Of course, the appeal of belonging to a privileged club is not new, and not confined to psychoanalysts. Psychoanalysts live in a culture that, itself, tends toward binaries of “us” and “them,” with the home team linked to positive attributes. If the price of belonging to an exalted enclave includes fealty to an ideology, throughout history many have been willing to pay it. Opening any newspaper can tell us that elitist hierarchies still exist and exert a powerful influence in the wider culture.
Ultimately, psychoanalysis tries to comprehend human experience. So did Shakespeare, Dickinson, Dostoevsky, and countless other writers, philosophers, portrait painters, and so on. Jargon, a token of exclusivity, obfuscates potentially fruitful thinking, and bars us from building bridges with fields other than our own. Bridges connect ideas, giving them an evolving life. The resulting hybrids become both old and new, familiar and exciting. A psychoanalysis that freed itself from stultified ideology, denial of its values, and mystifying jargon could attract curious minds.
I believe there are prospective candidates hovering at our field's threshold. They wonder if studying psychoanalysis will make their own life experience richer, and if their desire to help others will be honored. They wonder if thinking “outside the box” will be respected, even cherished. Will it?