Our Monster: A Minority View on Boundary Trouble in Psychoanalysis1

What is more subtle than this…

Which fuses me into you now, and pours my meaning into you?

Statement of the Problem

There is a strong consensus within the psychoanalytic profession that analyst-patient sexual relations constitute a serious violation of professional ethics. There are three deep reasons for this: they are harmful to the psychic life of the patient, thus violating the first principle of the Hippocratic oath, do no harm; they are a breach of social trust, placing the profession in disrepute; and they do a lot of damage to the psychoanalytic community, extending to other patients, prospective patients, colleagues, students, and all their relatives and friends.

Yet there is reason to ask whether this issue is really settled. Even if we feel convinced, whether by means of moral intuition or the logic of deontology, that sexual boundaries should never be crossed (at least in the current state of our knowledge and best practice), the consensus feels stilted and perhaps even somewhat artificial in its origins. We often claim that certain ethical principles, such as confidentiality, are intrinsically psychoanalytic—even “constitutive” of psychoanalysis (Lear, 2003); and we like to include our concerns about the sexual boundary in that category. Unfortunately, the historical record suggests a different understanding of how our ethical principles get established (Kerr, 1993; Gabbard, 1995). Freud frequently flouted confidentiality, discussing

patients with their spouses, colleagues who knew them, and other members of the family. The issue of boundaries, especially in the context of the power differential in the transference relationship, was not originally something that psychoanalysis considered foundational or “constitutive”; it was largely forced on the profession through public pressure during and after the 1980s. Prior to that reckoning, we had rarely taken seriously the need for public accountability with respect to sexual boundary violations (SBV). In fact, we were in the habit of turning a blind eye to the most egregious abuse of patients and also candidates (analyst in training). Powerful male training analysts kept harems of female candidates. Others engaged in serial relationships with patients that were known about in their professional community for decades, without consequence. The eventual decision to codify and actually enforce the sexual boundary violation rule was, therefore, less like a genuine consensus, at least at first, than a united front forged during a crisis in public confidence, in the face of public scandal. The motivation was survival in a changing cultural climate, where consumer rights and power relationships were becoming more of a political issue.

It is encouraging to see that from the closing decades of the 20C onwards, there has developed within psychoanalysis an excellent, clinically-informed tradition of ethical study and reflection. Boosted by this expansion of horizons, the “united front” of the 1980s has solidified over time into a sincere commitment, which counts as a genuine collective achievement. Nonetheless, I shall argue, if this happy result feels in many ways like a dream come true, we have yet to explore its meaning, or the underlying wish it expresses. Is it just that we are as good as we like to think we are – endowed with a special kind of knowledge and unique capacity for understanding? Or is it rather that we want to convince ourselves that the ethical problem of SBV has been settled and that it will soon go away.

In this paper I shall be referring to psychoanalysis primarily as an organized profession, its forms of collective being and modes of communication. I shall argue that psychoanalysis is trapped in a collective defense against feelings of self-doubt that inhibit our capacity to explore these forms and modes in depth. This defensiveness may or may not be evident on the surface to an interested observer; apparently it is less evident to ourselves. We seem to take our existence as a group for granted, and to view our predominant social posture as unproblematic. With regard

to SBV, we really want to believe, even though we know it is not likely to be true, that the problem is the improper behavior of certain individuals who happen to be lurking in our midst, through no fault of psychoanalysis. We naturally conclude, therefore, that the appropriate ethical response is to determine how best to distance ourselves from these bad characters. In short, we are unwilling, as predicted by Freud (but also enacted by him), to think psychoanalytically about ourselves.

Painful political experience has taught us in recent years that agreement about something, even within well-established groups, however credible the group may be, is not a reliable measure of truth or knowledge. This was already well-known in the annals of natural science (Kuhn 1970; O'Connor, C & Weatherall, J. O. 2019). The more people in a democracy realize this, the more it becomes a problem for psychoanalysis. Historically, psychoanalysis has relied for its sense of knowing something (important enough to boast about) on internal agreements or alliances, the consolidation of schools of thought, and the forging of professional consensus. The latter are, of necessity, grounded mainly in constellations of anecdotal evidence and the politics (however unintentional) of personality and influence. The institutionalization of psychoanalytic knowledge in this form is an extension of Freud's psychoanalytic movement, as expressed in the foundation of the I.P.A. (Freud 1914, p. 43). Fortunately, Freud, Klein, Ferenczi, Winnicott and many others were keen observers and hard workers; they also knew how to translate their clinical experiences into usable hypotheses and paradigms that still undergird the normal academic science of clinical and developmental psychology in our day. To Freud's credit, the depth of psychoanalytic insight into the human condition has saved the profession during hard times, as bureaucratic expediency and concrete thinking increasingly dominate the field of mental health. The pity is that we have not used this legacy to understand ourselves better. Though we may now recognize that psychoanalysis has a problem, as outlined above, we shy away from exploring its nature and causes. Psychoanalysis has only just begun to frame relevant questions about itself at the group level.

What is to Be Done?

Before delving further into these questions, it is important to get a feeling for where we stand on the question of what to do about sexual boundary

violations. Glen Gabbard (2017), an undisputed pioneer in psychoanalysis, especially in this area, strikes a pessimistic and even weary tone:

Despite my efforts and those of others to bring sexual boundary violations into the light of day and encourage prevention through seminars, regular consultation, and institutional awareness and reporting, sexual transgressions with patients continue to occur on a regular basis, often among analysts and therapists who are well regarded, thoroughly familiar with the risks and dynamics of boundary issues, and well educated. As a result, I have become increasingly pessimistic about our capacity to prevent the occurrence of sexual relations between those who practice psychoanalysis and psychotherapy and their patients. Personal analysis, education, and the use of consultants have undoubtedly prevented some clinicians from transgressing sexual boundaries, and these efforts certainly must continue. However, my former optimism has waned over the years. My growing pessimism has emerged from the recognition of the numerous ways that individual clinicians can rationalize why their situation is somehow different from others … and the inability of institutions to see what is in front of their eyes. (p. 151)

Gabbard's statement is striking for a number of reasons. First, one has to note the sense of failure he expresses; perhaps in this regard he takes too much upon himself what is really a failure of the profession as a whole. Second, Gabbard does not provide us with a convincing diagnosis of our collective failure. He seems to be assuming that psychoanalysis has already been established on a basically sound ethical footing and that sexual boundary violations, what he calls “our Achilles heel,” represent inevitable human failings about which even psychoanalysis can do little. In this regard, Gabbard's summation is reminiscent of Freud's (1937a) Psychoanalysis Terminable and Interminable, with its admission of impotence in the face of various kinds of “bedrock.” Without discounting the limits of psychoanalysis, I would agree with Poland's (2018) view that assumptions about human nature may disguise failures of understanding. The point to keep in mind here is that in the case of sexual boundary violations, it is our failure to understand ourselves as a group that may be blocking further progress. But this is not just a matter of coming up with an insightful interpretation of our collective behavior; psychoanalytic institutions profoundly resist any attempt to really work

on the problem. It is just too difficult and painful and we need to understand better why this is so hard for us.

Gabbard's pessimism is focused on the issue of prevention. This can be taken as a point in our favor. Leaving aside the statistical inevitability of a few psychopathic sexual predators, we have come to understand SBV as a psychologically complex syndrome to which we are all personally vulnerable, especially during periods of narcissistic depletion or other relational distress. We are actually quite sensitive to the plight of the sexual transgressor (Gabbard & Lester, 1995; Celenza, 2007, 2014). But we still tend to ignore three crucial factors:

1. the social conditions of the psychoanalytic profession itself may be contributing to the problem (Levin, 2021b);

2. we fail to recognize that transgressors continue to be psychological members of our community, even in their ghostly absence, after we have ostracized them;

3. we resist creating a justice process that includes the whole community; one that establishes a space for the analytic group to assume more direct responsibility and accountability.

In summary, we have not done enough as a profession to examine the role of our own psychosocial organization in both creating the conditions for, and then dealing with, the problem of SBV. Psychoanalysis needs to develop a process in which transgressors have a realistic opportunity to account for themselves, not only to the affected patient and family, but also to colleagues. We need to find a way to make it more possible for the whole analytic community to reach out socially to those involved, especially the immediate victims, and find ways to more actively take their discourse into account.

Of course, there is no disputing that the adversarial legal system and the burden of liabilities that it imposes on psychoanalytic societies and institutes discourages efforts in the direction of restorative justice and collective accountability. But this is not a sufficient excuse for lack of action. Gabbard's (2017) “30-year retrospective” might have been less gloomy if we had begun to face these issues sooner.

A very simple analogy illustrates the potential for further growth here. We know that when socio-economic conditions are relatively benign, and there is reasonable access to education, rates of crime go down, and quality of life improves. People will still do very stupid things; this is statistically inevitable; but social conditions make a significant difference in the incidence of anomie and violence. Surely this calculation also applies to the incidence of SBV within the analytic community—both its prevention, and how to handle it when it comes to the surface. There is no reason to think that we can eliminate SBV completely. Nonetheless, we ought to consider more seriously the possibility that if the social conditions of being a psychoanalyst could be improved, there would be a reduction in psychoanalytic crimes such as SBV.

Narcissistic Boundary Violations and Psychoanalytic Theory

Unfortunately, the need for transformation within the psychoanalytic institution does not stop with procedures for handling sexual boundary violations. It is even more vital that the profession openly acknowledge and address the far more pervasive and insidious risk of narcissistic boundary violations (NBV) in the analytic relationship (Levine, 2010; Levin, , 2016, 2021a, b, c, d, e). NBV can be defined essentially as the narcissistic colonization of the patient's psyche, which may be used for various kinds of perverse gratification, notably sado-masochistic; for trapping the patient in helpless dependence on the analyst; and especially for converting analysts in training into political drones programmed to act on the analyst's behalf within the institute culture (for a detailed example, see ).

While Freud recognized the risks and dangers of sexual misbehavior among his colleagues, he seemed to regard colonization of the mind as fair (apparently non-sexual) use of the analyst's power. He exercised it with his daughter, some of his patients, his colleagues in treatment, and enacted it in his correspondence with them about their patients, or about his treatment of their spouses and relatives. The early form of the training analysis system around which the Eitingon model was eventually built was essentially a didactic demonstration of psychoanalytic truths, or indoctrination—a form, however benign, of colonization.

The potential for so called NBV is built into the very structure of the

psychoanalytic relationship, and also our clinical theory. This does not mean that the psychoanalytic relationship is unethical, or that our theories are wrong; but it does mean that they are extraordinarily problematic, and need to be described and taught as such. This we do not do very much with our candidates. On the contrary, we celebrate this colonizing power as if it were something that could only ever be used for therapeutic benefit. And in our continuing search for ever more exotic accounts of our special psychoanalytic power to connect with the unconscious, or to deal with its absence (for obscure reasons related to the very earliest infantile experience), we boastfully expand the analyst's colonizing power in theory and practice to penetrate or otherwise fuse with the mind of the other.

When Melanie Klein (1946) offered the idea of projective identification as a primitive defense involving a violent effort to enter the object and control it from within, did anyone in the analytic community ask whether this might also be a description of what Klein herself was trying to do with her patients? It is no secret that we get many ideas about what our patients are doing by observing ourselves (whether we are aware of it or not). A question like this does not invalidate the concept of projective identification, any more than Freud's self-analysis invalidates his Oedipus. The purpose of such questioning would be to deepen psychoanalysis, not to undermine it. Learning to ask such self-probing questions regarding our clinical metaphors should be added to the prevention program Gabbard (2017) has outlined with respect to SBV.

To create a psychoanalytic culture truly apprised of narcissistic and not just sexual boundary trouble we would need to develop an entirely different approach to our own literature, the texts that we teach; one in which the author's conscious intentions (among them, to show what a good clinician or theoretician he or she is; or how wonderful psychoanalysis is) can be challenged, problematized, and deconstructed. This doesn't require that the text be intellectually destroyed, or rendered useless. It means that we learn even more from any given analytic contribution—a “more” that includes the reality of our social dynamics, and useful awareness of our rather flimsy ways of establishing clinical truth in the professional group process. If psychoanalysts want to credit their rhetoric of “negative capability,” this would be one of to do so in practice.

How well do we scrutinize our own discourse for symptoms of systemic malfunction? Basic familiarity with our own literature reveals that we have a marked tendency toward hyperbole, not only in our sometimes cultish veneration of various founding fathers and mothers, from Freud to Bion, but also in our general claims about ourselves and our work. We are also inclined to underplay the risks and limitations of psychoanalytic treatment.

As I have argued elsewhere (Giesbrecht and Levin, 2012, Ch.12), psychoanalysis likes to idealize itself, sometimes in exaggerated ways, by appropriating cultural symbols and canonical aesthetic references, particularly in the realms of “creativity” and art. This tendency is pervasive. For example, Jacob Arlow (1963) compares the classical technique of psychoanalytic supervision to Wordsworth's definition of poetry (emotion recollected in tranquility). In private correspondence, he writes self-idealizing peans to the profession.

“Psychoanalysis is … a celebration of the emergence of the self, a unique, unprecedented event in the history of the universe … . This miracle is confirmed … [it] is the dramatic element in psychoanalysis, a continuous, mutual reaffirmation of two independent but related selves, something that makes the long hours and the tremendous cost of psychoanalysis a very special and worthwhile experience. Psychoanalysis defines and celebrates both the changing uniqueness and the continuity of the self over time and experience” (emphasis added). (Arlow, n.d.)

It may well be that this kind of puffery is more about treating flagging self-confidence within the profession than fooling anybody else. Nonetheless, it has the effect of inhibiting development of a critical approach to psychoanalytic discourse. It rarely occurs to us that trends in psychoanalytic language might tell us as much about ourselves and the vicissitudes of the profession as about our patients. The shifting patterns of our discourse may be symptomatic of various undercurrents or deformations. Among the latter, I believe, we have long indulged a kind of institutionalized negative (“counter”) transference to the patient population, which has evolved from Freud's dismissive comments about “poor wretches” (Freud 1937b) to article after article about patients who are “dead,” “boring,” “empty,” “difficult to reach,” exasperating, and so on. The

issue is not that we shouldn't have our own emotional responses, or that such metaphors are inappropriate in themselves. Unfortunately, they tend to cluster and solidify, very quickly ceasing to work like metaphors; they condense into stereotypes and caricatures that are cited in a knowing, othering way, in the course of case discussions and supervision. They become institutionalized as surefire diagnostic signs: our visceral reactions or group responses indicate the presence of a hysteric, a borderline, a narcissist, etc. (See for example Bollas, 2000, e.g., pp. 176–177). Not so long ago, it was a commonplace for analysts commenting on a case presentation to express personal dislike for the patient, because we thought this meant we were “working with our countertransference.” Now we are a bit more subtle about denigrating patients, and try harder to hold the analytic couple in mind; but the underlying group function seems to be the same: to reassure ourselves in the face of insecurity, uncertainty and doubt. Of course we “know” that we analysts may also be worthy of such epithets: “dead,” “boring,” or “hard to reach,” with a psychotic core or an autistic enclave. Learning to pay attention to ourselves when we talk and write this way would be an important part of any program designed to address SBV and its broader, deeper source in the ever-present narcissistic temptation to exploit the patient's dependent mind.

To illustrate further, let us consider Masud Khan's (1979) definition of the sexual pervert's “technique of intimacy” in his influential book, Alienation in perversions.

The outstanding feature of the technique of intimacy is the attempt to establish a make-believe situation involving in most cases the willing seduced co-operation of an external object …. The capacity to create the emotional climate in which another person volunteers to participate is one of the few real talents of the pervert. This invitation to surrender to the pervert's logic … demands of the object a suspension of discrimination and resistance at all levels of guilt, shame, separateness. A make-believe situation is offered in which two individuals temporarily renounce their separate identities and boundaries and attempt to create a heightened … intimacy … There is always, however, one proviso. The pervert himself cannot surrender to the experience and retains a split-off, dissociated manipulative ego-control of the situation. This is both his achievement and failure in the intimate situation. It is this failure that supplies the compulsion to repeat the process again and again.

Cued by my theme of the narcissistic colonization of the patient's mind, the reader will easily recognize where I am going with this example. Khan's able description of the pervert's “technique of intimacy” may well have drawn from his own experience, not only of his patients, or in his private relationships, but also from self-perception of his own functioning as an analyst. Omitting his references to the body, as I have done in the citation above, and substituting the word ‘analyst’ for ‘pervert,’ one gets a picture of the analytic situation that is not far from many official descriptions: the make-believe situation, or transitional quality of the analytic space; the invitation to surrender willingly, to abandon the censorship; the analyst's skill at creating an emotional climate conducive to regression; the need for endless repetition; and finally, the tragically asymmetrical position of the analyst, who cannot personally regress, except in a highly controlled manner.

The phrase “technique of intimacy” applies neatly to psychoanalysis, whether we take it literally or figuratively; and the potential for this technique to fall under the sway of the analyst's narcissistic preoccupations is incontrovertible. Knowing what we now know about Masud Khan, we cannot help noticing these parallels. But we tell ourselves that, of course, this is not what we meant by psychoanalytic intimacy—this is not what we have in mind when we talk about transference and countertransference and reverie and intersubjectivity in the suggestive ways that we do. We rationalize all these dangers away with theories about the “third,” and so on. We never really let ourselves think too carefully about the obvious fact that we are always, and admittedly so (Cooper 2021), playing around the edges of potentially exploitable narcissistic and even “perverse” conditions of relationship with our patients.

Occasionally we let the cat out of the bag. At a packed meeting of the American Psychological Association Division 39 meeting in Philadelphia, 2006, when Muriel Dimen (2011) first spoke about her analyst's boundary violation, one of the most prominent analysts in America got up in the audience and said that we should not be talking about this topic because it would only inhibit good analysts from taking the emotional risks needed to do good analytic work. On another occasion, at an equally large IARPP meeting in New York, the same analyst boasted about his therapeutic “duty” to ignore his highly disturbed anorexic patient's plea for him to be less intrusive, as he went into “combat” with the “bad internal

object” he believed was holding her hostage.

The attitude of clinical entitlement and special privilege usually appears in more modest form, but it is present in all our schools of thought. When Giuseppe Civitarese (2015) says in the International Journal that the analyst needs to cultivate a state of “hallucinosis” (along the lines of Bion's (1965) “transformation in hallucinosis,” describing a psychotic process), we sort of understand what he is driving at in the context of the intersubjective nature of the analytic work. Like intuition, reverie is a vague and elusive concept in our literature (Busch 2019); something more forceful and experiential, like the analyst hallucinating, may be required! But Civitarese makes little effort to allay any concerns about the epistemological hubris of such a proposition. As Bion (1967, p. 164) himself had asked, “How then is one to explain the difference between an hallucination and an interpretation of an intuited psycho-analytical experience?” Evidently Civitarese wants to up the ante in this debate and assert that when an analyst hallucinates for therapeutic reasons, this can be differentiated epistemologically and diagnostically from the patient's hallucinatory process.

If one accepts Bion's debatable principle that “the central phenomena of psychoanalysis have no background in sense data” (1970, 157), then in a manner of speaking it follows that the analyst would have to “hallucinate” them, since for Bion they are not part of physical reality. On this basis it would seem reasonable to argue that hallucination “may be profitably seen as a dimension of the analytic situation” (1965, 115). But it will not do merely to say that the term hallucination is not intended here in the psychiatric sense, since the whole argument about transformation in hallucinosis is anchored in a hypothesis about clinical psychotic phenomena. Moreover, Bion judges the content of transformation in hallucinosis in pejorative terms involving the analysand's anti-analytic assumption of “superiority” and a kind of arrogant self-sufficiency (1965, 141–144).

I raise this example not because I wish to argue against the view that doing analysis requires us to open ourselves to unconventional and even extreme psychic states, and to be aware of them in oneself. The point is that we don't critically assess the implications, or the evidential basis, of this aspect of our work; we tend to idealize and romanticize it, as if

quoting Keats or Martin Buber is enough to get us by; and we do this to the point where we become the heroes of “O” in our own myths about psychoanalysis, ignoring the fact that our “technique of intimacy” can be risky and treacherous.

There is an ethical dimension to this endemic sloppiness in the literature. We don't want to look too closely at what we are claiming about our work for a variety of reasons: we know it is in large measure artifactual, conventional, formulaic, subject to waves and fashions. We know that we do a lot of hiding behind confidentiality and disguise and that much of what we say about our patients is theory-driven, on the one hand, and overdetermined by our own unconscious personalities on the other, no matter how hard we strive to do otherwise. The result is that we cut each other an enormous amount of slack, at least within the confines of our own schools of thought, to save face. We seem to be terrified that if we look too closely at what we write, we will also look too closely at what we do; that we will start to question our institutions, the only thing that protects us in a lonely profession that is out of public favor. We know that the social organization of psychoanalysis is relatively stilted and false; but we pride ourselves in the art of simulating propriety; we shun publicity, politics, freedom of expression. Those in our ranks who transgress this social code, who write openly about the contradictions of our profession, or their own ambivalence, are suspected of ethical impropriety, of misusing their privileges as inheritors of the psychoanalytic estate. We convince ourselves that psychoanalytic training gives us the right to speak with authority, but only in favor of psychoanalysis, or in order to “apply” it to some other topic, such as art or literature. We feel very deeply that we cannot afford to question our “psychoanalytic identity,” or to think about ourselves psychoanalytically as a group. This places us in great ethical peril, not only because it blinds us intellectually, but because it invites destructive rebellion (Levin 2021e).

In the aftermath of a recent scandal involving a senior training analyst in Canada, there was a spike in suggestions about what to read. Colleagues were saying that in order to understand what was going on we should study Giuseppe Civitarese's reconsideration of Bion's paper “On arrogance” (1957). The Civitarese text is indeed brilliant and apt for the occasion. Civitarese claims that Bion's original paper “lays the groundwork for a cogent criticism of the ideology of psychoanalysis and an

effective ethical re-foundation of the discipline.”

The selection of this paper is puzzling, however. It appears to reflect a wish on our part to recuperate the profession in its own eyes rather than to shed light on the ethics crisis itself. So far as one can make out (by coupling the original 1957 paper with Bion's later 1967 commentary on it in Second Thoughts), Bion's central thesis was that the arrogant ideology of psychoanalysis has mythic roots in Oedipus' “curiosity,” which was in a way “stupid,” leading to an arrogant vow (hubris) “to lay bare the truth at any cost” (86). To summarize and paraphrase, Bion interprets this narrative to mean that in the analytic situation the fetishistic psychoanalytic idealization of verbal interpretation becomes an “obstructive object,” denying patients the normal use of projective identification as a means of communication to be received and contained by the analyst. Bion notes in his later commentary (1967 p. 162) that this is a particularly dangerous problem in the training analysis, where (he claims), all candidates fear their “psychotic elements” and wish to avoid them.

The individual seeks to deal with his fear by becoming a trainee, so that his acceptance can be taken as an authoritative declaration of immunity by those best qualified to know. He can proceed with the aid of his psycho-analyst to evade coming to grips with his fear… . His qualification is an ability, thanks to projective identification (in which he does not believe), to preen himself on freedom from the psychosis for which he looks down upon his patients and colleagues (1967, 162).

Bion then characteristically breaks off this argument, keeping everything gnomic, without addressing its implications, explaining that he has dealt with the matter in “greater detail” elsewhere (citing only the concept of Catastrophic Change, as if the reader is well aware of it, presumably a reference to Bion 1965). As Civitarese points out, the conceptual valences of “On Arrogance” are ambiguous at best. In the commentary on this paper 10 years later, Bion was more explicit in casting the training analyst as one who at least colludes with psychotic arrogance. Still, the analyst's (or TA's) role remains passive and indirect. In the original paper (1957), it was the analyst who turned out in the end to be unconsciously arrogant, failing to understand the patient's need to use projective identification as a form of communication, and occluding the latter

with knowing words. In the commentary (1967) and in much of the discussion of hallucinosis in Transformations (1965), however, Bion shows little sympathy for the patient who wants to substitute psychotic “transformation in hallucinosis” for the analyst's preferred and appropriate method of “transformation in analysis,” i.e., through interpretation and insight. So there is a lot of confusion and inconsistency in these texts that Civitarese is aware of but unable convincingly to entirely sort out.

Bion considers the ambitious trainee (psychoanalytic candidate) as the active, driving force behind the arrogance in the profession. This shifting of blame from the Institute and the established analytic group to the aspiring analyst is unfortunately typical. Candidates are routinely treated as anomalous liminal creatures whose status is peculiar and suspect . Kernberg , in his otherwise excellent critique of the training system, singled out the toxic fallout from candidates' analyses, because their transference “liberates radioactive products.” There is an implicit logic of quarantine here that dovetails with Bion's disdainful attitude. Institutes and their Societies routinely project their own disappointment and hatred (fear) of psychoanalysis onto their students, suspecting them of responsibility for the real or eventual decline of psychoanalysis and its final betrayal .

As Civitarese (p. 4) admits, however, Bion's paper might easily be read as itself evidence of psychoanalytic arrogance, rather than as an exposé of it. In his usual presumptive style, Bion asserts his famously mysterious triad of terms (curiosity, stupidity, arrogance) as characteristic of a “certain class of patient” in which “psychotic mechanisms are active.” Very little in the way of followable clinical illustration is provided to back this up as a general formulation; the argument quickly turns into a theoretical allegory, a sort of codified and couched critique of Klein, in which the Oedipus myth and this “certain class of patients” in the analytic situation define and explain each other in circular fashion.

Civitarese nevertheless goes on to endow Bion and his early paper with a kind of a preternatural awareness of the systemic arrogance of our profession. The rhetorical strategy behind this does have surface plausibility because we know that Bion did eventually begin to articulate a serious critique of psychoanalytic institutions (1970 and after). The effect is of a kind of epistemological nachträglichkeit, a reinforcing loop

in which what Bion said later about the psychoanalytic establishment, but only indirectly (while still enjoying ascendancy within that establishment), permits a speculative claim about his earlier thinking, which then strengthens in turn the impression of his later work as progressive. No wonder, then, that Civitarese's bit of hagiography was recently so popular in Canada. He had managed not only to name psychoanalytic arrogance, for which he deserves credit; but to do it in a way that allows us to imagine that we had always known it: the sense of our own arrogance was just part of the inside knowledge psychoanalysts have about the way things really are, a quality that reading Bion seems especially good at helping us feel.

Though satisfying in this reassuring way, Civitarese's paper leaves us with an unresolved issue. If psychoanalysis is really a form of treatment for psychological suffering, it therefore needs to be “curious” (and presumably, unless we can find some epistemological alternative, this curiosity will always be “stupid”) to learn about something, and to know something, and to claim something about the patient and also to the patient. Given this inherent need—if Bion's reasoning about these things is correct—how can psychoanalysis (even Bionian psychoanalysis) evade the trammels of institutionalized arrogance? In grappling with this question, Civitarese brilliantly teases out, from the middle period of Bion's writing, a strong sense of the oppressive “moralism” of psychoanalysis. It would seem we are fated to be stuck in the vicious circle that Bion identified: every attempt to understand or to help the analysand with words risks producing a negative therapeutic reaction (1967 p. 87).

Civitarese's solution comes to us in the form of professional scapegoating. He simply throws all of Western science under the bus. After all, he argues, it was the foolish pretention of psychoanalysis to identify with this arrogant and nature-destroying science (an aspiration Bion certainly shared in his scientific rhetoric and his attempts at pseudo-mathematical formalization) that explains the (erstwhile?) arrogance of psycho-analytic institutions and attitudes. Psychoanalytic moralism, Civitarese claims, is “mostly … disguised as science. That is why it is insidious and treacherous” (p. 18). Reading this, one has to wonder if the whole problem of arrogance was just an epistemological misunderstanding. Is one to conclude that having molted the serpent-skin of science, psychoanalysis will then be free to embrace a non-arrogant form of knowledge, one

that is cleansed of dogmatic pride? Civitarese answers in the affirmative.

The affirmative, the supposedly non-arrogant form of curiosity, learning, and knowing, turns out to be, as announced in the article's abstract, hermeneutics. Those of us still wondering how Civitarese's critical analysis might play out in practical terms at the institutional level can be forgiven for feeling a little let down by this, since hermeneutics is already a familiar animal, a sort of domesticated psychoanalytic pet, in the form of clinical intuition (or “guessing” [Vassali 2001], or transformation-in-hallucinosis-while-practicing-psychoanalysis [Civitarese 2015]) that has been haunting psychoanalysis since Freud's death. According to Civitarese, the hermeneutic stance has nothing to do with the evils of science and somehow absolves us of our collective guilt for scientific pretension (the totemic IPA system, our professional copyright on the exclusive technique of understanding that only psychoanalytic training can provide). To this panacea, Civitarese adds the mother-infant relationship as the “model of [psychoanalytic] care,” for supplemental insurance against the stupidity of science: “It instantly immunizes us against the virus that makes us value cognition over affection” ( p. 16). Thus, any suspicion of professional bad faith that might have arisen while reading Bion is conjured away. “Science solves (its) riddles,” Civitarese ( p. 6) opines, “but in fact [science] can say nothing about the most important questions of existence, which have to do with the ineffable (Bion's concept of “O“), the sense that cannot be converted into meaning.” Supposedly, and apparently without risk of arrogance, psychoanalysis claims to be able, unlike science, to say something true about these ineffable things, “the most important questions of existence.”

Civitarese brilliantly identifies some of the key features of the psycho-analytic “monster” referenced in the title of this paper. Among others, I note the institutionalized negative transference to the patient population, and the ideological use of sexual trouble to cover up and displace the deeper problem of narcissistic trouble in the profession. For this we can be grateful. But at the same time, Civitarese's study of Bion's concept of arrogance is blind to, and indeed exemplifies, the most “insidious and treacherous” behavior of this monster—namely, to further displace and to cover up at the self-protective institutional level. Personal responsibility and confrontation with the organized psychoanalytic group is deftly sidestepped through anachronistic ventroloquizing of fetishized masters,

such as Freud and Bion. In this regard, Civitarese is only following in many other eminent analyst's publishing practice of rewriting the analytic canon in the register of the current professional ego ideal. We need to recognize that this genre of theoretical nachträglichkeit is, though often useful for teaching, deeply ideological in its fundamental purposes. The underlying unconscious message is always the same, whether it concerns the faults of our professional organization, or the inadequacies of our clinical method: we have always known that we are not perfect, because somewhere it is written; so there can be no real problem, nothing that cannot be solved by further reading.

As noted in the introduction to this paper, we like to believe that certain values are intrinsic to psychoanalytic thinking, whereas in fact they are sometimes forced on us by circumstances. (Admitting that we don't know is a case in point.) We then retroactively project our discovery of them into our earlier history and literature. At the height of the same Canadian scandal that prompted the reading of Civitarese on the question of arrogance, causing many colleagues to raise questions about the Eitingon training model, it was widely recommended that we also bone up on David Tuckett's latest research (Tuckett et al., 2020), which directly addresses widespread uneasiness with that model. This was a topical and appropriate suggestion in the circumstances; and in Canada, as elsewhere, Tuckett is a respected author. As it turns out, however, the research (surprise?) tends to exonerate the Eitingon model, blaming any dysfunction on human factors. The reasoning starts from a crucial distinction between the model itself, and how it is “applied.” There is a finding, uncontroversial, that “implementations of the Eitingon architecture differ widely.” This sets up the argument that the model itself is not to blame. There are “dynamics” that psychoanalytic training “must inevitably create.” It follows that successful training rests not on the model itself, or its “requirements,” but on the issue of “how candidates, training analysts, supervisors, committee members, etc., confront these inevitable dynamics.” The sleight of hand in the argument is that the Eitingon model is equated with psychoanalytic training as such, rendering the dynamics it generates “inevitable.” According to Tuckett and his team, therefore, in an impressive display of circular reasoning, the Eitingon model works just fine so long as those involved believe in the model and live up to its training standards, which include thinking

psychoanalytically about the ways in which it doesn't work very well. Of course, to some extent, this must be true, if one accepts a minimal social constructionist view like the “looping effect of human kinds” (Hacking, 1995). However, while sincerity is always an asset, it cannot serve as the independent justification for any social form, especially if the form itself tends to disable healthy skepticism, as the whole of organized psychoanalysis, and not just the Eitingon model, seems designed to do.

Dynamics in the Psychoanalytic Group: Actual and Potential

Psychoanalysis offers no exception to the boundless human capacity for self-deception (Gabbard, 2008). In the logic of purity and danger (Douglas 1966), we deploy the self-serving trope of the “rotten apple” (Dimen 2016), the otherness in the barrel that just needs to be tossed out. We rarely consider how we may be implicated, and when we do, we quickly turn to a Civitarese or a Tuckett, a trusted author, for reassuring bromides. We insulate ourselves both personally and structurally from the “other's” primal crime. To achieve this end, we also maintain a formal legal distance from the victim and his or her family, friends and community. We offer little if any hope for some kind of reparative or restorative justice (Harris 2021; Harris and Gentile 2019). There is no word from us about the possibility that psychoanalysis itself may have to bear some responsibility for what has happened, not only to the patient, but also to the transgressor (Levin 2021e). We don't try very hard to honor and develop, or even acknowledge, the connective tissues that inevitably linger, painfully, between the professional group, its transgressive member, and its victim.

In 2010, I was in San Francisco for the Spring meetings of the American Psychoanalytic Association when rumors began circulating about Harry Smith. He had organized the meeting but he would not be present. I had not known him personally, but I was crestfallen; I had found him helpful as an editor. In the national meetings in New York immediately following this spate of preemptive resignations, Smith's name never came up once, even at a plenary session that touched on the problem of sexual boundaries. Remember, this was a meeting that would itself have already been substantially planned by him. At some point during the audience discussion I got up and said, in so many words: “There is an elephant in this

room. His name is Smith.” The meeting then went into a kind of spasm from which it never quite recovered. Some helpful discussion followed about how important it would be to create a safe place where these matters could be discussed openly and frankly, but there was also a lot of fear and confusion and denial in the room.

In my utopian fantasies about what the psychoanalytic group should be capable of, I imagine a different scenario. I imagine that Harry Smith could somehow have been persuaded to attend that meeting and to speak about what he had been through, trying, if possible, to help us understand. My fantasy also includes the possibility that the candidate in analysis with him would have felt safe enough to address that same audience with her own perspective and emotion about what had happened between them, including how she was now feeling about psychoanalysis. I imagine Harry Smith and his patient in the same room, with other concerned analysts present, not necessarily at a large meeting, but contributing to some kind of quixotic effort to reach an understanding and to forge a sense of justice being done not only for them, but for the analytic community. And they would tell us in their own words about the element of derailment in their psychoanalytic relationship, how it had crept into their work, to the point where they were willing to embark on the utter madness that has tarnished Smith's stellar career (without, apparently, ending it), and damaged his patient's soul, her marriage, and her career as an analyst.

In the fantasy, I imagine it turning out, to everyone's surprise, that the analytic community itself feels a considerable burden of guilt and a sense of responsibility for what has happened. And I imagine the analytic community would not shun this failed analytic couple for reasons of legal liability. I imagine the analytic community taking the view that it would be important to address the possibility that there exist in our profession underlying social conditions for psychosexual calamity—more important than ostracizing its wayward member; and that the analytic community would be ready to focus its attention on the major unnamed affordance that psychoanalysis inherently sets up, at both the institutional and clinical levels—the opportunity to rationalize exploitive colonization of the patient's psyche. In this scenario, Harry Smith could actually retain or regain his standing as analyst on condition he be willing and able to contribute to our ethical understanding and re-framing

of the multi-directional transference free-for-all that our method invites; moreover, that he be willing in public to review and comment upon his own writings, particularly those that directly hint at boundary trouble, such as Smith (2006a), and also (2006b, p. 716), where he wrote the following:

…if one of the features of perversion is the secret or hidden pleasure in some activity that constitutes a disavowal of reality and entails using something for a purpose other than the one it was intended to serve, then we have to consider that analysts and patients are engaged continuously in the activity of disavowal. For in every analysis the patient embraces activity that by virtue of its actualizing a gratifying fantasy with the analyst disavows the reality of the analytic relationship and the analytic work; the activity of analysis is used for something other than that for which it was intended. At the same time this ongoing gratifying activity is itself disavowed in the apparent pursuit of understanding. The two exist side by side. I would argue, further, that the analyst cannot help but participate in these activities. In short, if we think of this sort of disavowal as perverse, we must consider the possibility that analysis itself rests on a foundation of perversion.

Note that in this argument, Smith tendentiously places the “purpose” of analysis on the side of “reality,” and then defines its intentional suspension of this reality as a “disavowal” of reality, describing the patient's acceptance of the analytic invitation to actualize (or at least contemplate) a gratifying fantasy as a “perversion” of the analytic relationship. This formulation offers a rather concise example of the ethical double bind that psychoanalysis seems to impose on both its practitioners and its consumers. It would have been extremely useful—one might even say epoch-making from an epistemological perspective—if the analytic community had somehow managed to create conditions under which it would have been possible for Smith to talk about this and other parts of his published thinking in the light of his sexual relationship with his patient. He would then have been actively contributing in a powerful way to education not only about the ethical risks of psychoanalysis, but about psychoanalysis as such.

In my utopian fantasy, Smith would of course be expected to match the

analytic community's efforts, including financial, to assist his former analysand and sexual partner, the candidate, psychologically, socially and professionally, in a process of recovery and reparation. This is a scenario in which the entire community would be able and willing to take active responsibility for the screw up of one of its most distinguished members.

Is that such a pipe dream?

Perhaps it is, though surely many analysts have shared similar reparative fantasies. The reason why such thoughts may be unrealistic is that they presuppose not only a legally safe environment for all concerned, but a willingness on the part of the transgressor and the transgressed to risk emotional exposure at an extremely delicate and dangerous time in their lives. Nonetheless, we should try to continue down this track, if only because it is important that we consider all the possibilities.

One striking thing about the vision of restorative justice in psychoanalytic groups is that it raises a stark question: would the greater prospect of understanding and reintegration in our community strip away all the deterrent effects that a harsher climate of opinion brings, in which the default position is divestiture and banishment? I don't think so, but this is certainly worth debating. I am inclined to think that if the default position were restorative justice, the effect would be precisely the opposite, namely, to create a professional atmosphere in which all the recommended prophylactic and preventive measures would become more effective. We would be less afraid to admit to our colleagues that we might be in trouble, less reluctant to consult, more willing to speak out and educate ourselves about such matters. One would hope that any reduction in the paranoid atmosphere of shame, taboo, and stigmatisation around SBV would have a beneficial effect and lower the incidence of ethical violations. On the other side of this coin, one can well imagine that the prospect of having to give an accounting of oneself to one's colleagues might actually seem more daunting—more of a deterrent—than mere expulsion from the group.

The following anecdote is based on a pseudonymous report by an analyst who had committed an ethical boundary violation, which eventually led to sanctions, and ostracization (Davis 2021). In the published account

of these events, the analyst expressed a great deal of remorse and grief over the harm caused to the patient. The analyst also described the social dynamics within their psychoanalytic group.

The analyst had slipped into an emotional vicious circle with a patient during the end phase of their analytic work. In order to manage feelings of insecurity during the termination phase of the analysis—and fear of the patient's anger—the analyst revealed a great deal of painful personal information. This led to declarations of love which were followed by private meetings after the analysis was officially concluded. They became emotionally very intimate in an anxious way, but did not have intercourse.

The intense “transference” on both sides continued for quite some time following termination; analyst and patient dug deeper and deeper into a psychic colonization process that was clearly driving them both crazy. In an effort to try to disentangle matters, the analyst gave the former patient lengthy explanations of why the analyst's behavior had been inappropriate, which only compounded the pattern of intimate self-disclosure. Finally, the analyst went into treatment and also into supervision, preparing themself for the day when they would have to break off these discussions with the patient and risk an ethics complaint.

When the complaint finally came, all hell broke loose in the local psychoanalytic community. After many months of investigation and deliberation, which included an outside consultant from another Institute, a decision was handed down: the analyst could remain an analyst, but must undergo an extensive rehabilitation program. This decision met with a great deal of opposition within the community, with wild rumors flying around about the analyst's sexual conduct. There was an enormous amount of pressure on the analyst, who was told in confidence that “people want blood.” Following advice from a friend, in the hope of quelling the uproar, the analyst resigned their position at the Institute and issued an apology to the community. Unfortunately, the tempest continued for at least another two years, with repeated attempts to reverse the decisions for rehabilitation recommended by the national organization and the licensing boards. Eventually this led to the analyst being expelled entirely from the home group. However, the analyst complied with all the requirements of the rehabilitation program and maintained his status

within the national organization and in the eyes of the licensing boards.

What can we learn from a story like this? One lesson concerns the evident failure of the analytic group to understand and contain its own emotional turmoil. The complaint against this analyst created a deep sense of narcissistic injury in the group, which led to ferocious narcissistic rage. This reaction is understandable; but the failure of a psychoanalytic group to recognize the nature of such a reaction and to work it through instead of acting it out is less forgivable.

In his summation of years of work in this tortuous area of psychoanalytic life, Gabbard (2017) described the group dynamics related to SBV in terms of Bion's “pairing group.” He understands this basic assumption group as a variation on the manic defense against depressive anxieties. Individual transgressors may believe that they are “creating something new with a patient” (p. 54) in order to ward off feelings of disappointment and disillusionment about psychoanalysis. The transgressor may also be unconsciously acting out defensive fantasies that pervade in the analytic community. I think this is true but would argue that the problem in the group is of a different order and occurs on another, in some ways more primitive, level that is more paranoid in nature.

The reaction of the group to transgressions will, of course, be manifold, all of it in one way or another inevitable and in that sense “normal,” including a sense of the injustice done by a powerful analyst against another more vulnerable person, who is often a colleague; a desire for revenge; hostility and suspicion toward the authorities concerning the possibility of corruption and cover up; fear that the profession will be morally discredited; and anxiety about one's own potential for transgression, together with denial in reaction formation against unconscious identifications with the transgressor and even envy of the transgressor. All of these can be summed up under the headings of narcissistic injury, threatened identity and fear of contamination. What I am suggesting is that when boundary violations occur, the analytic group will be at risk of turning into a narcissistic monster.

We have learned a great deal clinically about narcissism since Freud's 1914 essay. However, it is only when we think about narcissistic phenomena at the group, cultural and social levels that we truly come to

understand its central role as a force in our lives, a force that seems to dwarf sexuality (particularly through the organizing power of idealization and the projection of split-off “bad” parts), but also includes it (Giesbrecht & Levin, 2012). By 1914, Freud seemed to realize that when he wrote about sexual libido, he was mostly writing about narcissism, and this became clearer in Group Psychology (1921), though he would never state it plainly.

Narcissism in the group can be conceptualized in terms of the submissive transformation of narcissism (Levin 2021e). This is the underlying structure of any patriarchal group, and its primitive default position when the group finds itself under stress. The basic idea is that the group creates an avatar or a projective transference object who is imagined to embody the socially dangerous or problematic aspects of narcissism in the community and its members. These may include (as graphically illustrated in the Pentateuch) omniscience, omnipotence, a boundless sense of entitlement, delusions of uniqueness and superiority, vanity, paranoia, aggressiveness and vengefulness, envy, possessiveness, megalomania, pettiness, the denial of reality, deceit, covetousness, licentiousness, promiscuity, among many other common negative precipitates of ordinary narcissism that typically inhabit us all and threaten social solidarity, peace, and good government. By ascribing all of these proscribed qualities, or as much of them as we can, to a supreme being, or into the job description and privileges of a leader who is functionally above the law, such as a monarch or a privileged class, the group manages to hang on to them in the very act of disavowing them—a collective social process that in individuals and small groups we describe as projective identification. Through the submissive transformation of our narcissism, we find a way as a group to bind and restrict our worst impulses and most destructive states of mind, while still enjoying them vicariously through idealizing identification with the Lord or leader, and while still holding open the possibility of reinstating our grandiose narcissistic strivings, fantasies and impulses, such as murder, at the leader's command or behest.

In normal circumstances, the supreme leader is idolized in ‘His’ binding function (Freud 1921). He gives official state condolences, reassures victims of natural disasters, and rallies the population in the name of the State. This is the positive social function of group narcissism. But when the group is under stress, these binding functions easily take on

monstrous qualities. This is what happens in a psychoanalytic group when, for example, it is discovered that a senior and respected colleague has been engaging in a sexual affair with a patient, perhaps an analyst in training and therefore a colleague, while charging for the “sessions,” and carrying on for a number of years like this while running an Institute. The analytic group's identification with its ideal of psychoanalysis as a good object is then easily transformed, at least psychically, into a rampaging mob hungry for the blood of the transgressor. The rage that may ensue empowers the ‘mob’ to act in the name of the leader (psychoanalysis), and to act out ‘His’ powers in a narcissistic manner against the violator. The chief benefit of this archaic mechanism is to preserve the sanctity of the group. If there has been an ethical violation, the causes and responsibility for this are shown, in a dramatic way, to belong only to the deviant member, and not in any way to the group as a whole.

As it stands, our consensus policies on professional ethics still reflect this form of general collective denial, not only through the scapegoat mechanism, but also, and more subtly, through displacement onto sexuality (Levin 2021d). We largely ignore the narcissistic abuse of patients, of which sexual violations are only a sub-category. Policing sex is not in itself an ethics of the analytic relationship. Narcissistic enactments are the potentially damaging things that we may still do with patients even if, to paraphrase Adam Phillips (Bersani & Phillips, 2008), we agree not to have sex. What remains unexamined in the psychoanalytic relationship are all the traditional discretionary powers of the priest and the father. Normally, we take these for granted, as professional privileges and procedures, whether we are men or women. Under the cloak of the “trained” psychoanalyst, many forms of extraordinarily intrusive intimacy are contemplated routinely without the least sense of any boundary risk at play.

This one-sidedness in the discourse of boundaries reflects the original patriarchal conceptualization of the psychoanalytic form and its Institutions. Sex is the thing that the father controls, and reserves for himself, according to Freud's (1912) original formulation of human social origins. Thus, to equate the risk of boundary violations with sexuality per se is, in a sense, to sugar coat them. Sexuality carries the can for the whole method, effectively exempting the standardized intrusiveness of analytic technique from close scrutiny. Unlike sexual relations,

narcissistic relations are not categorized as exploiting the power differential, fostering inappropriate intimacy, or “acting out.” The implication is that sexuality has nothing to do with the professionally applied and approved method; it only appears as a form of deviance. Ethical displacement onto sex, therefore—even the shock of blatant sexual transgression—is actually reassuring for the profession: it provides an opportunity to argue that the approved method is risk-free, vulnerable only to contamination by an extrinsic factor that is present in all human relations yet, paradoxically, defined out of psychoanalysis itself.

Of course, it is entirely natural that as psychoanalysts, we want to shield the profession from criticism and protect our sense of professional identity. If one of the underlying problems is really primitive narcissistic functioning in the group, we are understandably reluctant to face it; it would require a socially awkward, embarrassing, painful, and morally troubling group process that could spin out of control (we fear), and lead to even further regression, more bad behavior, and irresponsible acting out that is not sanctioned by our Institutes and other authorities. The fear on all sides of these questions is, of course, moral panic—moral panic in society, moral panic in the profession. We seem to believe that the best way to keep the whole situation under control is to one-sidedly single out sex as the problem, give the impression that it is not really part of psychoanalysis, and declare that the “boundaries” of sex are well patrolled by the profession.

Any move toward restorative justice in this regard would bring this neat public relations compromise message into jeopardy. It would be dangerous because it would require an untested degree of democracy in the profession. In the words of the IPA website (IPA n.d.) description of the Eitingon model,

There is conflict around the dispersion of power: greater democracy is evident, but there are many questions about its effects (e.g., “pluralism and democracy have become buzz words for anything goes”; “difference between secrecy and confidentiality—democracy has certain limits in a psychoanalytic society.”)

To go down the road of justice reform would lead to the unwelcome realization that psychoanalysis is nobody's perfect possession; it does not

belong to the approved analyst by right of “training” or exclusive initiation; it cannot be inherited or bestowed. Rather, it is an ambiguous collection of ideas and conjectures in the public domain—fair game for non-analysts to develop into other things: attachment theory, developmental psychology, social theory, film theory, art, what have you. The accredited members of the profession might only count as a minority among the many devoted custodians of psychoanalysis; and the established psychoanalytic group to which they belong would be at best ambivalent about itself, retaining the power to educate and train clinically, but with little real power to control, even among its most loyal members, a practice so intimately involved with something as inchoate as the unconscious and fluid as psychic life.

There is always a sense, even in a constitutional liberal democracy, or an enlightened psychoanalytic society, that the Law ultimately derives from the submissive transformation of our own narcissism. Our fantasies about the power we would like to have are invested by tacitly negotiated collective agreement in a power that will stand over all of us, and this is the power vested in some authority, sometimes violent, to enforce the Law. In a democracy, we say that no one is above the law, which of course we know is at best only a relative truth, so long as there remain serious forms of inequity, discrimination, and socio-economic injustice. But to the extent that we are able to maintain our faith in the good intentions of that bargain, we can have peace and good government at least some of the time.

There will always be a debate about how much narcissism we can tolerate in polite society, and this is a conversation that analysts still need to have. Right now we have an ethical rule that analysts shall not have sex with their patients, pretty much under any circumstances. We have a consensus in our community that this is an important rule because it relates to a sort of ‘primal crime’ (Dimen 2011). There is an idea that we could be doing more to prevent it from happening so often. The discussion we need to have next is about the best way to realize this idea. That discussion would lead in turn to another discussion we have never yet been able to have, namely, about the group's implication in the persistence of this primal crime. To do that, we need to think more carefully about the ways in which we organize our own professional narcissism,

as inherently narcissistic individuals in an inherently narcissistic group.

Concluding Summary

The following is a list of some issues and themes awaiting consideration at the institutional level:

1. Our community, like that of the Christian Church, which also has a serious boundary violation problem, was constituted through identification with a primal father.

2. We gave that Father enormous power over ourselves, which made original thinking in our field controversial and problematic.

3. Many of our most original thinkers, not to mention those expressly banished, like Jung and Ferenczi, were men or women who had serious ethical boundary problems. They include Jones, Klein, Winnicott, and many others. Much original work was done based on self-analysis and self-diagnosis and inappropriate analysis of one's own children. New ideas came out of extraordinarily intimate relationships with patients, like those of Ferenczi and, I suspect, the relationship between Winnicott and Marion Milner or Masud Khan. The list goes on. In addition to this social fact of our history, we have to accept that in a real sense the very idea of psychoanalysis involves a problematic boundary violation—certainly it was perceived that way in Freud's day—and we have to admit the possibility that the profession attracts mainly those looking to cloak their wish to go where angels fear to tread.

4. The atmosphere in psychoanalytic societies was, and to some extent remains, inhibited and oppressive. This stiltedness may be an attempt at a cover up. We seem more careful than is natural not to draw attention to ourselves for fear of provoking questions about our mental stability, our propriety, and whether we have been sufficiently well-analysed. Though our governance has become less authoritarian during my lifetime, there remains a streak of puritanism in our group culture that easily transmits authoritarian impulses in unofficial and secretive ways.

5. It is easy to imagine in any of us a certain mood of potential rebellion that consumes our psychic energy as we struggle to remain

   Page 148

   good professional citizens.

6. It is easy to imagine, from self-observation alone, that many of us develop a keen sense of the hypocrisy within our group. We can observe ourselves towing certain party lines with which we are not entirely comfortable; or agreeing with harsh judgments of others for things we know we and our friends also sometimes do or think.

7. Our sense of our own hypocrisy traps us in a vicious circle of evasion and deception that makes it difficult for us to contemplate a more therapeutic, exploratory approach when transgressions do emerge, complaints are made, and gossip overtakes. (In the Psychoanalytic Center of California, candidates refused to read or discuss important papers by Robert Caper because he had been expelled for an alleged sexual boundary violation.) It is difficult for us to say of a transgressor in our midst, “this is a member of our group, we had interesting conversations with him, he or she has supervised us, and we have used their papers in teaching, and we learned from them.” Instead we say the equivalent of: “He or she must never have been a legitimate member of our group. We just didn't know it till now. They were here among us on false pretenses. Let's get rid of them.” We may not always do that in practice, except in the really egregious cases; but we think it; and we act as if that is the moral bottom line.

From this perspective, our consensus on sexual boundary violations remains valid ethically, but as I have been arguing, it is in some ways

superficial and defensive. We certainly need to keep the consensus, but we also need to go deeper into the matters that underlie it: 1) our phobic anxiety; 2) the tendency for any discussion of actual cases of transgression to become hysterical and punitive; 3) our feelings of narcissistic vulnerability and shame when something imperfect happens in our profession; 4) our “hatred” of psychoanalysis, which surely feeds into an atmosphere in which our own rebellious impulses are suppressed, only to fester unconsciously, and be transmitted through unconscious channels in the group; 5) our unwillingness to really acknowledge that the work we do is messy and ambiguous and risky; 6) our tendency to foster an unrealistic image of ourselves as selfless in our work, setting our own needs and passions aside; 7) our reluctance to fully embrace moral responsibility for the damage caused by our colleagues to patients and thereby the larger community.

Let us be optimistic about our ethical future. Further democratisation, with innovation of more enlightened forms of self-regulation, including a more restorative as opposed to punitive model of justice, may significantly reduce the incidence of sexual boundary violations, while helping to better manage the fallout when these tragic events occur.