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What a delight having a discussant like Philip Cushman! However much we may agree or disagree on particular issues, he joins me in addressing major questions on the relationship of culture and history to psychoanalysis. These questions are seldom asked today because American psychoanalysis largely excludes those in the social sciences, the humanities, and the arts from psychoanalytic training.
How are we able to know another, particularly a person from another civilization? However much we as analysts rely on different ways of knowing—ranging from sensitivity to the symbolic significance of a patient's associations, to self psychology's empathic immersion in the other's subjectivity, to object relations' attention to the induced countertransference to shed light on the transference—the psychoanalytic endeavor is fraught with ambiguity and uncertainty. But working with patients from another civilization, such as Indians and Japanese, can result in a far more discomforting experience. One can easily be at sea, totally perplexed as to what is going on. This situation requires far more than the openness, self-examination, and surprise Cushman cites.
I have become convinced from this cross-civilizational, comparative work that in assessing all of the subtle interactions in the psychoanalytic relationship, we are always working on implicit understandings as to what goes or doesn't go in our own culture; that is, we have in our minds an implicit normality to psychopathology continuum that we don't even reflect on. To give the simplest example, if patients come to us stating they have slept next to their mothers for several years, or sometimes into their teens, we would certainly wonder about the