Psychoanalysis in El Barrio

CHRISTOPHER CHRISTIAN: The documentary you're about to see emerge from two important conferences held in New York City co-sponsored by IPTAR and The New School. The first conference was Latin American Contributions to Psychoanalysis held in March of 2013. The second conference was Psychoanalysis in El Barrio, held a year later. Both conferences capture complexities of working across issues related to culture, class, immigration, language, ethnicity, and race. And they challenge the not uncommon notion that Hispanic patients who are affected by poverty could only benefit from psychotherapies that relied on very concrete interventions. In these joint ventures, IPTAR and The New School manage to recapture the progressive ideals once embodied in Freud's free clinics.

PATRICIA GHEROVICI: Now we're going to take a trip that is a nice experiment in socioeconomical change, because in a 10 minute ride, we will be able to go from well-off middle-class bustling business, nice, comfortable middle class homes on to an area of post-industrial Philadeliphia with abandoned factories, some of them have been reclaimed as living space with nice loft. At the end of the 18th century, Philadelphia was one of the biggest industrial cities in the world. Many people in Puerto Rico were recruited to come and work, attracted by this by then, very [? byrun ?] factory activity that no longer exists.

And now if you look at the setting, it looks like a relic of the past. Then we'll see the collapse of the welfare state with abandoned projects. And we'll make a left there, and that will be the Bloque de Oro-- Golden Block is the heart of the neighborhood. Man-made palm trees to give you memories of beautiful, tropical settings. And the Golden Block sidewalks have this yellow swirl painted onto the ground to comemorate the dream of getting reach quickly in America.

Like many of my patients, I am an immigrant. And when I came here, I didn't feel that comfortable doing clinical practice in English, and I found the possibility of working with the Hispanic community of North Philadelphia. And I use the word Hispanic-- and maybe we could talk about that-- purposely. I discovered a vibrant community that lives in very precarious condition that survives in very difficult and challenging situations. I would hear every day at the clinic, every report of a death. Every single day.

And this major thoroughfare is where that building across the street is the clinics was called then Centro des [INAUDIBLE] and it was the first place I worked at for almost five years, as my title there was Staff Psychologist and that's where I discovered the neighborhood, the community, and the possibility of psychoanalysis in the Barrio.

[MUSIC PLAYING]

RICARDO AINSLIE: I arrived in Berkeley, California in 1969. Like many people from Mexico, I was fairly conservative, didn't really have any formulated ideas about the Vietnam War. I had a therapist who was an analyst named Doctor Fernandez. I don't even remember what I was talking about in terms of some relationship issue or something, and he says to me, [SPANISH]. It wasn't exactly classical psychoanalytic technique, but it's interesting, because there is this tighter relationship between social issues and individual psychology than psychoanalysis has historically thought there was.

DANIEL GAZTAMBIDE: When I came stateside to pursue my education, it's something that very quickly reared its head, the idea that there are people who are analyzable or not analyzable. It was always a very weird conversation to have when you have professors, faculty, people presenting at conferences, and they're talking about who was analyzable, who was not, and you're in the audience, and you're kind of like, wait, you're talk-- so you're talking about me.

PATRICIA GHEROVICI: Here, there is a lot of a stigma associated with psychoanalysis. Whereas in Argentina, it's something that people feel proud of. People will even put in their resumes whether or not they had been in analysis, and if it' someone famous, they will put the name. Psychoanalysis is accessible to all, because also what you have in Buenos Aires if you have free public clinics that offer psychoanalytic services. So it's not considered to be a luxury.

RAFAEL JAVIER: I was working at [? Clinoboro ?] Psychiatric Center. And that is New York. At that particular time, what a depressed area. One of my greatest passion was to try to demonstrate that it's unfair to assume that because you're poor, you are not curious about yourself.

MARIA DE LOURDES MATTEI: A quote that I like to use, paraphrasing Winston Churchill around democracy, democracy is the worst form of government except for all the others that have been tried. And I think, oh, I would say that about psychoanalysis too, sometimes with my non-psychoanalytic colleagues. I go, it's the worst form of therapy, except for all the others that have been tried.

ERNESTO MUJICA: I left Cuba when I was six years old, lived in the United States for nine years, moved to Spain. In Spain, I entered psychoanalytic psychotherapy. And I was very interested in eastern philosophy, Zen Buddhism, and psychoanalysis.

CARLOS PADRON: My interest is in the connections between philosophy, psychoanalysis, and literature. In analysis, you come up with ethical issues, epistemological issues, all kinds of different issues, but it's in the concrete situation it really tackles the issue of is life worth living, or it's not worth living, et cetera. These are all philosophical questions ultimately, but suffered in-- they're not intellectual questions. They're real, embodied questions that people have and suffer from.

DAVID RAMIREZ: I use the wilderness as a metaphor. That we all have a wilderness in our heads. That the unconscious is kind of a wilderness. And at the analyst is like the guide who is going through the wilderness with his patient-- his or her patient-- and discovering together how things work.

[SPEAKING SPANISH]

Anna Viera.

[SPEAKING SPANISH]

[SPEAKING SPANISH]

MARIA DE LOURDES MATTEI: I worked in community mental health in a Puetro Rican community for many years, and my most recent function there is to run the seminar for graduate students. I tell my students that I think of psychoanalysis as a sensibility. If there's nothing else of the seminar that they might forget or anything, is instead of coming in to meet client immediately to figure out oh, this child is attention deficit disorder, I will do this, this, and this. First thing I go is who is this child? Psychodynamic training in psychotherapy is becoming an exception except in the cities. But around here, if I leave and stop doing the seminar, it would be unlikely that somebody would continue.

CHRISTOPHER CHRISTIAN: Right now, insurance companies tend to favor cognitive therapy, what they think is something that would provide effective results in short term.

RICARDO AINSLIE: When you talk about Latinos or African Americans or people who are not part of the mainstream, one of the things that's been so wounding-- no one's interested in what their experiences have been about.

DAVID RAMIREZ: An absence of recognition.

RICARDO AINSLIE: Right.

DAVID RAMIREZ: Yes.

RICARDO AINSLIE: And in the world of mental health, we have had an explosion of all the so-called empirically validated treatments that are short-term treatments that are basically, you come in for eight to 10 sessions, and let's target the symptoms that we're going to reduce. Those treatment modalities are not particularly interested in understanding your life story.

DAVID RAMIREZ: They can be experienced as being disrespectful, at some level, I think.

RICARDO AINSLIE: Yeah, I think so.

PATRICIA GHEROVICI: One development of psychoanalysis in the US, which is to think that psychoanalysis will only work we've people who are described as highly sophisticated, intellectually sophisticated, and [INAUDIBLE]. And that kind of thinking, at times, leads people to believe that someone is who is poor could not benefit from psychoanalysis.

CARLOS PADRON: And the argument is that insofar as these people are poor and pressured by the exigencies of poverty, they're externally driven. They don't think about themselves. They're only thinking about solving day-to-day problems, et cetera.

PATRICIA GHEROVICI: And I have my clinical experience to prove the contrary, that the one-- I often say that, indeed, it's a little extreme, but poor people may be poor, but they can afford to have an unconscious.

CARLOS PADRON: This thing that poor people are unsophisticated, meaning that they can't reflect, blah, blah, blah-- it's a bias, because what it means is that they don't reflect like the analyst does.

DANIEL GAZTAMBIDE: But then the question becomes, how is my inability to relate and to understand this other language, this other world getting in the way of the process? And that's the question that I think people have a tough time entertaining, that maybe you're Latino patients, your patients of color don't stick around, because there's something that you're doing.

CARLOS PADRON: There's many ways of thinking and reflecting and being inwardly directed. Some patients will have access to their inner life through stories or [? metaphor ?], metaphors. I have a patient from Latin America who I've been seeing for about four or five years now-- sexual trauma, trauma related to him being gay, discrimination, the police beat him up. He came from a very poor environment. He also lived in poverty here, in the US, as an illegal alien. He told me that he started in his home country, sending money to fix his house, this house of his childhood.

He actually called it the house of terror because of all this emotional stuff that had happened there. He said he started painting the houses and fixing the house, painting the walls. And then slowly, he would connect that as a metaphor for fixing his own mind. It was always through very poignant metaphors, introduced by him, never by me. So having insight can mean different things in different contexts and with different people and of people from different kinds of backgrounds, right. You have to adapt psychoanalysis to the specific reality of that person.

RAFAEL JAVIER: I have seen Latino patients who, in a sense, maybe used storytelling-- they're aware, they are very [? cautious ?] in other ways, but they don't engage in asking themselves, what am I, you know, this? You could have that kind of work with someone. Would that make it psychoanalytic? I don't know, because that, this next question is the personal responsibility piece. The extent to which someone can then use that cultural way of making sense of what's happening with their life, from the perspective of asking themself a personal question, what is it that I am doing that is contributing to my current situation? There's two different processes that may interplay with many patients. And when they interplay, it can be an explosion, beautiful. But not necessarily happens across the board.

[SPEAKING SPANISH]

SPEAKER 1: Sometimes you dream about a number, and [INAUDIBLE] the number in my head.

[SPEAKING SPANISH]

SPEAKER 2: Like-- I could dream of

SPEAKER 3: You have an example?

SPEAKER 2: --my grandmother. Yeah. She died and she'll come and say things. And I'm looking at her, but mom, you're already dead, what's wrong? Or she'll say, something's wrong with the family.

PATRICIA GHEROVICI: What is crucial about psychoanalysis is that you listen to someone. Often, the population I was working with tend to occupy a social position in which they are infantilized, they are often told what to do. They're not really treated as subject. The Puerto Rican population in North Philadelphia has had three generations of unemployment. If you were to find a job-- which there're not too many, but if you were-- you would lose many of the necessary things you need as a working poor person. So it was very complex. In the analytic exchange, you make somebody who is by the given situation of society plays as unemployed, unproductive, work becomes somebody who works and who produces. And occupy a different social position, in that sense. And that's why I think it has political potential.

CARLOS PADRON: Meaning that it can free up things that have been occluded by the oppression proper to the socioeconomical circumstances in which these people live, and that have become internalized. Internalized racism, for example.

[SPEAKING SPANISH]

DAVID RAMIREZ: My parents explicitly raised us speaking only English, my two younger brothers and I. Even though they communicated in Spanish. I didn't know how to reconcile these mixed messages that I was getting. On the one hand, we want you to be proud of who you are or where you come from. But on the other hand, there's something sort of vaguely second-class about being Mexican-American. I went back to my hometown to give this talk about the conflict I had felt with my own culture and the rejection that I had displayed in relation to my culture. And interestingly, there were a lot of Mexican-American people in the audience and some of them were psychologists. And afterwards, they came up to me and they said, that was so brave of you. And I felt the same way. I went through the same thing.

The parallel between that and psychoanalytic theory is that the therapeutic process at its best, kind of holds people, allows them to experience everything that they need to experience, including their conflicts. Creates a space where that can happen so that a person can so fully realize who they are and how they're put together.

CARLOS PADRON: So imagine, right, if you can work with a patient who has internalized homophobia, racism, et cetera, and help this person overcome that and liberate him or herself from that, you're creating subjects that are not only able to lead less conflicted lives. They can make a difference within that community once they've kind of overcome, or freed up, become free from these internalized oppressions, I think.

PATRICIA GHEROVICI: If you are someone who can question things, who can make decisions, who can claim a little bit of freedom would be someone who may, perhaps challenge oppressive positions.

CARLOS PADRON: Those are my best-- the moments in which I best think the best of psychoanalysis in terms of-- politically, but other times of also when I work with very impoverished people, I feel like, OK, we're talking about dreams and blah, blah, blah. And then I say, but what am doing? This is a much bigger political problem that has to do with legal problems related to immigration. It goes beyond psychoanalysis.

PATRICIA GHEROVICI: Psychoanalysts could become activists, but we will be intervening like citizens. Once an analyst is outside their office, he's no longer an analyst. I think that an analyst who's only an analyst is somebody in their office talking about their dreams who tells you, who believes you are his or her analyst. But also what you will have to keep in mind is that there is this sort of narcissistic investment of a Savior, the analyst as Savior, that one should try to avoid. We can beat up people with kindness, give them diagnoses like Puerto Rican syndrome, infantilizing them. That we can beat them up rather than give them a space where they can do something about themselves independently.

MARIA DE LOURDES MATTEI: I tell my students that I think of psychoanalysis as a sensibility. I just have found it indispensable in understanding things that make no sense. In Europe, there's committees where they take people from philosophy, blah, blah, blah. There's always an analyst there. The United States, as far as I know, there's never an analyst there. For example, what do analysts have to say about Ferguson? What does analysts have to say about immigration? Within the US, in terms of doing something, I think that psychoanalysis has to be drastically demedicalized. Drastically. And it has to become part of culture and of community. That would mean changing the curriculum of many analytic institutes, it would entail changing the way we write. Stop writing scientific papers, who only four or five people are going to understand.

DANIEL GAZTAMBIDE: There's no shortage of philosophers, social critics, even political scientists who draw on psychoanalysis and psychoanalytic insights that talk about politics to talk about issues of race or gender or class or what have you. The psychoanalytic community proper, the community of clinicians who practice psychoanalysis, is less inclined to do that. They're people who do it

RICARDO AINSLIE: I formulated this idea to study small-town Texas. This was my first psychoanalytic ethnography project, No Dancin' in Anson. This is the Garcia family that I was talking to you about.

There's a Mexican American family. Neither of them spoke English. I'm interviewing them in their living room with Mexican telecomedias on in the background. I'm hearing about past trauma in their lives. Their anxieties about losing their daughter because she's becoming americanized. I understand what's going on with them in a way that truly is indistinguishable from the narratives that take place in my office.

And I started to understand that the real conflict in this town was not about dancing. Prior to the Civil Rights era, Mexicans were not allowed to live in the town, were not allowed to enter restaurants by the front door. The woman who was the leader of the footloose club. Her name was [? Merci ?] Torres. Her husband was the town physician. He had gone to medical school in Mexico. And so here, you had one of the leading couples in the town, if you will. Posed a real conundrum for the local social hierarchy, because they never had people of Mexican ancestry who were educated in this way. Did you invite [? Merci ?] to join the garden club like the physician's wife had always been invited to do, et cetera.

And this is the first time that I encountered the power of the analytic tools that I use every day in my clinical work. The power of these tools outside of the consulting room.

Let me tell you about how I think that patients think of me as a Hispanic or Latino. Analysts. Normally, they're a bit puzzled. Especially more upper-middle class, more socioeconomic advantaged people to think about a Latino or Hispanic who is educated, sometimes. It's kind of puzzling for them. Oh, this guy's an analyst. And then my [? reaction-- countertransferrence reaction could be-- and this is the kind of reaction that we'll have as analysts, and that many analysts are not willing to talk about. Like, what do you think that I'm not as educated as you are? And I can get angry at the patient, right? So again, you see that there, that the ethnicity is inseparable from a class situation. Or the opposite case, of seeing-- for example, I think about one patient who was very poor, from Latin America, a woman-- and there, I started to feel in me a certain sense of guilt, because I had certain privileges that she didn't have and both being Hispanic or Latino.

RICARDO AINSLIE: One aspect of countertransferrence in relation to poverty, though, is our own fear of it. Our own profound anxiety about poverty. So I think that's one way in which we otherize people who are poor. And therefore, when we have-- one way in which that may translate is our sense that they're not analyzable, or they're not amenable to this kind of process. That's a countertransference, because we don't want to hear about the poverty. We don't want to hear about what it's like to not know if you're going to get your food on the table. Or we may not want to hear what it's like to be the victim of prejudice in a society that claims that prejudice is on the run.

RAFAEL JAVIER: The patients see us as what? Poor? No. They see us as middle-class and most likely a privileged class. We might not feel that way, but the patient is here, notice that, you are obviously in a better position than we are, because we come in to you. So there is a tension that we all have to negotiate.

ERNESTO MUJICA: The emphasis that you may place on, let's say, talking about issues of education, of moving up economically. You may have more or less of an investment in securing that the patient, let's say, takes a job that has good benefits. So it could be a pressure on the patient, that the patient wasn't coming with.

CARLOS PADRON: And the thing is that, how within the analytics seen in the clinic not to reproduce the same kind of expressions and exclusions that these people have been subject to.

RAFAEL JAVIER: If we become too defensive about that, it's more likely that we will show some distance in from the patient. Almost as if, please do not contaminate me. Very subtle. But the patient will feel it. In the way you shake the patient's hand. The way you greet the patient. The kind of questions you ask. How you look at your patient. All of that will be shown if you're struggling with that issue.

ERNESTO MUJICA: I worked with someone from Central America. He was struggling with bouts of psychosis. One day, he said to me, Doctor, I'm embarrassed to ask you something, but it's something that keeps coming to mind. [SPEAKING SPANISH] I said, why are you asking me? Why don't you just let me know that you'd like to use the couch. He said, well, I thought that the couch was only for people who could come multiple times a week. The most burning issue was a socioeconomic issue and that he felt that the couch was for the wealthy.

I said to him, look, the only reason for you not to use the couch is if it increases your paranoia. And if you and I can have an agreement that if you start to feel uncomfortable that you let me know. He laid down in the couch, and after about four or five weeks, at one point in the session, he turns around and looks up at me. He said, I know what you're thinking. And I said-- playfully, I said, I think I know what you're thinking. And we both laughed. And he goes, but you know what, you're wrong, because you think I'm getting more paranoid. And I said, you're right. And he said, the reason you're wrong is because as I'm laying down on the couch, you're watching over me. And that's an experience that I've never had.

[SPEAKING SPANISH]

ERNESTO MUJICA: There's been a movement in psychoanalysis to bring more and more attention to cultural issues, but sometimes it's a bit prescriptive. And perhaps what is most important about attending to issues of culture is attending to the issues of culture that the therapist brings.

MARIA DE LOURDES MATTEI: I was talking about the DSM, the diagnostic statistic manual, where now we have this section that are called culture bound syndromes. It implies that the rest of the diagnostic categories are not culture bound.

PATRICIA GHEROVICI: The diagnostic manual, the DSM, it is also bound to a culture, the American Psychiatric Association, that for instance, assumes that depression is universal, when there are cultures that do not suffer from depression and do not have a word for depression. And that's something that anthropologists and anthropologists have explored at large, but that at times, psychiatric practice seems to forget.

ERNESTO MUJICA: The patient may come with rather concrete questions at first. And if one just takes a perspective that this is being overly reliant or what we commonly call now co-dependent, we may humiliate the patient, giving them the message that, no, you can't rely on me for that. You have to come up with your own point of view. This is something that is stronger in American culture, to sort of stand on your own two feet and figure it out yourself. The word in Spanish individuo has a negative connotation. Un individuo, an individual, is someone who is suspect. Someone who is up to no good.

DANIEL GAZTAMBIDE: In a lot of clinical theory and a lot of psychological perspectives, you very much have view as an [? atomistic ?] self. But when you have a sense of self that's defined not by a sense of I but a sense of we, then it becomes a little more kinetic. Questions such as, how does that make you feel, or what do you think become confusing for both patient and therapist. You ask the patient, and how did that make you feel. And the patient responds, well, my mother thought this and that, and my cousin. And you could try to direct them, as many of us are trained to say, yes, yes, yes, but what do you feel? And you can very quickly get caught in essentially a combat of selves. A self defined as unipolar [? atomistic ?] self and a self that's defined by relationships, without understanding that the way to get at how this person felt is through their relationships. Because in talking about what their mother said or what reaction they had or their uncle or their cousin twice removed, you're really hearing a lot about their self.

CARLOS PADRON: This whole thing of like you have to follow your dreams, and never fall down, and have success, and be goal oriented, and all that thing. And there's many people who don't live that way.

RAFAEL JAVIER: If you use a model that has very clear parameters as to work on, to [? help ?] an illness. And suppose, for instance, that one of the ways in which you define function, is you say, well, you should move out of the house after you reach certain time, because otherwise you're totally dependent upon your family. And that clearly suggests a arrested development. And in some cultures, you're not suppose to leave the house until you get married.

PATRICIA GHEROVICI: One of discoveries I made working in North Philadelphia is that I started reading in the literature and occasionally seeing in the chart this label, this diagnosis called Puerto Rican syndrome. And it surprised me a lot because there is in the psychiatric diagnosis, there's no other diagnosis with a nationality. [? With, ?] [? I'm ?] [? talking, ?] American anxiety or French melancholy, but there's a Puerto Rican syndrome. Already, in the name, you have something very clinical, very classical psychiatric manifestation with a political and cultural problem right there, in the name.

DANIEL GAZTAMBIDE: If you look at what people write about the underlying dynamics of [SPANISH], or the Puerto Rican syndrome, it's that it's a response to a lack of freedom. Or it's an active resistance against perceived restriction. And when you put that in context, then it's not really a culture bound syndrome. It's a culture that's bound.

PATRICIA GHEROVICI: And that maybe there is perhaps a connection between the individual suffering and the collective social situation

DANIEL GAZTAMBIDE: To bring it back to this question, is there something analyzable about the Latino self? I would say that if we're going talk about it that way, under those terms, then, yes. I think the Latino self is highly analyzable. The type of symptoms, experiences that get encoded on the body. There's so many people who experience trauma in the body, and they go to their medical doctors time and again and there's no concrete medical reason why they're experiencing those symptoms.

PATRICIA GHEROVICI: At times, the body speaks of pain that cannot be put into words. Psychoanalysis grants this space. Where things that are being unspoken, are not being said, could be put into words and symptoms can disappear.

[SPEAKING SPANISH]

CARLOS PADRON: The Latinos and Hispanics here did not come with the terms Hispanic and Latino to refer to themselves. These came [? and ?] [? posed ?] from above.

PATRICIA GHEROVICI: When you look at the way for instance, the census is filled out, any race could be the Hispanic race. That's what the census concludes, any race. So why do we need a race that could be any race? Why create this racial construction that is completely artificial and symptomatic?

DANIEL GAZTAMBIDE: Freud talks about the ego being this Frankensteinish pastiche of different bits or pieces that are barely held together. And La Con talks about the ego as this perfect, immaculate sphere almost without blemish. And when we talk about Latino, sometimes we talk about in that second sense. That it's this harmonious integration of different cultures and people and lands, when really it's more Frankenstein. That's why we all look the way we look.

PATRICIA GHEROVICI: And also, for me, it's very suspicious when you read more carefully the literature of what Hispanic means. Often, Hispanic means only one thing-- poor.

SPEAKER 4: I grew up in Colombia and I was a Colombian. I never perceived myself as a Latina, per se. And then I moved to the US, and I realized that being from Columbia meant being Latina and that had a connotation in and of itself. There is sort of generalized in the narrative in America is to relate Latinoness with poverty, wealth, criminality. But for me, that comes as a surprise in the sense that I've experienced Latinaness in different kinds of ways. But nonetheless, I think that we all surrender sometimes to stereotypes.

PATRICIA GHEROVICI: I use it purposely to read it as a symptom like we do in analysis. Symptoms could be developed and hopefully overcome. And maybe, there will be one day where we will not need those type of labels.

[SPEAKING SPANISH]

[SPEAKING SPANISH]

[SPEAKING SPANISH]

RAFAEL JAVIER: Language is a complicated process because we're not dealing with just cognition in the absence of emotions. They are interrelated. Part of the beauty of having different ways to organize one's experience is that the aspects of the experience, regardless of how fluent you are, and we've been able to test that out in research, by the way-- how fluent you are, there are some experiences that remain language specific.

ERNESTO MUJICA: The patient described a situation where she was at home and someone was coming to visit her, and she was saying in one language, I was so afraid about having this person over. I didn't know what to do. And then she would switch and in the other language say, but I knew how to handle it. And then switch back and say the opposite. Well oftentimes, in these kinds of interactions, you'll find that the first language is used to describe the more upsetting feeling. Fear, anger. The second language may be a more intellectualized language. So they will use the second language to dominate their emotional experience.

RICARDO AINSLIE: It may be that you can talk about things more directly in the second language precisely because you're less emotionally connected. So I can tell you about my trauma. I can tell you about my sexual fantasies, whatever, in English, because it's safer. It's a little more diluted, emotionally. But don't ask me talk about them in Spanish.

ERNESTO MUJICA: A gay patient was able to talk about his being denigrated and bullied in high school better in English than Spanish, because he was too emotionally upset if we discussed it in Spanish. It was almost as if he started to feel humiliated in our session. A couple of years into the treatment, we were actually able to discuss and use some of the Spanish words that he had told me, I never want to hear this word. Like faggot. And it was very poignant and very therapeutic that he was able to use English to first explore his feelings, and gradually we were able to say some of these things in Spanish, as well.

RAFAEL JAVIER: It allows for that kind of flexibility. And this is true whether or not you understand the language, [? actual ?] language of the patient.

DAVID RAMIREZ: I had a patient. A college student who was from South Korea. And he had an experience as a child in his school where the other children pretended that he was invisible and didn't exist. I invited him to talk to me, to describe it to me first, in Korean and then, in English. And when he talked about it in Korean, he got very emotional. And he stopped himself. And he said, you know, I've talked about this before, but I've never felt this way about it until now.

RAFAEL JAVIER: What happens then, when the patient is speaking a language that you don't understand. Would you be asking the same question? I said the answer is yes. You're facilitating the patient to kind of connect with the original experience. And although, you might not understand the words the patient may be saying, you can see the emotions associated with it.

DANIEL GAZTAMBIDE: Many of the Latino academics that I meet are white Latinos. Overwhelming majority, I would say. And that's kind of something that we don't really discuss. What's our own tension, our own conflict, or our own resistance towards looking at race and racism within our own communities.

RICARDO AINSLIE: I would say the psychoanalysis is kind of self-congratulatory in seeing itself as a subversive enterprise.

DAVID RAMIREZ: Yes.

RICARDO AINSLIE: That we deconstruct the manifest, what's conscious, and we challenge it. So there is a kind of an irony here, because on the one hand, there's that truth about psychoanalysis, and yet, psychoanalysis itself has been

DAVID RAMIREZ: Institutionally.

RICARDO AINSLIE: --very institutionally rigid. Not very self reflective about its own processes, its own hierarchies, and how those hierarchies subvert creativity.

PATRICIA GHEROVICI: Psychoanalytic thinking, at times, we could consider contradicts how psychoanalytic institutions have behaved. But itself, the practice, just to when you're alone in the office and if you listen well to a patient, it's very different and very freeing in practice.

RICARDO AINSLIE: One of the problems that psychoanalysis has had is that historically, it subscribed to this sort of positivistic view of the world, this kind of internal versus external reality. And external reality was construed to be something pretty static.

DAVID RAMIREZ: Like the truth. It was the truth.

RICARDO AINSLIE: But also just things like culture and values and so on. It was static.

DANIEL GAZTAMBIDE: Because the same person who engages in some very real conversation about race, class, sexuality, gender, is the same person who for a job interview, which would be roughly 30 to 45 minutes, would be really impressed by the fact that I can speak English without an accent.

RICARDO AINSLIE: And one of the challenges of any of every analyst, or every therapist, really, is to say attuned to the idea that the way that you understand reality today and culture today isn't necessarily going to be the same way you understand it a year from now.

DANIEL GAZTAMBIDE: So long as this community is still very much white middle upper class, more or less cis heteronormative community, I'm less certain about its capacity to engage in any kind of real formative change. We can have panels with people of color. We can have like black psychoanalysts speak, but it's not really going to create spaces for our communities, unless we're not just part of panels, but also part of structures, and part of faculty, and part of organizations that have the power to make real big decisions and real big changes.

DAVID RAMIREZ: We've got at our meetings all of these young people who are coming as scholars, and they're not part of any Institute structure. These people are clamoring at the gates, if you will, of our organization.

RICARDO AINSLIE: You don't need to be in an Institute to grasp the power of these ideas.

You can be in a community mental health center, you can be in a college counseling center, any number of places.

PATRICIA GHEROVICI: I think this is one of the interesting things of thinking of psychoanalytic practice in nontraditional spaces, that you can in a way, be freed from all these constraints. I feel sorry for these Park Avenue analysts who have to only maybe listen to a very specific kind of patient, that they cannot maybe have the variety of cases. So maybe, in the Barrio, away from the mainstream, there has been room for a return to the most creative and maybe most anarchic roots of psychoanalysis.

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