On September 28, 1996, the Los Angeles Psychoanalytic Society and Institute celebrated its 50th anniversary. The distinguished featured speaker for the event was Arnold Cooper. In his address to the assembled members of LAPSI he argued that psychoanalysis, unlike most other sciences, has no generally agreed-upon way of incorporating data and perspectives from other disciplines into its theorizing and praxis.
Because it has never resolved key methodological issues of disciplinary validity, Cooper went on, psychoanalysis has not been crossfertilized by other fields. Indicative of this intellectual frigidity (I paraphrase here), this absence of real intercourse with other intellectuals, is the fact that psychoanalysis is poorly represented on university faculties and remains largely confined within the somewhat monastic walls of psychoanalytic institutes — a negative factor, Cooper suggested, for the survival of the discipline.
After Cooper's remarks, the audience broke up into several pre-arranged workshops. I had originally registered for “Psyche and Soma,” which dealt with recent advances in neurobiology. I later changed my registration so that I could participate instead in the session on ethics. My request to switch was met with some surprise by the employee of LAPSI who took my telephone call. I was getting out of the workshop with the “hot topic,” she said. This telling comment echoed the enthusiasm I had heard in one of my seminars the previous year, when an instructor had offered the opinion that “this neurological stuff” was going to “demonstrate once and for all” what psychoanalysis had been trying to explain for decades. Because of my instructor's excitement, I had acquired — outside my assigned seminar reading — a fairly lengthy paper on the topic of neurobiology and infant development.
Following the planned workshops at the 50th anniversary conference, another plenary session was held, where reporters shared the results of the discussions. The first reporter spoke about Workshop No. 1, “Psyche and Soma.” Here my evenly hovering attention captured the following impression: The topic was exceedingly complex, new facts were constantly emerging, but someday psychoanalysis would have a quantitative basis for making its claims. There was a palpable sense of wonder and enthusiasm for the possibilities opened by this new field. I regretted not having attended this workshop after all; I had missed an opportunity to experience this enthusiasm and to study it. And yet I was overcome by ambivalence toward what I was hearing.
In order to convey the depth of my ambivalence, I must digress, in lengthy Proustian fashion, into my associations at that moment. I wondered if anyone in the room that day appreciated how deeply invested I am in the link between psyche and soma. “No one in this room,” I thought, “or at least no one as far as I am aware, can be as attached to the topic of psyche and soma as I am. Is there another person here for whom this issue is a matter of life and death?”
After my mastectomy in 1989, I spent a considerable portion of my “free” time over a period of several months reading clinical literature on breast cancer in UCLA's Biomedical Library. I had been misdiagnosed two years prior to that with a false negative mammogram in the hands of a doctor who convinced me that a biopsy was not indicated — a misdiagnosis with probably fatal consequences for me — and I no longer trusted any doctor to tell me what I had and what it meant.
As a UCLA faculty member, I was able to get a password for Medline so that I could log on at home and surf the database for results of clinical trials. I learned to use “carcinoma” as a search word instead of “cancer.” This harvested more titles. I read about “multivariate analyses” and “chi square tests” and “prognostic indicators.” I learned what factors were associated with “poor prognosis” — i.e., death. (I had to decipher the euphemisms of the medical profession.) I saw charts and graphs that told me I would be dead within a year should I ever develop hepatic “lesions.”
In 1991 a CT scan revealed an “anomaly” in my liver, and a bone scan located a lesion on one of my vertebrae, subsequently confirmed with an MRI and back surgery with biopsy. The liver site was too small to biopsy, and in fact disappeared after my first autologous bone marrow transplant in 1991. In April 1993, three sites in my liver appeared (they were biopsied one year later), along with another bone tumor. I had hoped that the first BMT would provide me with a long-term remission, perhaps even a cure. This was not the case. Having read the clinical literature, I knew that the only purpose of standard outpatient chemotherapy at this point would have been to allow everyone to feel that something useful was being done for me. Hence I asked for and received a second bone marrow transplant, this time abandoning the notion that I might be cured by this experimental treatment, but hoping simply to lengthen any eventual disease-free period. In the fast-moving/slow-moving world of cancer research, another year can mean another “treatment modality.”
After the hysteria cleared (the reader will forgive me if I use this term in the popular sense of “being extremely upset”), I decided to live as actively as I could. I wanted to lessen the degree to which the disease dominated my life. It might occasionally affect my physical functioning, but my mind was relatively intact. (In fact, the disease itself has rarely had an impact on my physical abilities at all. It is the therapy that affects me.)
I resolved to live hypothetically, to pretend I wasn't sick, because this might help me live longer. For example, in addition to my academic work, I carried on with my plan to pursue psychoanalytic training, for which I had applied several weeks prior to the discovery of my 1993 relapse. This required that I persevere through some institutional resistance, but I was happy to do so. After all, analytic training was a longstanding professional objective of mine. Besides this, I had decided it was in my best long-term interest not to have time to be sick. Even though I knew I could not wish the disease away, I fantasied that I could lessen its progression with the appropriate attitude. The disease, I thought, might take my body someday, but I would not, while I waited, let it take my soul. Workshop in Survival No. 1: “Psyche and Soma.”
Jill Anne Kowalik, Ph.D., is a third-year research candidate at the Los Angeles Psychoanalytic Institute and a senior faculty member in the Department of Germanic Languages at UCLA, where she teaches philosophy, literature, and intellectual history.
One of the interesting things about having cancer, if you can step back from the trauma, is the opportunity it affords to observe helping behavior on the part of those who know you, those who love you, and those who do both. Apparently rational people whose love for me is considerable display their own sense of helplessness by suggesting that I seek out faith healers, south-of-the-border therapies of all kinds, and “clinical trials” that the delusional contingent among my left-wing friends describes as “treatments the medical profession refuses to acknowledge because they would put the chemotherapy industry out of business.” My standard answer is, “I only do science.”
And I do analysis, pace Ralph Greenson, who I believe was probably a very fine analyst but who does say on page 55 of his book on technique that “severe physical illness” may be a contraindication for analysis. When I observe the emotional flatness and the incapacitating, just-under-the-surface rage of other cancer patients with whom I share hospital rooms, I think how much some of them might benefit from analysis, just as I have, and I regret how rarely analysis seems to be deployed among this cohort. Perhaps Greenson's advice could be re-examined. It's important to me, for example, to be able to separate the anxiety caused by my illness from the pre-existing neurotic anxieties I have. Only analysis enables me to do this.
Science has been good for me. I am a statistical wonder simply because I am still alive. I am, in medical terminology, “responding” to yet another quasi-experimental protocol carried out at City of Hope National Medical Center according to the rules of scientific method. This does not prevent me, however, from observing how I and others imagine the power of science.
Science seems to have been a “hot topic,” as the administrative assistant so aptly put it, among the colleagues assembled for LAPSI's anniversary celebration. My impression is that there is a fantasy at work in the minds of some — or even in the minds of many — that psychoanalysis (a complex and multifaceted discipline) will someday be “proven” or “demonstrated,” if only there could be enough neurological facts.
As I observed the enthusiasm for neurobiology on September 28, I connected it to other expressions of wonderment that I had previously absorbed regarding this field. I heard again in my mind Arnold Cooper's words from that very morning regarding the challenges facing psychoanalysis, especially the challenge of defining what constitutes “truth” in the discipline. When one of the afternoon speakers invoked, somewhat obtusely, Nietzsche's name, I began to think again about the enlightening aphorisms at the beginning of Beyond Good and Evil where the philosopher-poet asks us to consider: “Why does Truth matter?”
This question has often been interpreted by unthoughtful or uninformed readers of Nietzsche to mean “There is no truth.” This is incorrect. His arguments are poised, hyperbolically, against “truth” as a monolithic, one-dimensional entity. Truth is multidimensional and complex, he asserts, but to those for whom complex meanings arouse anxiety, such as my colleague that afternoon who sarcastically mentioned his name, Nietzsche and his like are agents of chaos.
No one can read Nietzsche's defense of science over superstition in Daybreak and conclude that he would not, for example, care deeply about the truth of scientific data indicating that the substances flowing into my veins every month will have a positive effect. While Nietzsche is dismissed in popular consciousness as a radical relativist with nothing to say to scientists, he is merely (!) asking us to reflect on the fact of our investment in “truth.” Why is truth so valuable to us? Phrased analytically, Nietzsche argues that we all suffer from a transference to “truth” that ought to be analyzed. We ought to be clear about what truth means to us.
The history of psychoanalysis teaches us that psychoanalysts have not been particularly adept at analyzing their own transferences to theory. Yet if analytic clinicians remain unaware of the phenomenon of transference to theory, about which Nietzsche has written so powerfully, they will neglect an important dimension of their work. Theories whose value has been confirmed experimentally may enlighten every analyst immeasurably, but the greater their explanatory value, the greater will be their apparent certainty and — with that — the greater their power to blind clinicians to their own relationship to the theory.
I am not competent to evaluate neurobiological arguments. Moreover, it is not my purpose to criticize the work of neurological researchers whose dedication to interdisciplinarity is manifest. I am addressing instead the symbolic status of this work for analysts who cling to simple notions of certainty and “objectivity” in the analytic encounter.
I earnestly hope that one day neurobiology or immunology will be able to explain to me why living hypothetically has allowed me to live at all. But I am concerned about the meaning of the enthusiasm I sensed for the material presented in the “Psyche and Soma” workshop. I wonder if such enthusiasm may eventually preclude the rigorous working through of multiple pressing epistemological questions in the field of psychoanalysis — a working through that was at the heart of Arnold Cooper's eloquent exhortation.
Clinicians may look increasingly to neurological and neurobiological models to define the parameters of their discipline, not just because these models have enormous explanatory value, which they undoubtedly do, but more importantly because they may offer a seductive solution to — but not a resolution of — those vexing questions about “truth” and “meaning” in the hybrid discipline of psychoanalysis.