Peter Whybrow, executive chair of the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles, recognized the winners of the 2015 Leo Rangell Essay Contest at an event on May 20. Award winners Kelley O'Donnell, a 2015 graduate of UCLA's M.D./Ph.D. program, and Richard Tuch, dean of training at The New Center for Psychoanalysis in Los Angeles, presented their work and engaged the audience in a discussion of their papers. The event was sponsored by the Leo Rangell Professorial Endowment established in 2011 by Stewart and Lynda Resnick in memory of psychoanalyst Leo Rangell (1913-2011), past president of the American Psychoanalytic Association.
Essay writers were invited to address the question, “Why Does Psychoanalysis Still Matter?” Bearing the provocative title “What Is the Matter with Psychoanalysis?,” O'Donnell's paper challenged the psychoanalytic community to clarify the proper object—the “matter”—of psychoanalytic inquiry. Doing so, she suggested, will be essential if the field is to reinsert itself into the public discourse on science and subjective experience. However, the response she proposed is not simply to embrace the incipient field of “neuropsychoanalysis” at the expense of all else. Instead, she challenged the field to engage in a discussion of its own epistemology, its theory of psychoanalytic knowledge, by clarifying its objects, methods, objectives, and limitations and exploring the differences between its own and those of experimental science.
Though she argued that these differences must be recognized, O'Donnell did not endorse any ontological dualism. Rather, she described scientific and psychoanalytic inquiry as representing distinct but essential approaches to the study of human subjectivity. Authentic experimental science, she wrote, poses no real challenge to psychoanalysis, “because science restricts its objects and methods; it makes no assertions about what lies outside its scope.” Meaning, she insisted, falls decidedly outside its scope.
O'Donnell ended her paper by making a distinction between authentic science and “scientism,” a term she uses to characterize much of the rhetoric used in the condemnation of psychoanalysis. “The concepts of ‘falsifiability’ and 'objectivity,' ” she wrote, “are wielded as weapons against 'pseudoscience,' with little reflection on the meaning, the implied epistemology, of any of those terms.” Critics guilty of such scientism, she believes, often “have little direct experience or understanding of the practice, philosophy and proper objects of scientific inquiry.” She warned that scientism, unlike science, “is a threat [to psychoanalysis], not because it has intellectual power, but because it has captured the contemporary imagination, generating arguments with little content that are never theless loudly expressed.” She urged the psychoanalytic community to participate in the public discourse on these issues, reinserting meaning, which lies at the core of psychoanalytic inquiry, into the dialogue on how we understand human experience.
In his paper, “An Updated Psychoanalytic Perspective on the Doctor-Patient Relationship,” Tuch identified an implicit psychoanalytic theory of interpersonal interaction that has yet to be referred to as such, but exists nonetheless. Contributions to that theory include Joseph Sandler's work on role responsiveness, Madeleine and Willy Baranger's work on field theory, Theodore Jacobs's explication of countertransference enactments, and a host of writers who have outlined the mechanisms of projective identification.
“This clinically-based theory,” Tuch pointed out, “directs us to attend to the clinicians' subjective reactions to their patients' behaviors, the patient's subjective reactions to the clinician's behavior, and the ways in which the explicit expression of these subjective reactions contributes to the development of the doctor-patient relationship.”
Joel T. Braslow, M.D., Ph.D., is professor of psychiatry and biobehavioral sciences and O'Malley Chair of Neuroscience History at UCLA.
Tuch went on to illustrate the utility of applying this theory to the understanding of conflicts that arise between medical doctors and their patients because the needs and proclivities of each are at cross purposes. A view of the doctor-patient relationship from a two-person/intersubjective perspective, noted Tuch, transcends tendencies to produce typologies that take, as their starting point, the exclusive identification of types of patients or types of doctors. Failures of doctor-patient dyads can then be viewed from a more nuanced perspective, one that circumvents the blaming of one party for having been the sole cause of the problem.
Physicians can become unwittingly drawn into interacting with patients in ways they never consciously intended, noted Tuch, who suggests they had best accept the fact—in the way analysts have lest they end with a sense of failure in not having lived up to their vow to never let patients “get the better of them.” Knowledge of their own susceptibility can help mitigate the shame and harsh, painful self-recrimination they may feel when they realize their actions fall short of the unrealistically high expectations they may have set for themselves.
Based on his own research (Gamer, Tuch and Garcia 2003), Tuch described the utility of graphing the intersection of a particular patient's style of relating to his doctor against that doctor's particular needs and proclivities. Three particular needs can be identified as existing along a continuum: “1) the wish to be liked and admired can become a need to be idealized, 2) the wish to be heard, accepted and respected as an authority can become a need to have one's words taken as gospel [to be obeyed], and 3) the wish to feel in control can become a need to dominate.”
The more extreme the need, Tuch reasoned, the more vulnerable a physician would be when that need was frustrated in interactions with particular patients; furthermore, the more frustrated the physician, the greater the chance he will experience intense feelings difficult to contain. A consideration of the wide array of needs and proclivities clinicians bring with them to the office generates an equally wide array of potential difficulties that can arise in the process of treating every sort of patient—control battles, narcissistic injuries on either party's part, struggles around the theme of authoritarianism, mutual respect or the lack thereof, fear of being disliked for denying the other's wishes, and more.
The Leo Rangell Professorial Endowment is dedicated to advancing the sort of psychoanalytically-informed scholarship that characterized his career. Rangell published 450 papers and nine books. The Endowment, which sponsored a lecture by Nobel Laureate Eric Kandel in November 2013, “In Search of Memory: The Emergence of a New Science of Mind,” has created a website highlighting Leo Rangell's life and work () and plans to support psychoanalytic scholarship for years to come.