Illustration by Tati Nguyễn
MR. FARLEY'S CULTURAL references, and the historical moment of his psychoanalysis, are mine. We were both college freshmen in the early 1980s. As teens, we both discovered sex-themed, pop psychology paperbacks on our parents' bookshelves. (Nice Girls Do and Now You Can Too! was one title that, oddly, shows up in the inventory of my adolescence.) Farley was influenced by John Boswell's Christianity, Social Tolerance, and Homosexuality, which I also read, owned, and eventually gave to a curious, churchgoing, family member. And, contrary to stereotype, it was our mothers who charged themselves with the responsibility of solving our atypical masculinity. More painfully, we also share memories of bullying, and worse, teachers and staff turning a blind eye—what researchers call the “innocent bystander” phenomenon.
Everybody has a teenage playlist, the soundtrack to their adolescence. Farley's account of high-school bullying has Bronski Beat's “Smalltown Boy” wailing plaintively in my ear once more, his rightful anger at psychoanalysis calls to my mind Billy Idol's hypersexual, sneering “Rebel Yell,” and his whole treatment seems to ask Missing Persons' snappy, new wave question, “What Are Words For?” For psychoanalysts, Farley touches on many points worth exploring, the complicated history of antihomosexual bias in psychoanalysis, the unique role that sexual desire plays in the developing identity of queer people, and our field's evolving awareness of the significance of social circumstances in the functioning of the psyche. But for me, a gay psychoanalyst who was also, more than once, a gay patient, the Gen X anthem that best recaps the central question of the essay is “Enjoy the Silence” by those inveterate gay social critics, Depeche Mode.
As Farley's world is familiar to me, so too is Dr. R. and her silence, a feature of the technique that psychoanalysis terms, puritanically, “abstinence.” We must not speak too much or reveal anything about ourselves so as not to deprive the patient of the “blank slate” upon which they draw their unconscious fantasies. I recall the spirit of Dr. R. in my first supervisor, who thought I was talking too much and suggested that I practice psychoanalytic abstinence by forcing myself to be silent for the first 20 minutes of the session, no matter what. (The treatment was ended by the patient shortly thereafter.) Dr. R. was also my colleague who feared revealing too much about himself—it would “be too stimulating, and would pollute the transference”—to the point where he kept no personal items or art in his office. But Farley notes that such violent removals of oneself from the therapeutic setting are not consistent with Freud's work. Freud was “warm and empathic,” not “blandly observant,” and Freud did understand that social factors are implicated in our patients' suffering.
Dr. R. has also been me, not speaking, not showing myself, hidden behind neutrality and abstinence. In 2010 I wrote, along with Karen Gilmore, about this dilemma in an article entitled, “This Strange Disease: Adolescent Transference and the Analyst's Sexual Orientation.” Here, though, the roles were reversed; I was the gay analyst who was using silence defensively against the desperate attempts of an adolescent to destroy her treatment by “outing” me. At least, that was the formulation we held in the paper. I was relentlessly abstinent and refused to disclose my sexual orientation, a technical choice that we ultimately decided was of most benefit to the transference/countertransference. I still believe the conclusion we came to was correct. But
sometimes I wonder: Had I retreated into my own adolescent trauma and deprived “Diana” (the pseudonym I gave the eighteen-year-old woman in my case presentation) of the possibility of feeling seen by a flesh-and-blood human being, not “the man behind the lamp,” as she called me? Perhaps Diana, like Farley, even needed to know she was admired, especially the parts of herself that she most hated?
There is a coda to my treatment with Diana that is not in the paper. She came back from time to time after the analysis ended, with progress in many areas of life. But the theme of feeling devalued and hopeless as a woman persisted. Though she was an accomplished singer, she felt categorically disempowered because she could not name a female vocalist she admired. At a certain point, I became exasperated with her constant complaints and I said, “What about Madonna?” She had heard of Madonna but had never seen a Madonna video. (I was suddenly confronted with a skull-crushing epiphany — Buddhism is right—nothing is permanent, not even Madonna videos.) To challenge her inconsolability, I told her to watch “Express Yourself.” The next session, Diana came back elated. “Madonna is right! I'm not going to settle for second best anymore,” and then, “You're gay, aren't you, Dr. B.?” It was several years after the part of our work where I had withheld disclosure of my sexual orientation. We both laughed as I shrugged, “yes.” This exchange began an exploration of images of powerful women and the determinants, both social and dynamic, that led to her inability to identify with these available models around her. I believe that my moment of transparency, of reacting to Diana, not just observing, was an important one in the evolution of her adult identity as a woman. She now has her own daughter and still emails me every time she goes to a Heart concert.
“Freud was ‘warm and empathie,’ not ‘blandly observant,’ and Freud did understand that social factors are implicated in our patients' suffering.”
Despite his frustration with Dr. R., Farley does not present her as a bigoted monster. In fact, it sounds like she was helpful at times, clarifying the significance of an earlier developmental event and strengthening a lifelong capacity for self-reflection. But the central theme of the treatment is of an adolescent who, like all adolescents—and all patients in one way or another—comes to treatment and first desperately needs to be seen, to be recognized, and, in that relational process, to be felt as loveable. In her silence, and her neutrality about Farley's sexual orientation, Dr. R. unfortunately created a space where socially conditioned self-hatred expanded, blocking out, not improving, the ability to reflect on this feeling.
Depeche Mode asserts, “Words are very unnecessary.” Like all analysts, I often sit and hold back the need to speak. This allows for the marvelous experience of something new and authentic emerging that neither I nor my patient would have found without “enjoying the silence.” For me, the challenging question is, how do we know when to go beyond observing without judgment—being merely cognizant of the injuries of the patient's particular social situation—to acknowledge that we analysts are not outside observers but also participants in the social and cultural moment we inhabit together? If only Dr. R. had acknowledged the danger of an identity that must be hidden for fear of violence, and the pain of an adolescent desire that will, mostly, not be returned.
It's hard to know how to strike this balance. As an end to the soundtrack, I hear the Psychedelic Furs' poignant musing, “Love my way, it's a new road. I follow where my mind goes.”
Our job is, of course, to follow where the mind goes, but we do need what Hans Loewald was brave enough to call “love.” This is warmth and empathy, but it is also a willingness to not merely observe, but also to demonstrate that we are walking alongside our patients, their way, on each new road we have the privilege to travel.
John Burton, MD, teaches psychoanalytic concepts to trainees in the Division of Child and Adolescent Psychiatry and the Center for Psychoanalytic Training and Research at Columbia University. He has a private practice in New York City with a special interest in psychoanalysis and psychedelics.