Identity, PTSD, and Trigger Warnings

I am in the middle of a research project right now on the history of psychoanalytic psychological testing. I am taking a broadly historical perspective on the evolution of theories of psychoanalysis and the ways in which our theories of development and psychopathology are mediated by the psychologist’s absorption in the sociocultural milieu. One of my guiding ideas is that individuals who are designated as mentally ill often reveal the dark underside of culture, as they are essentially the casualties of our sociocultural system. After all, built into the very definition of mental disorders in the DSM-5 is the requirement that the ‘mental disorder’ prevents the individuals from adequately functioning according to the standards of the day.

This has led to me try to begin thinking about the current times. A couple of things have jumped out at me in my research. First, I have been trying to come to terms with the emerging trend over the last years for people to be described as “empty”. Now, this idea has always puzzled me. How can a self be empty? What does it mean when individuals seek out psychological treatment citing emptiness as a major symptom? Does emptiness convey a desperate hunger? Does it suggest that the subject hates what s/he sees and thus reports feeling empty, i.e. is emptiness defensive? Does emptiness adequately capture the person’s internal experience? There are many cultural critics who have attempted to address this idea. Philip Cushman has written a cultural history of psychotherapy in the US and has noted the economic underpinnings of emptiness and the ways in which people turn to consumer capitalism to ‘fill up’ this void. Others such as Christopher Lasch decried the terrible narcissism of the 1970’s with its purported obsession with inner discovery. This afternoon I have been reading Lunbeck’s latest text The Americanization of Narcissism, and she casts a critical eye towards to these jeremiad condemnations of the modern American subject. She rightly points out that every younger generation is condemned by the older generation as being spoiled, hedonistic, self-absorbed, etc.

So, I began to think more about what is the current diagnosis of my generation (as someone who is 28). Well, enter the new Atlantic article on the coddling of the American mind (http://www.theatlantic.com/magazine/archive/2015/09/the-coddling-of-the-american-mind/399356/). I assume many of you read it. In it we encounter a long-winded somewhat whining criticism of the current university student in the United States. I want to address some of the issues laid out in the article.

On a broader cultural level, the trigger warning issue suggests to me that our generation’s is trying to address issues of validation, shame, and aggression. Part of the notion of trigger warning is that Person A exposes Person B to phenomena C that ‘triggers’ unpleasant reaction D in Person B. One of the problematic aspects underlying the concept is that Person B’s unpleasant reaction D is wholly created by Person A exposing Person B to phenomena C. It is as if you push a button in Person B then it is your fault for whatever reaction it generates. It strips Person B of agency, decision, or reflection, rendering Person B a machine that is simply activated whenever the controls are adjusted in a certain way. What is fascinating to me is that it is based upon a PTSD-based notion of subjectivity. In other words, a person’s sense of self is organized around certain traumatic events that s/he need to be utterly shielded from stimuli that threaten to fragment the integrity of the self.

Implicit in this notion is a prescription for moralistic behavior (i.e. since we all carry around unresolved issues that can easily be set-off if the individual is exposed to unfavorable circumstances then you should tread lightly). It leads to deep anxiety and undue guilt in Person A, as if Person A is wholly responsible (and thus guilty) for whatever reaction Person B experiences. I hear this type of discourse at my work in a psychiatric hospital. Generally, we hear about how some patient has triggered another patient. The person who has been triggered (traumatized?) then attempts to exert a level of control over others by warning people about this vulnerability. It is based on the notion that someone should never be triggered, as if the person’s vulnerability is everyone else’s responsibility. I think what I am trying to say is that the agency and responsibility of the subject is being undermined with the PTSD-model of subjectivity.

At the same time, I think there are reasons to be critical of the Atlantic article. For instance, the notion that our generation is being coddled (intellectually) while we are being destroyed financially through the overpricing of advanced education seems suspect to me. Furthermore, I think many politically active students have pointed out the particular examples highlighted in the article are skewed in a certain direction. The article generally portrays students as excessively irrational and hypersensitive. The recent racial issues on campuses from Missouri to Yale highlighted these issues. In some examples, the media depicts the students as needlessly sensitive or alternatively as being subjected to intense discrimination. Also, the idea of prescribing to students ‘cognitive behavior therapy’ to make them more rational seems woefully naïve and stupid, almost like thought policing college freshmen. College is about being offended and learning from one another. I am not currently in a university, having graduated two years ago with my doctorate in psychology. I am curious what others thought (both students and professors) about this article. I am personally trying to understand what is going on psychologically and sociologically with the ways in which identity is being expressed and shaped in our current cultural moment. I would also appreciate any suggested readings people have.

On Finding a Place in History

One of the major discoveries I have had in my personal analysis has been the importance of history on my religious and psychological development. Growing up in a conservative Evangelical family in the South left me in an historical black hole. Like many Evangelicals, my parents rebelled against their (non)religious upbringings and created a new family culture ex nihilo in the early 1970’s during the Vietnam War. This is not particularly surprising given that both my parents emerged from unhealthy households with parents who were grossly incompetent. Evangelicalism offered them a sense of community, security and identity in a world that was being torn asunder by war, political strife and social upheaval. Continue reading “On Finding a Place in History”

Conference Presentation at APA’s Division of Psychoanalysis (39)

I’ll be in New York at the end of April presenting at Division 39’s annual spring conference. This year the topic of the conference is Conflict and the dates are April 23-27. I’ll be chairing a panel on April 25th entitled: Childhood Sexual Abuse and Conflicts: The Traumatic Sequelae. I’ll be presenting an individual paper as well that I’ve entitled Pathological Caretaking: Changing Object Relations for Adult Survivors of Childhood Sexual Abuse. Here’s the abstract.

Childhood sexual abuse (CSA) warps the individual’s sense of self and object relations. Adult survivors of CSA internalize a sense of badness and guilt that makes their very existence seem criminal (Ferenczi, 1933), contributing to their belief that they deserve punishment and mistreatment. These internalizations inhibit their ability to form healthy and satisfying relationships. They are severely anxious about attachment and are often counterdependent due to their mistrust of others. They often initiate relationships in which they assume a pathological caretaking role, excessively devoted to partners who can be needy, immature, narcissistic and sadistic. These relationships allow them to disavow their dependency needs and yet still have them vicariously met by taking care of a needy other. In this paper, I will analyze these relational patterns that I have termed pathological caretaking, in which the survivor empties himself of desire (Ehrenberg, 1992), choosing to elevate the needs of the other. Also, I will focus on the ways in which these childhood traumas lead to personality-fragmentation (Ferenczi, 1933) and to the erasure of the true self and the creation of a false self (Winnicott, 1960). Furthermore, I will highlight from my own clinical work how I have used a Lacanian (Lacan 2006) focus on desire to destabilize the fixed relational patterns that render these individuals vulnerable to future victimization.

Reflections on the State of Public Mental Health Treatment

As my year-long intenship is wrapping up at a public community mental health clinic, I thought it would be an appropriate time to offer some reflections about the quality of mental health care people are receiving in this country. Starting in two weeks I’ll be transitioning to begin a post-doc at a private psychiatric hospital. The transition will be quite an adjustment. Currently, the majority of the patients I am seeing are on Medicaid or Medicare. Many of them are also being treated by psychiatrists for “medication management” and some are also in a community psychiatric program where they are paired with a community support specialist who attempts to promote the patient’s adjustment to the community by providing resources. The critiques I will lay out on this post are not directed towards any of the social workers, psychologists or psychiatrists who valiantly provide mental health care to the severely “mentally ill” who are serviced in community mental health clinics (CMHCs). These workers are vastly underpaid and unappreciated. The pay that psychologists receive is a complete insult. Of course, the pay is dictated by Medicaid’s cheap reimbursement for psychotherapy and psychological testing. Many psychologists opt to go into private practice or enter private hospitals or clinics where they are more adequately compensated for their services. Along with the wonderful training I will be receiving during my post-doc, the benefits and pay certainly played a significant role in my reluctant decision to transition from a public to private setting.

First, psychotherapy is undervalued and disrespected. Continue reading “Reflections on the State of Public Mental Health Treatment”

Radical Theology-Lite

I recently posted this comment in response to this blog post. Thought it might of interest to some readers. Note, this an edited version of my comment:

I really wish you guys would stop using the term ‘radical theology’. You have invented an entirely new genealogy of radical theology (Hegel, Tillich, Derrida and Caputo). Arguably, only Hegel belongs upon that mountain. Neither Derrida nor Caputo are proper theologians. Moreover, you’ve also enshrined Tillich, the liberal theologian, par excellence. Why is Altizer curiously omitted? In reality, what is being offered here is radical theology-lite. In this genealogy of this new tradition of radical theology-lite we are really getting a liberal theology that is in denial about its roots. Not that there’s anything wrong with liberal theology. There’s a lot of good ideas in the history of liberal theology. It is my contention that the reason why many emergent do not simply accept that they are liberal theologians is that they have bought into evangelical propaganda regarding liberal theology. Due to the fact that many people who are part of the emergent-radical camp are disaffected evangelicals, they simply cannot accept liberal theology and the mainline church. As a result, new words were made up that attempt to outdo liberal theology (see progressive, radical, incarnational, or emergent). Notice that “liberal” is always a dirty word in these circles. Liberal theology is always the convenient strawman that is created to make the new “third way” appear categorically distinct from its conservative and liberal brethren. I find the caricature of liberal theology that is operative in the discourse at Homebrewed Christianity unacceptable. In many ways, liberal theology is consonant with the radical theology-lite values laid out here: pluralism, humility, belief with doubt, an appreciation of symbolic language and political.

In response to the Subverting the Norm II Conference, Tony Jones wrote, “There are two types of radical theologians: those who want there to be a God, and those who don’t.” He is mistaken. I would argue that there is only one radical theologian and that is the one who rejects God. I was first introduced to radical theology by reading Altizer. What made Altizer, Hamilton and others radical is that they were Christian atheists. That was actually radical and Altizer grounded his atheism through a strange reading of Hegel, Blake and Milton. He didn’t equivocate with all of this postmodern posturing about language, mystery and the unknown. Radical theology was ontological.

I am curious about what is driving this rapid need to appropriate the term “radical”. It is overused in modern theology (see radical orthodoxy, radical theology, “ordinary radicals”). I am almost tempted to say that radical is an empty signifier that simply designates something as “cool”. Is this just another effort in the endless re-branding on the theological market? Is radical theology-lite simply the left-wing of emergent movement trying to buck its more conservative followers? What made the time right for someone like Caputo (upon whom this movement is clearly dependent) to capture the attention of theologians? I almost think that the desire to brand this theology as “radical” is a way to push actual radical theologians out of the market. Isn’t it bizarre that Tony Jones would act as if there are some bad radical theologians out there who don’t want to believe in God? For God’s sake, the whole point of radical theology was to proclaim the death of God! Translating that into radical theology-lite terms, we have this warped notion of Lacan’s Big Other that now is basically another way for the believer to disabuse himself of a false idol. The Big Other is bad. The God who is beyond the Big Other (who is insisting in the event) is good. It is only through ridding one’s self of the Big Other (which is possible?) that one can arrive at a purer, more “real” conception of God. The irony being that the very need to find a God beyond the Big Other in and of itself is a sign that the Big Other is still operative in the ideology grounding this theology.

CHANGE: Social-Psychoanalytic Perspectives Conference Announcement

The Association for the Psychoanalysis of Culture and Society (APCS) is hosting its 2013 Annual Conference at Rutgers University Continuing Education Center, New Brunswick, NJ from November 1-2, 2013.

This conference takes up the issue of change from a social-psychoanalytic perspective: change in our bodies, our minds, our ways of being, our forms of communication, our social structures, and our values.

We seek proposals that investigate what psychoanalysis—in both its theoretical and applied forms—can offer for a better understanding of the meanings, process, and effects of change. Please think broadly about these issues from your own discipline, and consider proposing interdisciplinary conversations that discuss these issues across disciplines, or that invite commentary from a different discipline. Consider, for example, the following:

Continue reading “CHANGE: Social-Psychoanalytic Perspectives Conference Announcement”

On Being a Psychologist

As a psychologist/psychotherapist, I have always found it fascinating the ways in which strangers react whenever I inform them that I’m a psychologist. To avoid awkwardness, I know many psychologists lie about their profession to total strangers. It is interesting to note the ways in which strangers respond to my disclosure. I also think it opens up a window into the ways in which Americans thinks about psychotherapy.

One of the major responses I hear from people is “well, we’re all a little crazy, right?” Cue the nervous laughter. In these moments, the stranger is often dreading some sort of mini psychological evaluation and attempting to avoid my (fantasized) all-seeing eye by demanding that I give him/her a clean bill of health. Here I am being placed in the position of the subject supposed to know. Continue reading “On Being a Psychologist”

The Subject-Supposed-to-be-Awkward and Group Dynamics

(Note this is an updated post that I wrote years ago on my personal blog. I’ve expanded the original post and it is worth the re-read.)

In Seminar XI, Lacan argued that whenever the subject who is supposed to know (SSK) exists then so will transference. The typical neurotic patient will grant the analyst his trust, and thus allow him to assume this position of knowledge. Furthermore, as soon as the analyst is the positioned as the SSK, “he is also supposed to set in search of unconscious desire” (Four Fundamental Concepts, p. 235). The patient comes into analysis assuming that the analyst has some sort of understanding of his symptoms. Of course, this is untrue. Psychoanalysts are not mediums and have no special intuitive capacities. This belief of the patient is the very thing that often motivates him to enter analysis. The patient interprets the analyst’s interventions as information from the SSK, sometimes granting the analyst omniscient powers.

I’ve been thinking more about Lacan and the way we sometimes attribute certain characteristics to different people (e.g the analyst as the SSK). In social groups, especially group therapy, it is very common that a scapegoat emerges. Generally, this person sticks out in the group as being different and thus worthy of hate. The group tends to project their hatred onto this individual and treats this contaminated group member as a “leper” who must be kept at a distance. Inevitably, the group turns against this one person and alienates the person from the group. Scapegoating is a universal phenomena and it can take many forms. Continue reading “The Subject-Supposed-to-be-Awkward and Group Dynamics”

The Repression of Sexuality in Contemporary American Psychoanalysis

Two weeks ago I had the pleasure of reading Conci’s biography of Harry Stack Sullivan entitled Sullivan Revisited – Life and Work: Harry Stack Sullivan’s Relevance for Contemporary Psychiatry, Psychotherapy and Psychoanalysis. It’s a wonderful work that contextualizes the radical innovation of Sullivan’s contribution to interpersonal psychoanalysis. Sullivan is the grandfather of contemporary American psychoanalysis and Stephen Mitchell recognized his work as foundational to the contemporary movement. Sullivan began his work at Washington DC’s storied St. Elizabeths Hospital. He then went on to work at Sheppard Pratt Hospital, outside of Baltimore. While at Pratt, he began a therapeutic wing for young male psychotics who recently had psychotic breakdowns. He collaborated and influenced Frieda Fromm-Reichmann’s work at Chestnut Lodge, a hospital located in the DC suburbs (in Rockville, MD).

What was interesting about Conci’s story about Sullivan’s theoretical and therapeutic innovations was the ways in which he re-worked psychoanalytic theory. Although he relied heavily on Freud’s notion of transference (which he re-named) and had an appreciation of unconscious processes, Sullivan was innovative in stressing the social nature of human beings. Sullivan (like many other early dissenters such as Fromm, Thompson, Fromm-Reichmann, etc) argued that Freud had overemphasized the sexual in human nature. Sullivan also collaborated with many social scientists, believing that the cultural and political background greatly informs the ways in which society understands mental illness.

Although I greatly appreciate Sullivan’s contribution to the theory and treatment of schizophrenia (along with the other notables in the interpersonalist tradition such as Fromm-Reichmann and Searles), I was astounded to find how quickly these psychoanalysts dropped sexuality from their theory. Continue reading “The Repression of Sexuality in Contemporary American Psychoanalysis”

Repetition and Remembering – Thoughts on the Season Finale of Mad Men

1) The Bar Scene – During this scene, I really worried Don was going to have a conversion experience to Xianity. Instead, he punched the minister for offering him salvation and for damning JFK and MLK (although apparently Don was OK with Nixon). While Weiner draws our attention to another memory of Don’s life with the condemning minister, another idea came to mind. As Don is once again coping with his emptiness through alcohol, this minister attempts to offer him the ultimate escape: the fantasy of a redeemed past. Don rejects this illusion and beats the hell out of him. The past cannot be changed. Dangling the carrot of redemption in front of a broken man is torturous.

2) California – As usual, Don attempts to deal with conflicts and problems by wanting to run away. He hopes to escape the ennui of his existence and his frustration with his marriage and children. Given that he and Megan had good experiences in CA, Don believes he can magically save his marriage and himself through a change of scenery. Perhaps this represents Don’s attempt to reconnect with Dick Whitman who was only ever himself with Anna in CA. Of course, there is no holiday from one’s self. This becomes apparent in Don’s next major scene.

3) Hershey’s – After presenting his typical sentimental pitch to Hershey’s of an imagined childhood that he never experienced, Don begins to have a tremor in his hand. While everyone appeared satisfied with his presentation, Don cannot contain the repressed truth that is demanding to be spoken. He confesses his truth. He was an orphan raised in a whorehouse, neglected by his mother. He only obtained Hershey’s chocolate bars by stealing change from men who rented prostitutes. He then engaged in some ritual wherein he imagined (probably dissociated) having a life where he was wanted and loved. He fantasized about a life where things were sweet rather than bitter.

4) The Final Scene – Now that Don is being given an unspecified holiday, he decides to continue down the path of his own redemption. My friend reminded me earlier tonight that Sally had previously said that to Don, “I know nothing about you.” Don has decided to finally open up to his children about his past. He came from poverty and the “bad side of town”.

Analysis: In these movements of the episode, we see that Don is continuing to confront themes of redemption. In the first scene, Don violently rejects the myth of the redeemed past. He knows this is cheap. As is typical, Don imagines that he can only be saved by fleeing to CA and hiding. This reminded me of Freud’s (1914) beautiful paper “Recollection, Repetition, and Working Through” in which he argues that repetition is a defense against remembering (past traumas). Don’s entire life has been a series of repetitions of the same scenarios: impress, seduce, self-destruct and hide. CA would be another way to repeat the cycle. However, it would simply represent another attempt to avoid remembering, recollecting, and integrating the past traumas. Don’s salvation will only come through remembering and being honest about the horrors and suffering of his childhood. Moreover, Don will only receive grace by coming to terms with his own sins and confessing them to the people he loves, especially his children. No God can save him, however. Only through recollecting and mourning the difficulties of his past can he hope to live a life full of integrity, wholeness and honesty. This final scene represents the first steps of Don trying to be honest. Perhaps he will not survive this exploration of the past (many trauma survivors suicide during this painful phase). The number of repressed memories that resurfaced this season indicates that his unconscious demands to have a voice. The return of the repressed must be dealt with and alcohol cannot silence the truth of his history. Can Don survive the final season?