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?

The Psychotic Superego and God

This weekend I read Franco De Masi’s text Vulnerability to Psychosis. It’s an interesting object relations account of psychosis. In chapter six he addresses the relationship between the psychotic individual’s auditory hallucinations and the superego. The psychotic superego is often punitive, persecutory and excessively critical. Many individuals who have psychotic experience have command hallucinations such as “You should hurt yourself because you’re pure evil.” Interestingly, command hallucinations are particularly common for individuals who experienced serious childhood abuse. In this chapter De Masi draws a fascinating parallel between the God of the Book of the Job and the psychotic superego.

De Masi writes: “Blind with wrath and haughtily insistent on His right to dispose of His creatures as He sees fit, God hurls Himself upon Job and yells at this mere worm crawling in the dirt who dares to ask for explanations of His behavior. Before such an arrogant and narcissistically touchy God, Job appears as a desperate and devout person; the violence of his words against God is dictated more by exasperation that by rebellion. Everything would be assuaged if he would only understand the link between sin and punishment. The story of Job can, in my view, also be understood as the description of a relationship between the ego and the psychotic superego during the course of a psychotic breakdown, in which the protagonist, like my patient, finds himself expelled from the state of well-being and flung on to a dung-heap, a prey to a destructive and accusing voice…The psychotic patient is more like Job: he has to confront a threatening world that is out to annihilate and terrify him rather than to make him feel guilty. The God of Job demands subjection without even allowing him to understand the reason for the wrath and the origin of the sin: the patient in this phase therefore has to face not so much guilt as terror” (P 120-121).

De Masi then connects this experience with Klein’s understanding of the infant in the paranoid-schizoid position who attempts to negotiate the terrifying and chaotic world. At this stage, Klein understood the infant as trying to survive the annihilation anxiety generated by the infant’s powerful death drive. Bertram Karon has also described schizophrenia as a “chronic terror syndrome” where the patient is contending with horrifying realities that threaten their very existence. Job’s experience with the arbitrary and vengeful attitude of God parallels the psychotic individual’s experience with their auditory hallucinations. Often the psychotic individual is taken by complete surprise by the unpredictable and inexplicable ridicule of the menacing voices.

Bonus points for readers who can find other Biblical stories that nicely illustrate psychoanalytic principles.

ISPS-US Fourteenth Annual Meeting: What’s in a Name? Emerging Perspectives on the Intersection of “Schizophrenia” and “Recovery”

When: October 4-6, 2013
Where: The Hyatt Regency, New Brunswick, NJ

Keynote Speaker: Debra Lampshire
Experience-based expert, Senior Tutor at the University of Auckland, and Project Manager for Auckland District Health Board in New Zealand

Honorees: Marius Romme, MD, PhD and Sandra Escher, MPhil, PhD
Researchers, authors, founders of the International Hearing Voices Movement

ISPS (the International Society for Psychological and Social Approaches to Psychosis) recently changed its name to eliminate the word “schizophrenia,” based on a growing international consensus that the stigmatizing impact of the term far outweighs the limited validity of the construct. Our previous keynoter, Richard Bentall, PhD, has written persuasively that while there is scientific evidence for the existence of certain symptoms, there is no evidence for a unified “disease” called schizophrenia. Even one of the so-called hallmark features of schizophrenia – auditory hallucinations – has been called into question by traumatologists, who cite evidence that hearing voices is a common feature of PTSD and dissociative disorders. Professors Romme and Escher’s research shows that hearing voices is a common occurrence among patients and non-patients. Recovering voice hearer Ron Coleman has suggested that the phenomenon of “negative symptoms” is merely a description of people who are lost in their voice hearing experiences and too distracted or despondent to interact effectively with the outside world. Others have found that “negative symptoms” are the manifestation of profound depression and demoralization, which are also common experiences among those diagnosed with schizophrenia.

What is it that one is recovering from and what does it mean to be in recovery or recovered? Recovery has become a popular buzzword in mental health, but its definition is also controversial. For some it means living with symptoms; for others it means elimination of symptoms. Some use professional treatment including medication and consider themselves recovered because they lead highly functional lives. Others consider dependence on prescriptions and therapists as indicators that one is not yet fully recovered. Given that there are new challenges to ways of thinking about the experiences formerly defined as schizophrenic, it is time to reconsider what recovery from these experiences looks like.

Come, join us, and explore where interventions, research, and training in recovery are headed! Meet up with old friends and make new ones in New Brunswick, New Jersey (accessible by train from NYC and Philadelphia, and close to Newark Airport) to develop an appreciation for and engage in dialogues about the complex dynamics and forces that characterize and challenge recovery from psychosis. We welcome your proposal for papers or panel discussions, and seek contributions from psychiatrists, social workers, psychologists, occupational and art therapists, researchers, physicians, psychotherapists, case managers, rehabilitation specialists, nurses and nurse practitioners, peer counselors, consumers, survivors, students/early career professionals, and family members. Come and share your expertise, knowledge and experience. We are interested in integrative approaches that may include traditional psychotherapy and psychosocial interventions, as well as innovative methods being used to help people recover from psychotic conditions.

Jason Moehringer and I will be co-presenting a paper at the conference entitled “Psychosis, Defense and Recovery from a Psychodynamic Perspective”. Hope to see you there.

Cause and Effect in Modern Mental Healthcare

Jason Moheringer and I wrote this piece

For several years now, psychiatry, psychology, and the related mental health fields have been awaiting the release of the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) which is being published by the American Psychiatric Association later this month. This text forms the basis for diagnosis in mental health, as the DSM contains all of the diagnostic criteria, prognostic data, and treatment recommendations for each disorder. It strives to reflect the most up-to-date empirical and conceptual knowledge of mental illness and its many manifestations, and attempts to provide a foundation for consensus in the field.

Continue reading “Cause and Effect in Modern Mental Healthcare”

Winnicott Reading Group

We are looking for a member to join us for a reading group of Donald Winnicott’s work. We have spent the last five months making our way through Bion’s corpus (which was fascinating). We’ll likely be spending this spring and summer making our way through selected articles from Winnicott’s original texts (including Maturational Processes and the Facilitating Environment, Playing and Reality and Through Paediatrics to Psychoanalysis). Preferably, we would like someone with a clinical background or interest in clinical work. We will likely divide our readings into six sections: Attachment, Emotional Development, Theory, Creativity, Diagnosis/Therapy and Technique. Let me know if you’re interested.