Michael Brearley: Emotions brought to heal
Michael Brearley, former England cricket captain and now a psychoanalyst, begins a Society series by explaining how a typical analyst works.
Psychoanalysis seems a rum business. There are some obvious, visible oddities. Typically the patient lies on a couch, the analyst sitting behind her. In this country-contrary to the cartoons - he doesn't take notes. (For my purposes here the sex of analyst and patient is irrelevant.) He may well limit his gestures of sociability; a neutral and limited greeting when the patient comes and goes, a rather steady, quiet tone of voice, a stillness and unflappability. He rarely asks questions, or directly answers the patient's. He is silent about his life experiences. He will keep his consulting room relatively unchanged from day to day. The analyst keeps time, sticking precisely to the 50 minutes allotted. Thus, for four or five sessions a week, the patient is offered someone's uninterrupted attention.
Why is the analyst so self-effacing? And is this arrangement merely a ritual? I will return to these questions later.
First consider the content of the talk in this talking cure. The patient may well have been encouraged to say whatever comes into her mind. Certainly nothing verbal is ruled out. (Physical contact is ruled out). It is naturally hard to give a brief of a typical session (if there is such a thing) without caricature or arbitrary selection. However, caricatures not only send up, they also reveal, so I will take a risk and try to describe one typical feature of the psychoanalytic interaction: that many of analyst's remarks are about what the patient is feeling now, and in particular about what she makes of him and how she is treating him now.
For example, the patient talks about partings and loss, in her past or present life, in dreams or in stories. The analyst may suggest that she is more anxious about his impending holiday break than she allows herself to recognise. Or the analyst may comment on the emotional atmosphere evoked by the patient's manner and words, saying perhaps she wishes to create a highly-charged mood of intimacy with him; the last thing she wants is for the analyst to analyse it. Or again he may comment on the hurt and anger that his previous interpretation has aroused.
Not all the analyst's remarks will be of this kind, but a significant proportion will be (far more than in ordinary conversations). Why should this be so? Do analysts ignore the patient's real life, current or past? Are they unduly narcissistic? Of course such accusations may have weight. But they need not be true.
In fact the features of the analytic attitude which people sometimes find puzzling, and which they criticise are the very means by which patients can be helped to get closer to the reality of the anxieties attached inner emotional life.
To analyse, the analyst needs to be in touch with, and not shocked by or over-anxious about, whatever the patient brings. He will not be indifferent, nor emotionally distant. His task is not to offer sympathy, blame, or advice. He does need to be able to give himself room to think, and not get entangled. In everyday life, both parties to a relationship bring their own problems and idiosyncrasies. Sorting out what comes from whom is notoriously difficult, especially for the protagonists. So the analyst needs to be, in certain ways, unobtrusive. Only by this means is there a chance of a sufficiently uncontaminated field of enquiry. What's more, a relatively neutral analyst serves the function of providing a template by which the patient can more readily find in him whatever she is liable to find in significant others. But people not only see others in these personal ways (which derive from our versions of earlier figures in our lives), we also act on other people,- we nudge, press-gang or provoke them into various roles. For example, we may without being aware of it "invite" those who are close to us to punish us, or to pity us; to be sexually aroused by us, or to be turned off; to sympathise, joining us in blaming our partners, or to give us absolution for our breast-beating sinfulness. Such action is often as unconscious as are our pictures of others; the two processes play into each other.
All this helps explain, I think, the analyst's focus on the way the patient experiences him and impinges on him. In the microcosm of the sessions, the patient's unconscious and partly conscious distortions, vibrations and manipulations can with most immediacy and reliability be expressed and experienced; noticed and interpreted; and eventually fully owned by the patient. These elements of psychoanalysis do not constitute a ritual in any pejorative sense. Just the opposite. Through this strange process we can discover the core of our being, and then regain or gain it.
To return to my three sample interpretations: In the first the analyst is trying to show the patient that she is upset by his imminent absence and that this is difficult for her to recognise. There may be many personal reasons for this kind of unawareness about herself. The consequences too will be various. For example (second interpretation), one way of denying the reality of the anxieties attached to separation is to seduce the other or another into a cosy, mutually admiring and perhaps sexualised intimacy, whose aim is to avoid the discomfort and risks of hurt and hostile feelings. Such a mood serves as a cocoon from painful feelings of loneliness or depression.
However, anxiety or depression cannot be reliably evaded by such means. We may feel vaguely unfulfilled, or unaccountably panicky. That which is repressed returns, in symptoms, or in generalised dissatisfaction or "thinness" of emotional life- in any of the disabling conditions for which people seek and benefit from psychoanalytic treatment.
It is not for nothing that we have disavowed aspects of ourselves and that our resistance to self-knowledge is often so intense. Humankind cannot bear very much reality, and we which the analyst brings more or less unbearable. For psychoanalysis attempts to help us to face that which has been disowned, tracking it by its signs in moments of anxiety, hesitation, blandness, false cheerfulness - in any of the myriad ways we all use. Hence my third sample comment, that the patient doesn't like what the analyst has just told him. Hearing false accusations about ourselves is galling, but true observations about unwanted aspects of ourselves are if anything harder to take, or to take in. We often want to shoot the messenger, or to re-establish a comforting unity with him, anything but fully realise, and stay with the consequences of, this unwelcome knowledge.
Psychoanalysis is not, then, indulgent, tame or trivial. It is a means by which the suffering self can be radically changed and healed.
Michael Brearley is a member of the British Psychoanalytical Society.
Margot Waddell: When Great Minds Don't Think Alike
In the second part of this series Margot Waddell argues that Psychoanalysis is a living, changing field.
It is almost exactly 100 years - March 1896 - since Freud first applied the term "psychical analysis" to the treatment he was offering his disturbed patients. Within the next decade he was to publish two works that between them encompassed a new vision of human experience and reshaped the consciousness of the Western World: The Interpretation Of Dreams and The Three Essays On Sexuality.
Curiously, popular notions often end there - as if psychoanalysis were not only coterrninous with Freud, but with Freud minus the last 30 years of his working life. It is represented as a static, monolithic body of theory and practice, formulated a century ago in the mind of a Central European patriarch whose view was that sexual conflicts, hidden from the sufferers themselves, lay at the root of mental anguish. Much current prejudice stems from such ahistorical misapprehensions. What the following 90 years have made clear is that psychoanalysis is a living, developing field of study. Drawing on Freud's genius, it continues to evolve new models in the light of clinical experience and defies tidy definition. Freud constantly doubted, modified and reworked his own theories. Latterly his interest extended to problems of the composition of the self, but the main metaphor remained that of unearthing buried cities; the main model was a medical one,- curing symptoms; the main therapeutic method was reconstructive, with an air of the detective telling the patient what was on his or her unconscious mind,
The emphasis on the personality as a whole characterised the work with children that began in the 1920s and was to have so dramatic an impact on the theory and practice of psychoanalysis generally. The field was dominated by two Viennese women, Melanie Klein and Anna Freud. Both were concerned with developmental models and deficits in experience, and they shared a more forward than backward-looking emphasis. Yet while Anna Freud's position remained close to her father's, Klein's, by contrast, despite her locating it within the Freudian tradition, resulted in what amounted to a fundamental reframing of psychoanalytic thought. Drawing on her pioneering play technique with children, she stressed the pervasive force of infantile impulses in adult life and suggested that human development was less a matter of an evolutionary progress from one psychosexual stage to the next (Freud) than of different states of mind, each typified by particular anxieties and qualities of relationship.
Many of what to this day remain die-hard psychoanalytic shibboleths - most notoriously the male oriented concepts of penis envy and castration anxiety - lost their centrality, to be replaced by an extraordinarily rich and complex picture of the inner life of the young child. The mind became a kind of internal theatre, enacting the stuff of fairy tales. The individual was shaped from the very first less by biological drives than by relationships. Klein and others, -notably Fairbairn and Winnicott,- traced a crucial developmental shift from anxiety about self-survival to concern for others, emotional responsibility and a desire to repair. With the linking of development to ethical concerns and matters of value, psychoanalysis gradually became less instinct-bound and more interested in emotional life and meaning. It was with these ideas about the roles of infantile anxiety and environmental failure, later detectable in the symbolic arena of speech and play, that the ground was laid for the psychoanalytic understanding and treatment of psychotic processes (regarded by Freud as not amenable to psychoanalysis) and, more recently, of autistic and borderline states. Again clinical experience yielded new insights. The origin of these severe learning and developmental difficulties began to be located in very early disturbances of thought (Bion), of which the emotional determinants lay in the earliest unconscious exchanges and quality of care of the infant.
These changing theoretical psychoanalytic method. Analysts have become not so much detached experts as involved participants, reflecting on their own conscious and unconscious responses which then constitute less an interference (as Freud believed) than an indispensable part of the working method. Essential conflicts now tend to be formulated in terms of the predominance of different aspects of the self - the individuals struggle to become free of the deadening grip of narrow self-interest and open to the truthfulness of intimate relationships; able to have a mind of ones own and a respect for that of others.
The difficulty of the undertaking was
graphically expressed to his therapist by a six-year-old whose
appreciation of the help he was receiving was shadowed by the pain of it:
"I could kill you, Mrs D. I'm going to report you to the British
Government for making me think for the rest of my life".
Dr Lydgate's aspiration in George Eliot's
Middlemarch, that medicine be imbued with creative imagination, evokes
something intrinsic to the contemporary psychoanalytic endeavour;
Margot Waddell is an Associate Member of the British Psychoanalytical Society.
Sally Weintrobe: That old shrinking feeling
Just what is a psychoanalyst? In this third part of a Society series, Sally Weintrobe explains the shift in perspective since the early days for both patient and practitioner.
At present anyone can call him or herself a psychoanalyst and judging by what is written in the newspapers, frequently does. (but see uklist - Eds). So who and what is a psychoanalyst?
Mental health professionals in this country generally accept that a psychoanalyst is someone who has been clinically trained by the Institute of psychoanalysis, the training body of the British psychoAnalytical Society. Psychoanalysts are in the tradition pioneered by Freud. Modern-day Jungians call themselves Analytical Psychologists or Jungian analysts.
Psychoanalytic ideas have had a huge influence on the way many psychotherapists work. Sometimes the influence is a loose one; sometimes, as in the case of psychoanalytically oriented psychotherapists whose training is centrally based on ideas and methods from clinical psychoanalysis, the influence is more formal.
The psychoanalyst has become an icon - usually as a man, although just as likely these days to be a woman - of popular culture. The public has its own relationship with what the psychoanalyst is, quite separate from how the profession sees and defines itself. One place their relationship shows is in cartoons and jokes. Through humour we can focus and defuse our fear of finding ourselves in the vulnerable position of needing help with emotional problems and putting our trust in another person. In the world of the joke, the doctor is bound to let us die, the lawyer will certainly fleece us, and the psychoanalyst, along with the psychiatrist, will be a head shrinker.
"Shrinker" is an old word meaning someone who disavows the truth or diminishes the stature of a person.. Jokes about shrinks can be revealing of peoples ambivalence about gaining self-knowledge and looking at the truth about themselves. People tend to disown thoughts and feelings when they cause too much conflict or distress. "It's not we who are out of touch! It's the shrink!" We can locate in the psychoanalyst what we don't like to see in ourselves. We send her up and send her on her way.
What does the psychoanalyst look at in her work with the patient? By studying the particular ways in which the patient interacts with her in the relationship he forms with her, she hopes to gain an understanding of the difficulties that have brought him to analysis.
How has psychoanalysis evolved and changed since Freud? I think the biggest change that has taken place within psychoanalysis is one that was largely pioneered by British psychoanalysts. In earlier days the psychoanalyst tended to see her own inner responses to the patient primarily as a source of bias. She now recognises her inner responses as an important source of data, potentially very helpful to her in her attempts to understand the patent's underlying thoughts and feelings. Paradoxically the more psychoanalysts realise they are an inevitable part of what they study, the better chance they have to think clearly about what might belong to the patient.
I think this shift in perspective has influenced the way psychoanalysts write about their work. Of course what they say is bounded by confidentiality and this very much restricts the information they are able to give. How the psychoanalyst thinks about the patient and how she conveys the experience of being with the patient tends nowadays to be described in a way that is more easily understandable to the public. There is less abstract theory and more description of a relationship.
This is reassuring because the reader is in a better position to have a view of how the psychoanalyst thinks about the patient, is more able to agree, disagree and to consult his or her own intuitive knowledge of people and common sense about what the psychoanalyst is saying.
Because she is part of what she studies, it is important that the psychoanalyst takes very seriously the ongoing possibility that her inner reactions may stem from her own inner limitations and conflicts. There is always a potential for people to study the problems of others as a means of avoiding looking at their own problems. For this reason a basic requirement to be a psychoanalyst is to undergo a thorough personal psychoanalysis and this is an obligatory part of the training
In her work the psychoanalyst questions herself carefully about what she thinks she understands about the patient. She knows that what she thinks may not be right, and she also knows that, if the patient agrees with what she says, this may because the patient is being compliant. Psychoanalysis is a discipline and the psychoanalyst aims to try to help the patient with his problems by working with him in a disciplined, thoughtful way.
Sally Weintrobe is a Member of the British Psychoanalytical Society.
AN AVERAGELY INFORMED PERSON undergoing psychoanalytic therapy would soon find a number of their preconceptions challenged. Most of these would be personal, but some would be about psychoanalysis. They may well be initially surprised how little special interest the analyst takes in his or her sexual life treating it with no more attention than other aspects of life and personality. After all, isn't everything meant to be explainable by sex? Isn't that what Freud said?
One might assume that if sex as a topic doesn't arise, then the analyst is a Jungian. as it is common knowledge that Freud and Jung quarrelled about whether or not sexuality is central in the contents of the unconscious mind. But the analyst is as likely, and numerically more likely, to have trained within the Freudian tradition. Freud believed in "the instincts" as the prime movers of behaviour. He was inextricably involved in the assumptions of his Victorian bourgeois culture. Psychologically struggling with his patients, mainly women suffering from hysteria, to divine these suppressed instincts, the young neurologist prematurely concluded that they must all be sexual! With inclusive zeal he classified all neuroses under four headings,- two supposedly caused by sexual abuse in adult life, and two by child sexual abuse.
Hysterical symptoms were common in women in 19th century culture. In the context of the bitter sexual politics of the time, they functioned as a socially negotiated façade, covering anything from borderline madness to occasional whim. (Today hysteria is comparatively rare, but doctors are aware that it is still one of the common causes of psychiatric or neurological misdiagnosis). Freud found incestuous memories of childhood in all his patients.
He published his famous seduction theory,- that all hysteria is caused by child abuse. Nowadays we are aware that sexual abuse of children is more common than was previously thought, and hysteria will have been the outward expression for a number of such cases - but not all. It was the scale of incidence that made nonsense of Freuds theory to everyone. Humiliated, he retracted the theory. Freud realised that most of what he had mistaken for memories were fantasy - the stuff of any childhood. His exploration of this culminated in a universal unconscious narrative about mother, child and father,- the Oedipus complex, preparatory for adult life.
Regarding a special status for sex, by 1916 Freud was saying merely that "we accustom (our patients) to giving unprejudiced consideration to sexual matters no less than any others." However, with the public the early caricature stuck.
If sexuality did not prove central in the contents of the unconscious mind, well, neither has anything else. By 1913, when Freud and Jung quarrelled about whether or not infantile sexuality should be taken as the irreplaceable tenet - Jung preferred myth and symbolism - Adler had already made the claim for the "inferiority complex".
Since then there have been several such claims, for example biological adaptation; infant experience; the structure of language; self-experience. Each is put forward by a charismatic thinker and gathers a school of thought around it. There are quarrels and schisms. In fairness, the claims often arise to correct an old overemphasis and usefully explore previously neglected considerations. However, a centre to the content of "the innerworld" is proving as elusive to psychoanalysts as a centre to the content of outer space did to astronomers. In the numinous "space" of human experience, it may be the wrong kind of question. This is not to say that there is something about centrality itself that is alien to the work of therapeutic analysis. Patients will often spontaneously describe the improvement that therapy brings as having found, or refound their centre, or of feeling more centred.
There is something else, something about the centrality of which all analysts do agree. It is experiential and practical. When Freud and Jung first met in l907, they had a long private conversation. Freud is reputed to have asked Jung what he considered the single most important finding in the new field, and approved and agreed the reply. Jung had said nothing about either sex or symbolism. He said, "Its the transference". But that's another story.
Dennis Duncan was a psychiatrist who now practises as a psychoanalyst. He is a Member of the British Psychoanalytical Society, and a training analyst.
Eric Brenman: What is a psychoanalyst?
In this fifth part of the series Eric Brenman tells how analysis helps to bear the unbearable and think the unthinkable
FREUD regarded himself as a "conquistador." After the joy of discovery and the natural overvaluation of ideas that invariably accompany the "Eureka" phenomenon, he went back to the drawing board on his work with patients to get perspective. Here he also learned that many of his patients (and in varying degrees all of us) did not want to know - were resistant to knowing themselves and the outside world, past and present. These became important areas for study - the overvaluing of what one knew and thought one knew, the difficulty of bearing ignorance, and the powerful fear and avoidance of knowing and being known.
Consequently much of the work of later analysts became concerned with the process of the acquisition of the strength to bear knowing, and with the joys, fears, pains and relief of being known. Thus the insights and experiences which fortified the capacity to know and to experience life came to the fore. This came together with studying defences against the pain of bearing awareness, and the need for a relationship to help bear the unbearable and think the unthinkable. This development, together with knowing one's love, hate, jealousy envy, grievances and their damaging consequences, enables steps to be taken to deal with these issues, repair what man beings. This syndrome can be repaired, mourn what is lost and damaged and learn from these experiences.
The internalisation of this relationship between analyst and patient can provide the equipment and subsequent internal resource for future encounters. Life does not stand still and the equipment to cope with changing events and experiences is essential. This of course depends on the deepening and strengthening of the capacities of both the patient and the individual analyst, and the relationship over a period of time to enable these processes to be worked through.
This relationship and the understanding of it is at the heart of analysis. It forms the core which gathers past and present and enables differentiation. It is the area in which the passion of idealisation, denigration and possible collusion corrupt realistic awareness and therefore requires the most careful scrutiny and monitoring - to enable learning from this experience to take place. It is indeed this relationship which is so often, - and sometimes rightly,- the subject of criticism.
Some critics contend that analysts falsely claim to know everything, occupy the "guru" position, rob the analysands of their belief in their own capacities, creating a psychological equivalent of an imperial conquest, reducing subjects to unconditional surrender and demanding slavish devotion. These critics themselves appear to claim to be able to make purely intellectual judgements, unimpaired by emotional corruption. Analysts believe that these cannibalistic impulses to possess and own are inherent primitive forces (starting with His Majesty the Baby) that motivate human beings. This syndrome can be observed in wealth-seeking, wars, sexual conquests, racism, political beliefs, religious corruption, - often fuelled by a crusade of holy grievances.
It is the capacity to know about our primitive selves and to know of our human and truth-seeking values which conflict with them which offers hope of humanising our barbarism, modifying our behaviour and re-thinking our values - it is what maturation is all about. Whatever part environmental factors may play in helping or impairing our capacity to meet life, which indeed need to be understood, at the end of the day the most difficult and the most disturbing area is coming to terms with oneself.
Dealing with these issues by excessive claims to be all human understanding together with the disowning of cannibalistic ruthlessness and the projection of these primitive parts into others, leads to having to deal with an outside enemy which is then experienced as irremediable. Such cannibalisation of knowledge means that one has nothing to learn from another; even more dangerously the cannibalisation of moral supremacy leads to madness and cruelty in which there is a wish to exterminate alleged 'badness' to make the other as 'pure' as oneself. This may take place on an individual level, or worse still in monolithic organisations which live by the corruption of others to support this delusion and to remain officially 'sane'. Likewise the excessive projection of humanity and over valuation of others as 'Saints' leads to feelings of being an impoverished miserable sinner for whom there is no hope. Psychoanalytic findings have a considerable contribution to make in the understanding, bearing and integration of these phenomena. It is the detailed knowledge of these processes, along with the capacity to contain awareness, to be mindful of the corruption that disguises and seduces, that enables the analyst to help a person to understand why he cannot use common sense. Psychoanalysts are not alone in the belief that in understanding ourselves we will be more generously disposed to helping others, rather than making them 'diseased' outcasts. Then one is not only more truly in a position to put oneself in the shoes of the other, but one also has the opportunity to exercise choice and balance and to feel not so totally at the mercy of relentlessness. It may also provide access to the recognition of and the ability to reach toward the understanding capacity of the other - to replace the language of blame by the language of achievement.
Eric Brenman is a Psychoanalyst, a former president of the Psychoanalytical Society and a training analyst.
Neville Symington: What is a psychoanalyst?
Neville Symington concludes the Society series with this discussion of the essentials of psychoanalysis
As I write this article with focussed concentration I do not hear the plane flying overhead until my son draws my attention to it. Now I become conscious of something which I had been unconscious of. I was unconscious of the noise of the plane because my attention was focused upon the words in front of me. Once my son drew my attention to the noise then I hear it. Let us now consider another scenario.
Yesterday I was complaining about Ron because he is always making fun of his wife in a cruel way. The next day I tease my wife as she burns a stew in the saucepan. Just at that moment my son says to me, "You're just as bad as Ron. Yesterday you were complaining about him because of the way he makes fun of his wife and to-day you are doing exactly the same". I squirm and am just about to abuse him when I get a grip of myself and smile at him wryly.
When he points out to me the noise of the plane I receive the information benignly. When he points out my contradictory behaviour I become emotionally heated. In the first case he points to something outside of myself which I had not noticed. In the second case he draws attention to my own emotional behaviour. In both cases until my son's intervention I had not been conscious of the event but whereas in the former I receive the information with equanimity, in the latter I react by trying to repudiate it and push it away.
Freud noted the difference between two such unconscious events and named the first preconscious and the second unconscious. He also noted that people did not like it when unconscious events were brought to their notice. In everyday gossip I frequently say things like the following, 'Rosemary is incredibly jealous. I feel sorry for her husband'; or, 'Tom is so envious that he does all he can to stop his colleagues from flourishing'; or, 'Joseph is so mean-minded it cripples his perception of life'.
My sharp eyes are all too ready to make such judgements about others but am I able to say of myself that I am incredibly jealous, extremely envious or very mean-minded? Yet emotionally I act in such ways that earn those judgments and sometimes they are lucidly obvious to others and yet my eyes are blind when it comes to myself. If I hit someone with my fist I know that I have hit him. If I act emotionally in a sadistic way I do not know it, or I am likely not to know it. If I act emotionally in a way that could be described as vicious, whether it be sadistic, jealous, envious, or mean-minded, it is likely that I will not know it. I actively prevent myself from knowing that I act in such ways. I construct an unconscious veil which then presides over the arena where I play out my emotionally vicious acts. (Freud called this active prevention of self-knowledge resistance.) I may be so frightened of knowing these dark inner deeds that it prevents me also from knowing my acts of love. It is this area of unawareness that Freud called the unconscious. In a truculent mood I might say I am quite free to act in an emotionally vicious way if I want. I can, in the sense that no one can stop me but Freud made a startling discovery. He found that the source of neurosis and psychosis lies precisely in my emotionally vicious activity and in my active resistance to knowing it. Looking at it in reverse Freud made the revolutionary discovery that self-knowledge lies at the root of mental health. Freud stumbled upon this truth almost by accident. In trying to discover the origins of neurotic symptoms in his patients he found they were caused by resistance to knowing their own vicious acts. In his classic book The Interpretation of Dreams he gives numerous examples where he was able to trace a neurotic symptom back to an emotional wish of which the patient had been unaware. Many of the dreams in that book were his own and by scrutinising them he became aware of his own resistance to self-knowledge in several areas of his mental life. The book is a record of his personal growth in self- knowledge. Patients come to the analyst because they are suffering emotional distress. It is a principle of psychoanalysis that this suffering finds its origin in our emotional resistance to self- knowledge. As self-knowledge is filled with sadness, regret, guilt and pain we all need great strength in order to bear it. The analyst helps the patient to bear it. Self-knowledge also leads the patient to reduce his emotionally vicious behaviour and open his psyche to creative loving acts. Its goal is to help patients know themselves and become more loving. Our conclusion has to be that an effective analysis enables someone to become a creative and giving person. That we frequently fail to achieve such an outcome is a function of the human condition.
Neville Symington is a member of the British Psychoanalytical Society, and is currently residing in Australia.
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