Minding the Body and Embodying the Mind
Introduction for Conference: JUNE 2-4, 2001
Psychoanalysis in the twentieth century progressed from its modest beginnings to, by mid-century, the promise that it could be our panacea, then spent the second half of the century recovering from that hubris. Emerging from a self-containing optimism, psychoanalysts have been, not without reservations, rediscovering biology and the brain. These tidal shifts are the macrocosmic view of my own professional life.
When, finishing up medical school, I was applying for my residency training in psychiatry, I recall (and this is a memory that sadly I can’t forget, or repress, or even dissociate) saying to an interviewer who was asking me why I wanted the training, that I thought I understood what people’s problems were all about, and that I just needed help in finding the best way to tell them. I feel that, since then, my career has been a steady procession toward ignorance. But my self-assurance in those early days wasn’t so different from the sort of self-righteous master-of-the-universe declaiming we find in Freud’s case writing. In those early days of clinical psychoanalysis (in contrast to the earlier days of his neurological interests) Freud had as few self-doubts or uncertainties as I did – he spiritedly dispatched his patients each hour with tidily packaged interpretations.
I remember the day, perhaps five years into practicing, when, after the last patient left, I recorded the main theme of each session I’d conducted and dis¬covered to my great pleasure that they were all different. This was distinct progress from an earlier time when they would have all been the same, and not only that, when they would all have been versions of what my analyst had said to me that day, a time when I unconsciously understood all my patients to be versions of me. Furthermore, the behavioral manipulations of my early training were by now far behind me, and I had taken the vows of my hermeneutic voca¬tion. It also should be said that I continued to share Freud’s early optimism, not to mention my supervisors’ convictions, that patients could be made well by correct interpretations, and that their failure to improve reflected primarily my failure to, as yet, understand them. I did medicate the occasional patient who had a major mental illness but that took place in some other part of my mind, a vestigial residency-training compartment.
Over the years Freud lost his optimism about the psychoanalytic cure: he’d had time to see patients relapse, in spite of his best efforts some couldn’t be helped. I don’t think that he ever found an explanation that satisfied him for his patients’ tendencies to repeat insistently their self-defeating ways of behaving. Freud declared some territories impenetrable bedrock, most famously to the dismay of women. But even that particular bedrock (penis envy), although based on an organic given, was still a question of understandings, of the meanings attributed to that which was innate. Nonetheless, for Freud, insofar as the prac¬titioner was to be of any use, mind would have to triumph over matter.
My own shift in expectations may have begun with my experience of my two analyses. Both treatments were very useful, albeit in very different ways. Looking back on it, I would say that analysis has given me both more and less than I’d anticipated – more than I’d expected, and less than I’d hoped for. I think that my patients, at least those I’ve been of use to, have felt pretty much the same in this regard. On the plus side, I’ve helped some patients both to feel better and to feel better about themselves, and in that context to be able to make life choices that advanced their interests. In these regards it might be said that I’m not so different from Prozac at its best and hopefully without the anorgasmia. I also think that my patients usually finish treatment with a different understand¬ing of themselves, a different take on who they are and what’s made them that way, a fresh accounting in some regards, a self seen anew by virtue of having been refracted in our relationship – and all this may happen without the patient in any other sense changing, although it is also possible that the patient may feel radically altered. On the negative side, I don’t think I’ve had much success at altering character, even at budging character trends that are radically self-inter¬fering. Overall, I don’t imagine that I’m much different than the majority of my colleagues in the account I’ve just given – these goals and limitations now seem to me intrinsic to the treatment process.
In my darker moments (which I consider my honest moments) I believe that at least I’ve engaged my patient in an honest conversation, which has com¬pelling value in its own right. I’ve thought that the single greatest value of a sus¬tained treatment is not the confessions made, the feeling of having been under¬stood, the feeling of having been loved, the life events reconstructed, the enact¬ments deconstructed, the interpretations made – although all of these can be useful. The greatest value, I now think, is the experience of an intense unforgiv¬ing struggle with another person toward meaning. That seems far more impor¬tant to me than the particular theoretical framework that the analyst favors. It’s what Roger Angell said about baseball, that baseball is all about dailyness, pick¬ing up your glove and bat yet again and going out to give it your all, on days when you feel great and on days when you’re hung over, knowing that the differ¬ence between the guy hitting .330 and the guy batting .230 is just one more hit out of every ten at-bats, and going out and doing your best anyway. Doing analy¬sis is dailyness for two.
But there are times, actually very long times with some patients, when I can’t even reach this sense of a conversation well-had, and there are other times when even sustaining this dialogue I’ve just described feels way short of being enough. Seeing some patients continue over the years to undermine themselves, to deprive themselves of life’s pleasures, to treat themselves and others badly, to be so ineffectual, to be in such pain, so at the mercy of themselves, can leave me feeling helpless, or stymied, or angry, or can drive me to a defeated withdrawal. Limiting myself to more modest treatment ambitions isn’t always a satisfactory solution. Nor is self-blame. I actually think that at a certain point the analyst’s self-blame (“I haven’t gotten it right just yet”) is a manic defense against bearing the truth that there are matters way beyond our control. So what’s a fellow to do?
Psychoanalytic work has always been about meanings. While we are curious about feelings and desires, affects and motivations, they interest us because they point to meanings. We can’t make the sadness or craving dissolve, but we can try to understand it. Interpretation, which is still our industrial-strength intervention, is an attempt at translation, explanation. Over the recent decades our field has generally come to believe that there are powerful forces operating in the analytic situation outside of awareness and interpretation that may be the most crucial elements for the therapeutic outcome. But managing those aspects, insofar as they can be managed at all, has been mainly left to the ana¬lyst’s intuition, and our thinking, even about such charged matters as enactment and countertransference, has been about their meanings. While the self psychologists certainly have an agenda that focuses on the qualities of the therapeutic relationship, I imagine that in an hour of self psychology supervision the attention would still be on what the patient and analyst made of each other’s words. Of course there have always been exceptions. A supervisor once told me that a supervisor of his once said to him, “It would really have been best if just then instead of being so busy with the patient you’d been more preoccupied with what you were putting on tonight’s grocery shopping list.” My supervisor wasn’t telling me this just to gossip.
Our guest speakers this weekend are all encouraging us in two ways. One on the one hand, they’re giving us more to think about, ideas about attachment and memory and trauma and dreaming, to name a few areas of interest. The more possibilities we know about, the more richly we can construct meaning. So that’s the hermeneutic dimension. But on the other hand, they’re challenging us to move beyond our hermetic absorption in meanings, to find more space in the shopping cart. Or, to think about it as a different sort of cart. Drs. Pally, Suomi, and van der Kolk will all be prompting us to move beyond the verbal aspects of the analytic situation. All three are interested, among other things, in the impact of attachment encounters on development, on the ways in which attachment processes underlie adult experiencing, and on the impact of disrupted or violat¬ed attachment on subsequent functioning in relationships. At the risk of stating the obvious, even in the area of preverbal attachment, we’re, of course, still thinking about meanings, but we’re not only thinking about meanings. I think that it might make for an interesting analytic hour if I paid attention only to my state of attunedness with my patient during the session. Thinking about attach¬ment, Dr. Suomi might agree with this recasting of Harry Stack Sullivan’s dictum that we are more human than otherwise: we are more primate than otherwise.
Consistent with its focus on meanings, analysis has always been about memory; I imagine that we’d think twice about trying to treat a globally amnestic patient psychoanalytically. Apart from considerations of normal infantile amnesia, we’ve for the most part tended to view the problem of memory monolithically, as a challenge to bring matters into consciousness. Dr. van der Kolk, working from his studies on the impact of trauma, and Dr. Westen, attending to what we can learn from cognitive neuroscience, complicate this picture and destabilize our reassuring assumptions about access to the past, even about the nature of remembering itself.
Drs. Solms, Pally, and Westen are specifically interested in protecting the accumulated wisdom of psychoanalysis and finding meaningful links to the research findings of neuroscience. I think that for all three the task isn’t to find the correct explanation for a phenomenon, to choose between competing neu-robiological and psychoanalytic metapsychological propositions on how a partic¬ular thing works. They all seem interested in how an understanding from one discipline can lead to finding deeper truths in another area. That’s a particularly important quality because we seem increasingly to be living in either-or times, and I don’t simply mean the either-or of Paxil versus psychotherapy, but also the deeper either-or captured in such notions as that Paxil does one thing for the patient and psychotherapy does something essentially different. Dr. Solms’s project of rescuing dreaming for psychoanalysis seems in part a response to the efforts of dream neuropsychology during the past two decades to reduce dreaming to mindless brainstem activity which the forebrain simply tries to make the best of.
These developments in our field come at an interesting time. As a people, we seem less interested nowadays in history, more attuned to process, to interac¬tion. This occurs at all sorts of levels – on the one hand, in the consulting room where we are more tuned-in to the vicissitudes of intersubjective process, and on another hand in the dialogues of this weekend’s conference. I was writing this on Memorial Day weekend in the context of the movie “Pearl Harbor” having just opened. We seem to have a nostalgia for a time when history mattered more, a time when dying in wars seemed more meaningful, when we cared about political causes, when Senator Jeffords’s action (changing parties) did not seem an anachronism. But we also contemplate what we’ll do with our new tax refunds and await the Sony Play Station version of “Pearl Harbor”. Nonetheless you’ve all chosen to forego what might have been a leisurely weekend at the beach to engage with us in conversations that matter. Analysts above all know that the choice is not between remembering and interacting, between the brain as body and the brain as mind. Let us break thought together.