n e w s , a n a l y s i s , o p i n i o n f o r t h e psychoanalytic c o m m u n i t y i s s u e 20 SPRING 2016

Thinking Time to Training Societal about get out of and the collapse retirement our heads psychiatric 4 6 10placement 16 Similarly, the fascist leader, as described or reflection. Since the analysts or in ‘Freudian Theory and the Pattern of psychoanalytically informed theorists are Fascist Propaganda’, is distinguished from part of the same society in which these The social the followers in expressing more freely meanings are embedded, and in which the drives which incite the member of the many of the same things are taken for crowd to follow, in being less inhibited granted and remain unquestioned; and in voicing what is latent in them, thereby since they take part in the same social unconscious allowing them the vicarious gratification unconscious, they are not necessarily of merging with this passion. in a better position than anyone else to spot dehumanising practices of which and the herd Authoritarian populist movements they are part. I have elsewhere described construe immigrants, refugees, asylum how we can refer to condensation and seekers, black people, Roma and Muslims displacement, and other characteristics By Lene Auestad as enemies, threats to one’s community of primary process logic, as unfolding in and one’s ‘way of life’. The ‘other’ is public space when people are portrayed depicted in dehumanising terms as as masses and become mere objects of diseases, insects or vermin that threaten discourse, and when groups are depicted E ARE LIVING in dark Or: why this individual, rather than to destroy the body politic. In other words, as inwardly homogenous entities that times. Right-wing another, could be asked of the leader or as fundamental anxieties to do with are rigidly distinct. For instance, white populist movements of the follower of a right-wing populist, the destruction of one’s self, or attacks middle-class people in this society are spreading and nationalist movement; another question on one’s body, which are exploited for habitually displace racism onto white gaining in power throughout Europe and to which psychoanalysis could contribute. W the political purposes of reinforcing a working-class people and perceive it as beyond. These are shocking and A further question, why is this particular nation-state as an imagined closed unit a quality belonging over there. This is frightening days. category of people being targeted today, which successfully expels ‘foreign bodies’, allowed for because it is a shared social is one that is better answered by current pollutants or difference. structure of displacement, supported and One of the foremost promises in Donald social conditions, by relations of power. not questioned by social practices. Thus Trump’s electoral campaign was that In other words, the fantasies involved knowledge and experience of unconscious he would erect a wall on the border in prejudices against ‘others’, in social ‘What is dynamics as such, though important, is with Mexico and have Mexico pay stigmatisation and denigration, in ideas pathological today in itself insufficient without genuine and for it. Hungary did raise a fence with of what constitutes the qualities of the ‘us’ equal encounters with social positions, barbed wire last autumn on its border and the ‘them’ are remarkably constant may become the environments and practices. to Serbia and Croatia. While refugees – though the targets vary in time and in dominant trend of were drowning in the Mediterranean last space. The new nationalisms’ answer to a felt spring and the party voted to deny access tomorrow.’ need for belonging, significance and to Syrian refugees, the politician of the Rather than understanding the current security is an imagined unit which has populist right-wing Progress Party in political mood of increasing nationalism In one sense, psychoanalysis is in a unique the features of an ‘I’ made ‘we’, replacing Norway, Per Sandberg, sported a t-shirt and ethnocentrism, of idealisation of what position when it comes to understanding individual narcissism with group with a picture of an anchor displaying the the nation-state has defined as falling and interpreting such discourses, due to narcissism. Togetherness is allowed for text ‘good journey – sea adventure’. within the boundaries of the ‘we’, and the the unconscious meanings they draw upon in so far as the members of the in-group denigration of those defined as ‘others’ and exploit. Though this is complicated are imagined as being all the same, and What can psychoanalytic thinking as exemplifying pathology in contrast to when we reflect on the fact that these contribute to understanding such a perceived normality, I propose to see meanings are socially embedded in Continues over the page phenomena? What constitutes its these tendencies as qualities of the social everyday practices, in social norms and fruitfulness and what are its limitations? unconscious of these societies. The point is standards for what and whom counts, I would like to argue that psychoanalytic not that characterising certain extremists and who is not worthy of attention thinking is indeed invaluable when it as mad or ill in some ways is entirely comes to grasping what is at stake in wrong; it may indeed often be fitting. The such political movements, and that it point is rather that focusing one’s is a tragedy that its insights have been attention here may distract lost from mainstream social science, from a more serious issue indeed are avoided by it. At the same – the spread of attitudes time I would like to caution against previously thought of as a too uncritical reliance on some of extremist in the general its individualist assumptions when population. When that confronted with social phenomena. happens traits that used to be seen as ‘abnormal’ In witnessing these contemporary become normal in the sense manifestations, of shutting out, of being common, and their general humiliating and mocking a threatening social acceptance makes them recede other – an imagined other in so far as from view. To paraphrase Adorno the subject who does it is concerned, et. al., personality patterns that have but with real consequences of suffering been dismissed as pathological because and ultimately death for those who are they diverge from the manifest trends or targeted, what are the questions we dominant ideas in a society have turned would want to ask? Perhaps, what fears or out to be but exaggerations of what was fantasies are played on in the rhetoric of almost universal below the surface. Thus the politicians who enforce these agendas, what is pathological today may, with would be a highly relevant question to ask, changes in social conditions, become the and one that psychoanalysis is supremely dominant trend of tomorrow. equipped to explore, and (therefore) often left out in debates today. 2 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

Richard Sherry, in a challenging article, As well as taking the profession’s messages Editorial asks us to think how we address the to policy makers and politicians, a key profession’s often indifference to these role for the BPC is to support registrants societal issues; ‘to transform the very in their day-to-day clinical work. One privileged training we have received area we are increasingly recognising is to better apply these to the real world the issue of our ageing profession and problems.’ A theme of course that New retirement. This provokes very real A precarious Associations returns to regularly – anxieties for many of our registrants, and how do we articulate a voice for the Gill Barratt, Georgina Hardie, Judith profession in the wider political debate Philo and Ruth Pitman thoughtfully and policy making arena? How do we explore this sensitive issue in their joint balance get to Lene Auestad’s position where article. our psychoanalytic stance, with its focus on reflection, is seen as a much needed We are currently developing a range By Gary Fereday insight when Britain’s education system is of ‘good practice’ guides that are likely moving in the opposite direction, focusing to cover a range of issues that includes on efficiency and less thought? dealing with retirement as well as other concerns such as: clinical records and data HIS EDITION of New to say to policy makers, academics and ‘How well do protection; implications of the Equalities Associations carries its professionals from other disciplines. Act; and child protection. usual diverse range of we understand articles designed to provoke We face huge challenges as a global the intersection In many ways the BPC’s diverse work thoughtT and debate. The articles are society: on the political right we have a US mirrors the complexity and diversity of varied in their themes but there is a presidential candidate appearing to stoke between the articles in this edition, many of which challenge posed as to how psychoanalysis, up fear of ‘others’, with talk of building reflect on the theme of precarity. The with its focus on the individual and the walls to keep the ‘other’ out; on the left we individual, the precarious balance we have to strike to inner world, can and should relate better have North Korea aggressively parading group, a system ensure that we simultaneously support to the outer world and societal factors that its missile technology, presumably to and critically review the potential that affect individuals. mask the dire economic reality of day- and society?’ psychoanalytic thinking can add to to-day life of its citizens; and (surely wider societal issues, as well as support Lene Auestad argues that not only has dwarfing other concerns) we have climate With relatively limited resources (we are individual registrants in the complex job psychoanalytic thinking been lost from change scientists gathering data that a profession that is small in numbers) the of working with their clients, results in mainstream social science, but is even suggests our world is warming up at an BPC is working hard to respond to the a rich and dynamic mix of possibilities avoided by it. This should be of huge even faster rate than we thought; so fast challenges of articulating a voice for the and objectives. In the realm of pathology concern to all of us who believe our we may no longer be able to do anything profession. To do this we have to work and psychological understanding, our profession has something important about it. closely with our member institutions profession charts its course considerably, and our registrants. The willingness but how well do we understand that of individuals to give so much time external intersection between the and expertise freely is quite humbling individual, the group, a system and particularly when, as Elizabeth Cotton’s society? article highlights, so many are facing challenges in day-to-day clinical practice with increasingly precarious working Gary Fereday is Chief Executive of Social unconscious conditions and the steady decline of the BPC. effective teamwork. continued from previous page the emergence of a dissimilar other to ask: usefulness for what ends, the evokes all the rage which reveals the psychoanalytic stance of promoting limits of these bonds. These ideologies reflection, wherever that may lead, is a transform the liberal individual, an much needed alternative position, when isolated competitor seen as driven only even the education system is moving in by egoistic motives, into a herd-animal the direction of more efficiency and less sticking close to its kin though equally thought. This stance is worth defending, ruthless towards a perceived outsider. and it is worth questioning how it can be ‘Our contempt for weakness’ is common extended so as to provide more safe spaces to both of them – this is to point to how for thought features which now appear on the political scene in their extreme cruelty have NA already been fostered in the society we Lene Auestad holds a PhD in Philosophy share – of competitiveness, egocentrism, from The University of Oslo. She is editor coldness towards self and others, and with of Psychoanalysis and Politics: Exclusion New Associations is published by Managing Editor Gary Fereday Contribute to New Associations the British Psychoanalytic Council, Editor Leanne Stelmaszczyk We welcome your ideas for articles, contempt for many of the qualities that and the Politics of Representation Suite 7, 19-23 Wedmore Street, Production Janice Cormie reviews, and letters to the editor. make us human. (Karnac, 2012), Nationalism and the Body London N19 4RU Illustrations Leanne Stelmaszczyk In particular we are looking for Politic: Psychoanalysis and the Growth Tel. 020 7561 9240 Printer Blackmore reviews of cultural events, books Fax 020 7561 9005 and films with psychoanalytic To refer again to Adorno’s essay on fascist of Ethnocentrism and Xenophobia www.bpc.org.uk Views expressed in New Associations interest. If you would like to propose propaganda, he describes how fascism (Karnac 2013) and a book on Hannah [email protected] under an author’s byline are the a topic for a longer article (up to plays on unconscious forces in such a way Arendt in Norwegian (Akademika, 2011). views of the writer, not necessarily 1200 words) please contact Leanne Three issues of New Associations those of the BPC. Publication of Stelmaszczyk: [email protected] as to perpetuate the follower’s dependence. Her monograph Respect, Plurality, and are published each year in April, views and endorsements does not It expropriates the unconscious for social Prejudice: A Psychoanalytical and July, and October. constitute endorsement by the BPC. Deadlines: The next issue of New Associations will be published control rather than aiming to make the Philosophical Enquiry into the Dynamics Subscriptions © 2016 British Psychoanalytic in July 2016. The deadline for subjects conscious of their unconscious. As of Social Exclusion and Discrimination UK annually (3 issues): £10 Council. No part of this publication article proposals is 27 May 2016. a contrast, it is inherent of the practice was published by Karnac in 2015. Overseas annually: £16 may be reproduced, stored or Contributions and letters to the transmitted in any form or by any Editor should reach us no later of psychoanalysis that it takes a stand She founded and runs the international means without the prior permission than 10 June 2016. against instrumentalisation. In these and interdisciplinary conference series For insertion of advertising of the publisher. times where effectiveness and usefulness Psychoanalysis and Politics, materials contact [email protected] ISSN 2042-9096 are worshipped, with few people pausing www.psa-pol.org NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 3

What happened to teamworking? on in our professional minds. This The Surviving Work Survey Ours is not a sector which appears to cannot be done blindly or alone. A kind be well managed. Everyone reported of professional first aid – where caring problems of unmanageable caseloads and for our patients is based on a care for work intensification. Compounded by staff ourselves and the people we work with. shortage and short term contracts, the At some point this will mean negotiating vast majority of people said that they were wages and challenging targets, something Start where not functioning within their teams. that a fragmented and isolated bunch of workers cannot do. Many people reported that the NHS obsession with cuts, targets and ‘If we can start you are unrealistic caseloads really forced us into a command and control system. Do it now where we actually rather than ‘what can we realistically do?’ By Elizabeth Cotton are, we stand a Concerns aren’t being raised for fear chance of talking of victimisation. Only 4% have raised concerns about patient safety – this goes honestly about up to 47% raising concerns about working the future of our conditions and wages. ALKING ABOUT working We’re not earning enough profession.’ in mental health is not as The top issue for survey participants so far We had only two reported cases of easy as it sounds. Despite is how to earn a crust. Wages and the lack management responding to these To do this, we need to go back to our roots. being of the dialogic of a secure income was the number one concerns. Something is very wrong with To start realistically, to talk, and stand persuasionT many people working in issue of concern. 40% are working part our lack of capacity to negotiate changes up to the internal and external voices mental health are reluctant to raise time and 25% earn money from outside in the way that we work with patients. that say we can’t change. To contain the concerns about wages, progression and the of mental health. 14% work unwaged as anxieties that are flooding our consulting downgrading of therapeutic services. honoraries with an average loss of income Despite the emphasis on relationships rooms, and take some time to think about of £200 per week. The vast majority and group dynamics within our tradition how we work. We have been humbled Despite the crisis in mental health being estimated that 10% of their working hours there is very little evidence that we’re able by the care and concern respondents openly discussed, it appears that the were unpaid. to find a way of working collaboratively have shown to mental health services people delivering those services are not within our teams. At best we’re working where how we manage work is both a talking to each other about how this Precarious work is growing without a real understanding of our sector, professional and personal issue of ethics public crisis might also be becoming a A second tier of workers is developing at worst feeding what Sally Weintrobe of care. But can we really care for others deeply personal one. rapidly in mental health. This includes calls Noah’s-Arkism – a split between the when we care so little about each other? the Psychological Wellbeing Practitioners growing number of precarious workers Nobody knows how many people work who provide the main bulk of IAPT and the shrinking number of directly If you work in mental health – particularly in the UK’s mental health services or the services, the hundreds of honoraries employed, permanent clinicians. if you work for IAPT, a private contractor conditions under which they work. This working for free in the NHS, the people or a private employment agency or are year’s Mental Health Taskforce report manning the mental health call centres, In our psychoanalytically-minded society working in an NHS service for free – help bleakly reported that the data on who the clinicians carrying out disability there is a growing split between the us map what’s happening in our sector and how we work in mental health is not welfare assessments and the ones working established and the disestablished – we by completing our anonymous Surviving known. in social care and support services who see it every day in our services but we now Work Survey at www.survivingwork.org/ have been unable to secure clinical jobs. need to allow ourselves to see it in our surviving-work-survey Depressing pockets of data have surfaced. profession. That 50% of us are depressed (BPS Wellbeing Survey) and that 64% of us ‘The lack of a If we can start where we actually are, Elizabeth Cotton is a senior lecturer at don’t think that the therapy we offer is secure income is rather than where we’d like to be, we Middlesex University, associate at the intensive enough to do any good (BPC/ stand a chance of talking honestly Tavistock Institute for Human Relations, UKCP report 2015). The ‘pervasive the number one with each other about the future of our and member of the Chartered Institute for culture of fear’ within the NHS concern.’ profession. At some point we have to Personnel and Development, OPUS and compounds this lack of information about organise and speak about what is going ISPSO. mental health systems into a disorienting The use of honoraries and unwaged sense of impending catastrophe. labour to deliver NHS services, including IAPT, is widespread. Despite their fears of The job of containment becomes harder blacklisting the group most willing to be to do when we’re exposed to precarious interviewed were IAPT workers – perhaps working conditions – the stuff of monsters exposing the lack of opportunity this under the professional bed setting us up group has to talk about their working for a sectoral panic attack. People, when lives. did we become so scared? There is a growing number of people The Surviving Work Survey was set working for Private Employment up last December to find out what is Agencies – but only one respondent was happening with work in mental health. willing to have an anonymous follow-up The first phase involves an anonymous interview. Respondents were extremely online survey for anyone working in nervous about naming their private mental health – and we’re now starting employers despite the survey being to carry out follow up interviews to look completely anonymous. more closely at people’s experiences of working life and how it affects our own Many people said that the one thing states of mind. that would improve their working life would be to retire. This is what we have found so far, based on nearly a thousand responses: 4 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

Retirement Can we bear to think about retirement?

By Gill Barratt, Georgina Hardie, Judith Philo, Ruth Pitman

HE PROFESSIONAL room to reflect on how far this is a factor to make reparation to others. It also carries being invisible, and after the arduous Endings Group of BPF in their decision making. Sometimes, as a rite of passage when we qualify, a public process of deciding to retire from clinical (British Psychotherapy a variation to the theme, a speaker with presentation of a certificate, a celebration work and doing so it may feel too much to Foundation), are pleased to specialist experience was invited. Once shared. What does retirement offer us? be publicly named. Thave been invited to contribute to this or twice a retired member returned to edition of New Associations. Over the last speak about ‘life after retirement’. A Retirement is a major life threshold 23 years the BPC has forged partnerships special visitor was Diana Athill, whose accompanied by a multitude of complex ‘Retirement does with many training organizations and compellingly frank account of life in her choices, and whatever the circumstances, it not receive the established a community to define and nineties, and the courageous changes she is a very personal decision, each individual support professional practice and made in her living arrangements, aroused choosing their own path. There is however kind of attention standards. The ideas of partnership and the respect of a large and responsive a lack of tradition associated with this rite that qualifying community, including support, are themes gathering. of passage. Our psychoanalytic forebears, that the authors of this article wish to concerned with innovation, independence does.’ emphasise. We include a registrant’s As attendance at meetings dwindled and a need to establish theories and experience of preparing for their the committee decided that a change of methods, did not retire. In consequence, Sometimes there is no choice, life can retirement. name, to The Professional Endings Group, the subject of retirement does not receive be unpredictable. Some preparation or offered a way to broaden the thinking the kind of attention from organizations acknowledgement of our own expectation Beginnings of group meetings. Our thinking was or practitioners that qualifying does. of ending is realistic, and grasping the The Professional Endings Group, influenced by the prospect of a proposal This leaves many practitioners in private nettle can be emboldening. originally called The Retirement Group, to merge the British Association of practice in limbo, a word perhaps lightly is still in its teens, 13 years to date. It Psychotherapists with the Lincoln Clinic used in modern life but meaning a place Ways and means began when a small group of people and the London Centre for Psychotherapy, of abandonment. There is more than one way to prepare started a conversation about how to open all of which organizations had their own for retirement. A successful development a regular forum where the important distinctive character and history. Also the A similarly evocative word is ‘termination’, from the original Retirement Group and difficult subject of retirement could prospect of retirement begins long before an abstract theoretical term for the end of was the establishment of a Retirement be discussed. In June 2003 the event its actuality; we experience many types treatment. Course by three members of the then Opening the Door to the Third Age was of endings before we retire; we felt that BAP, and three fortnightly Saturdays were the outcome. Three members shared their the original name limited the scope of These powerful words can stir deeply designed to provide opportunities for free experience of planning for and embarking the group meetings. The merger occurred painful emotions if we relate them to discussion: on their retirement. Lively discussion three years ago. Now, in a difficult period ourselves. They may not be commonly 1. Contemplating change and loss: The followed on the merits, or otherwise, of of transition, the present challenge is to used, but they represent a level of anxiety meaning of work and retirement. the subject. Some were determined to find ways of reconciling our experience that links to an extreme reluctance to 2. The process of retirement. continue working until they dropped, of that loss with potentially new face the subject of retirement from a 3. What comes next? Creativity and a view which continues to be voiced opportunities and possibilities. profession in which so much of a sense adaptation. occasionally; how far an organization of self and worth are invested. When should be involved in what many people Change is difficult people do put feelings into words they The course ran for five years, was well believe is an individual and private matter We know this, as working with speak of ‘falling off a cliff’, remark on the attended and has been written up in the was also raised. The Retirement Group resistance and psychological defences loneliness of closing the consulting room British Journal of Psychotherapy. felt confident in the value of a termly is a fundamental aspect of our work as door and walking away with no witness to meeting where members could meet with clinicians. What we hope to facilitate in this moment of finality, or that they ‘love Sometimes we may be more engaged in similarly minded others to explore mutual the lives of the people who we work with their work’, implying that not to work is the process of working towards retirement concerns on the subject in an atmosphere is growth, a capacity to live life fully as unimaginable. than we think we are. The establishment of informality and trust. a separate being capable of making long of registration and regulatory bodies term satisfying relationships, and also to In recent years we were pleased that like BPC and UKCP has meant that the The Group development and changes manage their losses and bereavements. We the Professional Endings Group has profession now recognises standards of In the early years, a fairly consistent give weight to the process of assessment, become included in first the BAP’s practice, and training organizations have group of 15 to 20 people came together make formulations as to short or long and now the BPF’s AGM agenda as an ethical committees that review concerns. to explore the issues that the prospect of term work, beginnings and endings. As aspect of organizational life. However, Two related principles are recognised as a retiring raises, from practical, financial therapists we have had long hard years individuals prefer not to be named. foundation to practice which are: fitness ones, timing and management of the concentrating on our psychoanalytic How to speculate on this? At AGMs the to practise; and duty of care to the patient process for patient and therapist, to ethical training, which may also have been emphasis is on achievements, prospects, and to oneself. These two principles are in and psychological dimensions and the alongside other work responsibilities and growth. Honorary fellowships are awarded effect renewed in the annual undertaking thorny subject of age. Present legislation training in other disciplines. Becoming, to some ‘elders’ in recognition of their of recording CPD (Continuous no longer makes age a compulsory being a therapist has so much meaning for work, rightly, but a narrative for ‘ordinary’ Professional Development). At its best, requirement to retire, leaving individuals our identity, our sense of worth, our need members is missing. This might feel like CPD represents the growth of the NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 5

individual as a valuable and ongoing life has been very much my personal as well distress of patients who didn’t feel that of my patients in case this should happen. I process. Paradoxically this process deserves as my professional life. I have recently they were ready to end their treatment was would also like to feel that I could maintain closer attention the more experienced we decided that I am going to retire, and this mixed with anxieties about my husband’s a real and active link with colleagues in become and as we age. has taken much time and hard thinking, illness and treatment. Inevitably my main retirement. including thinking with others and talking focus was on him and on finding a way, Whilst retirement is a process of about my feelings. As psychotherapists we with him and our family, to live with his We all as psychotherapists and analysts relinquishment and mourning, it also are wonderfully good at listening to other diagnosis and bear and face the uncertainty have different circumstances and different carries a prospective potential that people, our patients, and talking about about how long he still had. ideas about how to approach retirement. offers new opportunities for the future. their feelings, but we are extremely bad at I am beginning the process of letting my There is an important distinction to talking about our own to each other apart patients know, and there will be a lot of make between retirement from clinical from to our closest friends. Of course our ‘There is a work and quite a long journey for us as work and retirement from the world of patients know us as a real other person, but distinction to we work towards the endings of their psychotherapy. Some people choose to we are skilled (rightly), when with them, treatment. It has been helpful this time make a complete ending and then pursue at keeping our personal stories and feelings make between to talk to others and to hear about their further studies or interests, develop to ourselves, and we continue to do that retirement from different thoughts and experiences. creative activities, or travel. Others in professional settings such as scientific Georgina Hardie continue to contribute to the profession meetings. The nearest we get to it is in clinical work and through teaching and supervision which talking about our countertransference, but from the world of In conclusion is enriched by their years of clinical that is still mainly about the ways in which The subject of retirement deserves experience. Yet others maintain an patients communicate their feelings to us, psychotherapy.’ attention from the beginning of interest in the field through links with rather than our own feelings. professional life, as it is an inevitable past colleagues, attendance at professional We moved to a small coastal town and I conclusion to it. Keeping it in mind as we meetings and, as members of committees, This is second time round for me, though struggled there after his death to build a develop our professional capacities allows contribute to the work of the organization. this time I feel that I am free to choose, to new practice, finally concluding that this for the idea to become an integrated part try to decide what is right for me. was an uphill struggle; I felt isolated from in understanding our responsibilities, If we are familiar enough with an idea family, old friends and familiar colleagues. not only to our patients, but to ourselves. we can allow it a place in our imagination, The first time I had little choice. My I decided to return to London to work and Retirement is also an organizational in our thinking, and give voice to it. Like husband, also a psychotherapist, was was lucky to be offered some consulting matter. As this gains recognition, there seeds, ideas need time to germinate; if diagnosed with a terminal cancer not work with fostering agencies and social can be greater clarity about what possible it is helpful to have options from long after I qualified. Nonetheless, I services cases while gradually rebuilding arrangements and responsibilities are which to choose. built up a small practice and worked as a some private work. I remarried. shared between us. Bringing retirement psychotherapist with parents in a families out of the shadows means that it can be Before concluding here is an illustration unit in an NHS hospital. He decided that he A year ago my new husband was diagnosed marked as a personal event and also one of one person’s experience. didn’t want his patients to experience him with cancer and had major surgery within the professional community. become increasingly ill, at worst, to die on which doctors were sure was completely Preparing for retirement them; also he wanted some time for himself successful. At first I thought I was facing the The Professional Endings Group aims to Retirement is very much a personal as before he died. We felt that we needed to same thing again and my initial thought provide a mindful space for discussion. well as a professional decision. Training leave London, which meant that I too would was that I should stop working. But the Where different stories are told and as a psychotherapist, building a private have to stop work. We gave our patients a prognosis was good and he was completely shared, as each person takes their own practice, working in institutional settings year’s notice. It was a huge wrench. But supportive of whatever I wanted to do. time and way. A valuable body of and coming to endings of work – all that the ending of my work and the anger and Even so, I found myself wondering about knowledge and experience has been my priorities. When my first husband died established that can now be shared and I told myself that I would no longer do drawn on. In writing the article together anything I didn’t want to do – impossible we have reencountered some of the really, but not a bad guiding principle. I am difficulties that the subject of retirement now fourteen years older. My enthusiasm arouses in everyone. We can also confirm is undiminished and I feel I am working as that we have each benefited from using well as I ever have, enjoying the stimulus the group as we undertook our own and encouragement of good supervision. process But if I were to take on new patients I could be committing myself to working into my eighties. I am conscious that life isn’t forever Selected reading and I want to make more flexible space for Athill, Diana. ‘Somewhere Towards The End’ 2008; other things now. ‘Alive, Alive Oh’ 2015, both pub: Granta Barratt, Gill, Kegerreis, Penny, Wetherell, Jean. I began going to the Professional Endings Retirement and Ageing: Thinking About and Planning for Retirement. Also: Kegerreis, Penny, Work with Group, a bit half-heartedly at first. Surely Older People. A Bibliography. British Journal of retirement was a private decision. I Psychotherapy, Vol. 28. No. 1 February 2012 gradually began to realise, however much Evans, Sandra, Garner, Jane, Editors, Talking Over the Years, particularly chapter 6. or little I was making use of the group, that Fisher, Susan. Reflections on Retirement: Questions my work and my decision to retire are not Raised. Chapter 13 in Contemporary Jungian just private matters between me and my Clinical Practice, (Elphis Christopher and Hester Solomon, eds.). London: Karnac, 2003. patients. Junkers, Gabrielle, Editor. ‘The Empty Couch: The Taboo of Ageing and Retirement in Psychoanalysis’, reviewed by Gillian Wiles in British Journal of In the BPF we are also in the middle of Psychotherapy, Vol. 30. No. 2, May 2014 the painful transition of the amalgamation Kelly, Michael, and Barratt, Gill. Retirement: of our original training organisations Phantasy and Reality, Dying in the saddle, or facing and trying to muddle through the painful up to it? Psychodynamic Practice 2007 Power, Anne. Forced Endings in Psychotherapy process of those endings and losses and and Psychoanalysis. Attachment and Loss in to make some sort of sense of our new Retirement. 2015, Taylor and Francis. With a incarnation. We are a part of that new forward by Peter Fonagy. professional family and there are mutual obligations. For instance, it is possible that patients might need help in future after their therapy ends. The BPF should be able to advise and refer them if they need this, and I would want there to be a record kept 6 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

Opinion It’s time to get out of our heads

By Johnathan Sunley

Why psychotherapists should not make a fetish of the brain

N THE LAST ISSUE of New are the implications for our psychological Associations, the author of the health of materialism, not as a synonym article ‘Where will the future be of sorts for consumerism, but in its found?’ issued a ‘rallying call’ original philosophical sense. This is the urgingI her fellow psychotherapists to pay doctrine that the world is ultimately more attention to the discoveries being made up out of hard bits of stuff known made by neuroscience (New Associations as ‘matter’, and that living organisms like 19, Autumn 2015). Colleagues who aren’t plants, animals and humans are made so impressed by the importance of the of this too. Materialism underpins the brain, she writes, generally display two claim that we are basically our brains. types of reaction. One she terms Arrogant Yet I believe that if anything in the early (psychoanalysis knows everything twenty-first century can be said to be already), the other Weary (neuroscience is driving us out of minds, it is the view just too difficult). that ‘I’ am somehow to be found in a few pounds of neural tissue enclosed in As a psychotherapist I find myself unable a fragile casing atop a wobbly stem that to share her enthusiasm about the joins me to the rest of my body. Such a zone either (this too has been pinpointed person having them – nor where they insides of our heads, and in this article sense of self is bound to feel precarious. in imaging studies). But it has long been come from. I want to make a case – one that I hope accepted that there are parts of the brain is neither Arrogant nor Weary – against associated with language and vision. And In philosophy this has been known for the view that this is where the future of ‘Materialism now thanks to the latest brain-scanning some time now as the ‘hard problem’ of our profession lies. I am aware that in underpins the techniques we can demonstrate that the consciousness (the ‘easy’ one being to our culture it practically goes without hippocampus is ‘for’ memory just as the specify structures and processes in the saying that you and I are in one sense claim that we amygdala is ‘for’ emotion. In other words: brain that in some way support such or other the products of our brains. The are basically we have the technology. We also have the experiences). Various solutions to this fact that, notwithstanding, barely a day kudos. So give us the funding to finish the problem have been put forward and one goes by without some expert appearing our brains.’ job and in a few years, perhaps a decade, that has proved surprisingly popular holds in the media to say precisely this (see, we’ll be able to tell you who you really are that we aren’t really conscious at all – that for example, the much-hyped recent How did we come to think like this? down to the last neural network. subjective experience is an illusion. ‘Are TV series ‘The Brain’ presented by Psychoanalysts of all people ought to be zombies possible?’ asks Daniel Dennett neuroscientist David Eagleman), might curious when they hear about a part of There are many difficulties with this in his book Consciousness Explained. itself arouse our analytic interest. What the body being endowed with special outlook. Some of these concern the According to this eminent philosopher kind of supposedly obvious truth is it that significance. Yet the well-nigh magical techniques currently in use for measuring and cognitive scientist, ‘They’re not just has to be asserted over and over again to powers that neuroscience attributes to the brain activity. We may think of fMRI possible, they’re actual. We’re all zombies.’ such numbing effect? brain attract little comment from them. Perhaps this is understandable. The same scans, for example, as taking a kind of snapshot of a brain engaged in (say) It may not be often that we meet someone But my greater concern with what Freud who wrote a paper on fetishism deciding something. That is certainly how in our consulting room who maintains philosopher and former professor of began his career as a neuroanatomist the results of experiments based on them they belong to the living dead. But I’m medicine Ray Tallis calls ‘neuromania’ and, for all that he frequently cautioned are often presented. In actual fact, such sure we all have patients who to a lesser is the impact I think it is having on against confusing either the conscious or scans only make it possible to detect levels or greater degree cannot bear having our minds in another way. This edition unconscious mind with the brain, never of blood flow across the brain – and don’t feelings and who will do anything of New Associations has the theme lost his fascination with the field of study take pictures of anything. they can to be rid of them. Generally ‘Precarious States of Mind’. Mental illness he had given up, famously writing in this involves the use of defences like is said to be at unprecedentedly high 1920: ‘Biology is truly a land of unlimited But let us suppose all technical and repression, splitting and projection. But levels in the UK, and one explanation possibilities.’ methodological challenges of this kind belief systems also play their part – as often given for this is that we are living could be overcome. What then? At best in the case of a patient of mine who in times of unprecedented social and Almost a hundred years later it seems to we would still only have a detailed map tried to persuade me that he was really a economic uncertainty. Why wouldn’t we me that neuroscience and its champions of the neural correlates associated with hologram. I am not saying that everyone all be chronically anxious and vulnerable are convinced we have finally reached the experience of remembering or eating who is a hardline materialist with respect occasionally to deeper disturbance? the promised land foreseen by Freud. Maybe there isn’t a ‘God spot’ in the chocolate or getting angry. We would not to the ‘hard problem’ needs to go on the be a single step nearer to understanding couch in order to understand why they Although there may be something in this brain quite as some research suggested. what these experiences feel like to the endorse the fantasy of a feeling-free argument, what I want to focus on here There might not be a chocolate-craving NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 7

world. But I was struck reading in the has shown is that the more we try to only happens, writes Winnicott, when breast’ that distinguishes it from other recent obituaries for Marvin Minsky, who grasp matter the more it slips through something goes amiss in development – compartments of the internal mother’s is seen as one of the fathers of artificial our fingers. Or as Gertrude Stein said in which it invariably does. To try and cope body as a place we may wish to inhabit at intelligence and who argued that human a completely different context: there’s no with this setback a person may well go the expense of our own minds. We load minds are simply ‘meat machines’, that he there there. into his head, meaning not just that he it with things we long for like knowledge had been bullied in childhood. becomes a bit detached from himself and and creativity and then imagine these are Many philosophers and scientists at work other people but that he starts to think of there for the taking. The problem is that If you aren’t philosophically-speaking today regard materialism not as a proven himself as somehow originating or being this is all a projection on our part, one a materialist, however, then what are fact about the way things are but as a situated there. that gives rise to a pathology that Meltzer you? Does that make you a dualist, i.e. dogma or even superstition that limits terms the ‘Delusion of Clarity of Insight’. someone who holds there must be a our understanding of the world. Rather second sort of stuff around to account for than succumbing to this superstition, ‘Isn’t it time for Are neuroscientists particularly prone to subjective experience – be that soul, spirit isn’t it time for psychoanalysis to be more psychoanalysis to this delusion? Perhaps only slightly more or something else? Or perhaps you think confident in sharing with these and other than the rest of us. Writing in an era the problem is just too hard for humans disciplines what it has come to find out be more confident when leucotomies were still considered a at our current stage of evolution to solve about ‘psychical reality’? The term itself in sharing what legitimate treatment option, Winnicott and are therefore content to be called a might have been coined by Freud but I did not completely condemn the surgeons mysterian? Psychotherapists may not care think that the paradigm-busting potential it has found out who performed these operations, much for the label itself but otherwise of it is still to be realised. about “psychical accepting that they were ‘caught up in ‘mysterianism’ might be the philosophical the mental patient’s false localization of position they feel closest to. For ours is a And yet the unconscious fantasy I referred reality”?’ the mind in the head, with its sequel, the profession that makes a virtue out of not to earlier of ‘me’ being my brain in my equating of mind and brain.’ Nowadays knowing. head is clearly a powerful one – despite Why the head, though? Why not the leucotomies are rare but pharmacological the fact that it contributes to our feeling hand or foot? Obviously these feature in approaches to mental illness tend to Some scientists may think they know so unstable. Can psychoanalysis throw any our fantasies too. But special about the be regarded as more effective than better – or at least more. And no doubt light on this? In his paper ‘Mind and its head, says Winnicott, is that it is a part psychotherapeutic ones and largely, I that can cause us to feel envy towards relation to the psyche-soma’, Winnicott of the body we are very much aware of suspect, for the same reason: it is the brain them. But what we seem to overlook is states that a healthy brain is certainly but cannot see. This gives it the feel of an that counts and pills entering the inside of how, over the course of the twentieth necessary for the normal functioning of enemy, one that we may seek to control the head through the mouth are thought century, the kind of old-fashioned what he prefers to call the psyche rather from within. He also thinks that the to have direct access to this most precious scientific materialism that Freud than the mind. But because the psyche is enormous pressure it comes under during of organs. was steeped in took a pounding from no more and no less than the ‘imaginative birth ensures that the head always has a physicists who really knew their stuff – elaboration’ of the soma (his term for unique importance for the unconscious. If we seem to be living in precarious and who came to the conclusion that, at the body), it is indistinguishable from times then I would argue that this is the sub-atomic level, ‘stuff’ as such can it – from the entirety of it. In his words: In his book The Claustrum Meltzer only be said to exist when it is observed ‘The psyche is not, however, felt by the acknowledges this importance but and thus depends for its existence on the individual to be localized in the brain, or provides a different explanation for it. Continues on page 11 minds of observers. What modern physics indeed to be localized anywhere’. That For him it is the richness of the ‘head- 8 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

training, sacrosanct doctrines tend to professionals. As Winnicott famously prevail in which there is an adherence stated, ‘there is no such thing as a baby,’ Recalibrating to the theories and life works of and it follows therefore that there is many remarkable pioneers who have no such thing as a child or adolescent made enormous contributions to our without the parental and family context. understanding of human psychology. our models There is a problem however when these How do we assess child and family theories, so illuminating in their time, mental health? become embedded and repeated as We need to consider not only the By Ruth Schmidt Neven articles of faith in the various training technical aspects of time-limited schools. These embedded articles of faith psychodynamic psychotherapy but also make it hard to overturn rigid views how, by changing the therapeutic model, Time-limited psychodynamic psychotherapy with children and adolescents: about how psychotherapy for children we inevitably change and recalibrate towards a paradigm shift and adolescents should be practised, with many of the elements that are inherent the result that what was once innovative in how we constitute mental health becomes stagnated into doctrine. for children, young people, and their parents and families. A core theme is This comes particularly to the fore that we recognise the enormous value T IS EXCITING to know that the the demands and challenges for change when we consider how psychoanalytic of the symptom through acknowledging BPC is spearheading what is are largely generated. psychotherapy with children and young how behaviour has meaning, rather described as ‘a renewal of our people is almost always defined in than placing emphasis on pathology. profession’ and creating My forthcoming book Time-limited relation to long term work. The ‘true Additionally, by including an active opportunitiesI for discussion in a forum psychodynamic psychotherapy with gold’ of child psychotherapy that takes therapeutic approach to parents and such as New Associations in which we can children and adolescents: An interactive place over years may be fascinating for caregivers we widen the therapeutic engage with difficult and challenging approach represents the outcome of a clinicians interested in the complexity frame and reflect the world that people issues. The need for a re-examination of lifetime of clinical work with children, of psychopathology, but does it actually actually inhabit. This approach is the what our profession has to offer and the adolescents, parents and families in ensure that the patient gets better? antithesis of a traditional therapeutic imperative for renewal is nowhere more a wide variety of settings and across Jonathan Shedler, who has championed approach that is entirely focused on the urgent than in the field of child and three continents: the United Kingdom, the contribution of psychodynamic child or young person separately, so that adolescent mental health. The new South Africa, and now Australia. In psychotherapy, refers to what he describes the parents are perceived as marginal to century has prompted a reassessment and the book I discuss some of the reasons as the endless preoccupation amongst the therapeutic task. One may speculate re-evaluation of many of the accepted and that have led to the marginalising of psychotherapists about what ‘really’ that this kind of decontextualised practice traditional frameworks with respect to our psychoanalytic and psychodynamic constitutes psychotherapeutic treatment and its accompanying rigidities have, even understanding of the social, health, treatments for children and adolescents with respect to the patient lying on the more than the old chestnut about lack economic, political and environmental that are due not only to the contemporary couch or the frequency of sessions. As he of research rigour, served to undermine issues with which we are concerned. For cost-cutting economic climate, but also pithily reminds us, ‘psychoanalysis is an support for a psychodynamic way of psychotherapists who work with children, to the reluctance of many practitioners interpersonal process, not an anatomical working in the public service. adolescents and their parents these issues to fully engage with the changing social position.’ of social change are at the tipping point, and emotional landscape in which they The pathologising of childhood since it is within the family context and practice. Within child psychotherapy The need for a refreshed vision for and adolescence: Why we need a the rearing of the next generation that training as well as adult psychoanalytic psychodynamic work psychodynamic approach more One of the main arguments presented in than ever my book is that by primarily identifying In current times we are bombarded with child psychotherapy with long term statistics citing the high prevalence treatment we confuse method, objectives of a variety of mental disorders in the and outcome. The claim that it is child and adolescent population. This the focus on long term work that sets coincides with the paradox that at no child psychotherapy apart from other previous time have so many children professions is further questioned, since undergone a variety of assessments and it is akin to the surgeon claiming that tests and been given so many diagnoses their real skills only come to the fore with such disappointing outcomes. Prolific in lengthy surgery. A further article of researcher Professor Sir Michael Rutter faith professed is that it is only through has made the point that improvements the experience of practising long-term in child and adolescent psychological psychotherapy that practitioners are mental health have not kept pace with enabled to carry out shorter term work. the improvements in physical health. He poses the question: ‘Why has this been I argue that time-limited psychotherapy so?’ and suggests, ‘If we had a proper for children and adolescents is not a understanding of why society has been so shorter or watered down version of spectacularly successful in making things ‘traditional’ child psychotherapy. It psychologically worse for children and requires more than a tweaking of young people, we might have a better idea established psychotherapeutic practice as to how we can make things better in in order to accommodate a shorter the future’ (Rutter 2002, p15). time frame. Instead, in time-limited psychotherapy the problems presented However, it may not be so difficult to by the child or young person are viewed understand why we have made things as an opportunity to do the internal and worse for children and young people when external therapeutic work differently. we consider the increasing narrowing By so doing, it promotes an integrative of the theoretical, clinical and research approach that must encompass the frameworks within which child and key people connected with the child or family mental health is constructed. young person, namely their parents and This reflects the predominantly bio- significant others. In order to be effective, medical approach to the construction of a time-limited psychotherapeutic child and family health characterised approach addresses the total field that by a focus on the identification of the surrounds the child or young person, as problem within the child or young well as, where necessary, other involved person, often to the exclusion of the NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 9

relational family and social context. Add Recalibrating the psychodynamic Winnicott’s conviction of ‘the natural carriers of problematic symptomatology. to this the power of the drug industry enterprise in time limited capacities for growth and self-healing in This has the potential not only to deliver in targeting psychopathology ‘within’ psychotherapy the child, given the right environmental reliable information but also to help the child or young person and you First of all, I believe that we must tackle provision and less convinced of the shift research into a new paradigm have an explosion of diagnoses such the thorny problem that is inherent in the indispensability of full-scale child of health and wellbeing and into the as ADD (Attention Deficit Disorder), use of the term psychoanalytic. Instead analysis.’ As Reeves explains, Winnicott important area of prevention. Given their ADHD (Attention Deficit Hperactivity of being presented as a treatment mode, conceptualised this in terms of an wealth of experience, the fact that child Disorder), and the grandly termed ODD it appears to have become a generic ‘economics of therapy’, not in the sense of psychotherapists are not at the forefront (Oppositional Defiance Disorder). The term for various types of therapeutic economising or rationalising, but at the of prevention is mystifying. If we are to true evidence for any of these disorders engagement which, while they may deepest level of promoting what fits the carry out meaningful research then we is pretty thin and contradictory. Given include psychoanalytic principles, are not child and the child within the family. need to engage directly with children and careful epidemiological examination in themselves specifically psychoanalytic young people as legitimate informants these conditions would be unlikely to be treatment.We may ask, ‘what’s in a Recalibrating research about their experience. We need to prevalent in any more than 3% of the name?’ but the problem is that the A post-modern perspective presents further explore the enormous capacity for population at any given time. ‘order of words’ quickly becomes ‘the us with the recognition that we growth and self healing in the child or order of things’ (Good and Kleinman, cannot isolate a particular treatment young person even in extremely difficult Another motivation to write the book is to 1985). This leads to confusion about the such as time-limited psychodynamic situations, and how this resource may posit that Cognitive Behavioural Therapy difference between a treatment mode psychotherapy for children, adolescents be harnessed in ways that contribute (CBT) is not the only apparently evidence- and a conceptual framework. In my and their parents from a broader critical to positive outcomes in therapy. With based form of short term therapy. Whilst book I identify the enormous value of reflection of professional practices respect to the process of time-limited CBT may be a valid form of treatment the psychodynamic enterprise and how concerned with contemporary child and psychodynamic psychotherapy itself, we option for a number of adult problems, its this is a critical component of time- family mental health. Within this context would want to examine what constitutes increasing usage in the assessment and limited psychodynamic psychotherapy. a values- and ethically-based position is the essential interrelationships between treatment of children and adolescents However, the psychodynamic enterprise one in which psychotherapy and advocacy children, young people and their parents should arouse our scrutiny and concern. as I describe it reflects a richness of are inextricably linked. How does this and how this contributes to therapeutic The main reason for this is that cognitive approach that is not only predicated on an affect research? We are all agreed that outcome behavioural therapies are concerned understanding of the individual, but also research is a good thing and necessary primarily with limiting the field of demonstrates the connections between for the promotion of our profession. We inquiry. In work with children and young the child and the parent, family systems, would also agree that psychoanalysis Ruth Schmidt Neven PhD is a child people this takes the form of attempting organisational life, culture and community. and psychotherapy have come very late psychotherapist, clinical psychologist and to eliminate the symptom or presenting to the whole project of research. In this researcher. She is the founding director problem, particularly if this takes the In work with children and young resides a dilemma. In our eagerness to of the Centre for Child and Family form of challenging behaviour. This of people the conceptual framework must be taken seriously as a profession, we are Development in Melbourne Australia. and course entirely denies the fact that the necessarily extend beyond the frame of in danger of carrying out research that was the inaugural chief psychotherapist at symptom or presenting problem is often the traditional psychoanalytic. A core all too often tries to hang on to the coat the Royal Children’s Hospital Melbourne. the only means through which the child theme that underpins the psychodynamic tails of empirical science. It is clear that Ruth worked for many years in the NHS or young person can ‘speak’ the family conceptualisation is the assumption the pursuit of the randomised controlled and was a pioneer in parent support in the and their experience. The symptom of continuity of process and meaning trial is a poor fit with the type of inquiry UK. This article is a companion piece to the is an immeasurably rich and accurate and the unity of brain and mind. This that is required to best approach the forthcoming publication of her book Time- communication. For example, at a time acknowledges a line of continuity from psychological and emotional problems of limited psychodynamic psychotherapy when we are confronted by the endless the inner world of the child through to children, adolescents and their parents. with children and adolescents: An revelations of child sexual abuse hidden family relationships and connections Current research inquiries into identifying interactive approach, to be published by for decades, it is sobering to learn that with the outside world. Central to this one variable such as clinical depression in Routledge. these children and young people were not integrated perspective is the recognition adolescents have also produced less than considered to be reliable witnesses to their that all behaviour has meaning and is hoped for outcomes (Goodyer, 2014). own experience. always a communication. Additionally, Bibliography the fact that behaviour, rather than being The further challenge of this type of Good, B., & Kleinman, A. (eds) (1985). Culture and perceived as rigid and fixed, is at all times research that is fixed on one variable of depression: Studies in the anthropology and cross- ‘At no previous perceived as dynamic and constantly behaviour ‘within’ the child or young cultural psychiatry of affect and disorder. Berkeley changing gives impetus to a renewed and person is that it reflects a modernity bias and Los Angeles: University of California Press. time have so Goodyer, I. (2014). From phenotypes to refreshed vision for understanding the that is already out of date. In response therapeutics: Sub-typing depressed youth to aid many children problems of children young people and to the cri du coeur from psychotherapist treatment success and be ready for treatment failure. Address given to the 21st World Congress of been given so their parents within an emotional ecology. colleagues who maintain that the powers IACAPAP, 11-15 August, Durban: South Africa. that be will only accept research defined Reeves, C. (2003) Creative space. A Winnicottian many diagnoses Shifting the paradigm from a focus within these rigid modernist parameters, perspective on child psychotherapy in Britain. Paper presented at a workshop of the European with such on pathology to the dynamics of I would reiterate that the first principle psychoanalytic psychotherapy in the public sector health and growth of our therapeutic work is a duty of conference, Stockholm, 2003. Published in Insikten disappointing I want to emphasise the need for an care to our patients. As psychotherapists No. 4 September, 2003. Rutter, M. (2002). Nature, nurture and outcomes.’ urgent paradigm shift from that of a struggling with these issues we tend to development: From evangelism through science focus on pathology to that of promoting display a confusing mixture of timidity toward policy and practice. Child Development 73 the health and growth of children and and omnipotence: timidity in not creating (1):1-21. It is clear that individually lived Schmidt Neven, R. (2010). Core principles of life, whether of a child, adolescent or young people. It is salutary in this respect a united voice to inform and educate assessment and therapeutic communication to be reminded of the therapeutic legacy the various powers about what type of with children, parents and families: Towards the adult, cannot be separated from the promotion of child and family wellbeing. London relational, family, systemic and wider of the paediatrician psychoanalyst research has a higher chance of being and New York: Routledge, Taylor & Francis. organisational social and political Donald Winnicott (1958b; 1964; 1965b), relevant and that will lead to positive Schmidt Neven, R. (2008). The promotion of who through his clinical work and health and wellbeing; omnipotence in the emotional wellbeing for children, parents and environment. The predominantly families: What gets in the way? Educational and pathology-driven discourses described writings may be described as the real sense that we may go along with these Child Psychology 25(2): 8-18. British Psychological Society 2008. above cannot lead to positive outcomes pioneer of time-limited psychodynamic narrow research parameters informed psychotherapy with children, young by pathology-based discourse in order to Shedler, J.K. (2006). That was then, this is now: in child and family mental health. In An introduction to contemporary psychodynamic fact it becomes increasingly evident that people and their parents. Winnicott had prove our relevance. therapy. www.psychsystems.net/Shedler: 1-47. narrow pathology-based diagnoses not already recalibrated the psychodynamic Winnicott, D.W. (1965b). The maturational approach through his recognition of the In conclusion, if we are to recalibrate processes and the facilitating environment. London: only compromise the child or young Hogarth. person, but also compromise the ability inherent capacity for health, growth research in a meaningful manner then it Winnicott, D.W. (1964). The child, the family and the outside world. Harmondsworh: Penguin of professionals to offer meaningful and self-healing in the child or young needs to be constructed in such a way as to person who is in the full thrust of involve children, young people and their Winnicott, D.W. (1958b). Collected papers: Through treatment and support. So what can paediatrics to psychoanalysis. London: Tavistock. psychodynamic therapy provide that can their development. Christopher Reeves parents directly as contributors to the make a difference? (2003), child psychotherapist, refers to research process, rather than solely as the 10 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

patients stop medication because they feel health team was not. As the relationship Training well, only to find themselves sectioned between this patient and his care again for not taking it. At the Maudsley coordinator broke down, I wondered about patients frequently had no idea why his future, trapped in an endless cycle of they were in hospital, and would often sectioning and re-sectioning, even though accuse family members of colluding with his actual behaviour – with or without professionals to have them ‘locked up’. drugs – was harmless. On ‘not They felt bewildered and there were times when I found myself identifying with In the meantime there were ongoing them. The consultant psychiatrist, Dr Dele debates in the ward rounds ranging Olajide, would use Socratic questioning to from philosophy, through colonialism knowing’ help these patients acknowledge their need and its effects on black Londoners today, for medication and also the fact that their to cannabis, and whether or not skunk behaviour may have led to their admission. induces psychosis. The cannabis debate By Carolyn Butler Some would respond quite well to this in particular was interesting because questioning but soon become paranoid, a British pharmaceutical company is hostile or grandiose in their behaviour. developing new, cannabis-based drugs Thoughts on a trainee placement at the Maudsley Hospital Others were sad and confused as they for several conditions – including tried to describe the voices in their heads, schizophrenia.3 Very little is known about or the bizarre thoughts in their minds. the different compounds in cannabis hour, multiprofessional meeting – NCE I HAD BEEN shown Others simply clammed up and left the (and there are hundreds of them), but punctuated by home-made cakes and round the ward, a softly room. Occasionally a patient would become some are believed to protect against caffeine. Several patients would be seen spoken nurse asked me what aggressive and the alarms would start to go. psychosis. The reality however is that during the course of the morning, many I would like to do next. We many patients simply smoke whatever is accompanied by family. Their entry into wereO standing in a large communal area One patient in particular stood out for available in order to self-medicate – with this room full of professionals seemed where several patients were watching a me. In the ward round he was polite and consequences that are still unclear. wall-mounted TV. ‘I’m not sure,’ I replied exposing and they all coped with it calm; however he declined to answer any differently. Some were clearly looking tentatively. And then, turning to the room questions at all, afraid his responses might The group dynamics of the ward emerged forward to the meeting and would shake in general… ‘Does anyone feel like a incriminate him. After much probing and during these debates and were also hands with each one of us, while others chat?’ As I took in the different faces – interrogation he still refused to explain interesting. The consultant psychiatrist barely acknowledged our presence. Some bemused, hostile, worried, giggling – my why he had stopped his medication, except used a lot of humour and was clearly in would dress for the occasion and make an question was met with total silence. It to say that he felt well. At the end of the charge of his ward; however, members of effort with their appearance, while others seemed no one wanted a chat, and I felt interview the verdict was pronounced: staff were constantly encouraged to speak in the early stages of illness would shuffle completely out of my depth. I then ‘Restrain him’ – and even then this man up and question the decision-making in wearing hospital pyjamas and slippers. noticed a young man sitting on the floor retained his composure, knowing that process. Initially I found this intimidating Each man was unique, and yet most had in a corner. I walked over, crouched down he was about to be subjected to enforced – more ‘not knowing’ – but the variety psychosis in common. and asked if he felt like talking. Smiling medication. Over the coming months I of perspectives felt important. The shyly he said ‘Okay,’ and as we found a met with him regularly and witnessed patients were also encouraged to express couple of chairs to sit on I inwardly ‘As I tried to this man’s internal battle to understand their thoughts and feelings, and often thanked him for rescuing me. Meanwhile why he had been sectioned. His only struggled to hold themselves together in the nurse retreated to his nursing station understand his rationale was that it must be some kind of the face of this challenge. Only when the leaving me alone with 19 adult male complex state of government plot to send him back to his meeting was over, and the doors locked patients – most of whom have a diagnosis country of origin. He also battled with the behind them, did they let rip with their of schizophrenia. It was the first of many mind, I felt the weight gain caused by medication, forcing frustration. Doors were kicked down and experiences on this acute psychosis ward fragility of my himself to do press-ups in his room. The nurses attacked as their precarious states of ‘not knowing’ – what to do, what to say, more the weight gain, the harder the of mind began to fragment. Again I felt or how to say it. own.’ exercise regime, but it proved too difficult the fragility of my own mind as the ward and in the end he gave up. According to round continued to the roars of their fury My next encounter was with a very tall And psychosis was a new and complex his notes, he was not a risk, to himself or in the background. man in his thirties. This time we met in phenomenon that I was struggling to others; however, many years ago he had the ‘interview room’ – a small room with understand. With my own background attempted suicide while psychotic, and so I found these episodes upsetting – surely a locked door, to which I had the key. I in psychodynamic psychotherapy I felt had become part of a system that was not there was another way to help them – and explained that I was a volunteer and asked unprepared for the variety – and also prepared to take that risk again. While yet as the weeks went by I often saw how whether he would like to talk. He looked the danger – of psychosis.1 I knew we staff at the Maudsley were willing to give their outlook improved as the medication wary and said, ‘What do you mean?’ were all on a ‘spectrum’ – that we all him a chance, the community mental somehow returned them to themselves. ‘Well,’ I ventured, ‘perhaps we could talk had our own ‘psychotic patch’ – but this about how you’ve been feeling today…’ seemed different – more disturbing He looked at me intensely and the small, and much more fragmented. Bits airless room suddenly felt oppressive. The of Kleinian theory came to mind, silence continued and as he stared at me I especially the paranoid schizoid sensed his increasing agitation. As another position – but these ‘bits’ were only few seconds passed – and his expression partially helpful in the here and now turned thunderous – I realised I should of the moment, when faced with the never have let the silence continue. ‘It’s incoherent thoughts and powerful okay,’ I said, ‘we can leave it for another emotions of a distressed patient. time.’ ‘No!’ he shouted and stood up very suddenly, towering over me. ‘No! I don’t I was also learning more about what know who you are, I don’t know what you it meant to be detained on a section want!’ As the patient walked out it was of the Mental Health Act.2 Mental another lesson in ‘not knowing’ – that in health workers have the power to this kind of ‘soft’ therapy silences are to be section people considered to be avoided because they can be experienced suffering from mental illness who as persecutory and threatening. As I tried pose a risk to themselves or others, to understand his complex state of mind, I but who lack the insight required felt the fragility of my own. to receive treatment voluntarily. They can also section people for not In the meantime I also attended the adhering to medication, and this can weekly ward round – a gruelling five- set up a catch-22 situation whereby NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 11

Time to get out of our heads News continued from page 7 partly because we insist on living in our Bibliography Young people are under too much therapeutic interventions in the treatment heads. This makes us feel extremely pressure of some people, but a way forward must be Bennett, M.R. & Hacker, P.M.S. (2003) Philosophical vulnerable. Is it why the decapitations Foundations of Neuroscience. Oxford, Blackwell Helen Morgan and Heather Stewart, the to acknowledge the need for many to voice carried out by ISIS add to this by filling Dennett, D. (1991) Consciousness Explained. Chairs of, respectively, the BPC and the their experience and story in a longer-term us with such a peculiar sense of horror London, Penguin Association of Child Psychotherapists therapeutic relationship. With one in four – as though other kinds of death and Dossey, L. (2015) Why materialism fails. (ACP) have had a letter published in the people in the UK experiencing a mental http://opensciences.org/blogs/open-sciences- destruction in the Middle East were less blog/232-consciousness-why-materialism-fails Independent (4 March). The letter states: health problem each year, how much shocking? As psychoanalytically-informed Freud, S. (1920) Beyond the pleasure principle. longer can this country afford to treat psychotherapists I believe we have a unique Standard Edition 18. London, Hogarth Press ‘Geraldine Bedell’s article on the teenage mental ill health without looking at the Freud, S. (1927) Fetishism. Standard Edition 21. contribution to offer to understanding how London, Hogarth Press mental health crisis was sobering and wider socioeconomic causes that so often we understand ourselves. Therefore let us Meltzer, D. (1992) The Claustrum: An Investigation disturbing. impact on life experiences?’ hold our nerve and not get sidetracked by of Claustrophobic Phenomena. London, Karnac the study of neurons Tallis, R. (2011) Aping Mankind: Neuromania, ‘The dominant narrative of the time we For further information on the efficacy of Darwinitis and the Misrepresentation of Humanity. Durham, Acumen live in is of austerity and competition. psychoanalytic psychotherapy, please visit Winnicott, D.W. (1949) Mind and its relation to In both public and private sector the BPC's research and evidence web page: Johnathan Sunley is a psychodynamic the psyche-soma. In Collected Papers: Through consulting rooms across the country our Paediatrics to Psychoanalysis. London, Hogarth www.bpc.org.uk/about-psychotherapy/ psychotherapist in private practice in Press (1975) psychotherapists and child psychotherapists evidence London. increasingly see anxious and traumatised individuals, troubled by matters such as Psychological therapy professional work pressure, money worries, addiction bodies respond to ‘The Five Year to social media, and loss of control over Forward View for Mental Health’ On ‘not knowing’ one’s life. As a society, we will likely face The Mental Health Taskforce, created to worsening adult mental health if we do come up with a vision and plan for mental continued from previous page not begin to challenge the expectations health on the NHS in the next five years, and unrealistic pressures foisted on published its report yesterday. The BPC, I also witnessed the staff doing their best mainstream productive roles. This view young people today. With the enormous BACP and UKCP responded with the to help the patients and especially to – like so many at the Maudsley – is the pressure placed on young people, where following statement to the press (this is an prevent relapse. A lot of work goes into subject of ongoing debate. the prevailing narrative is that everything edited version). In the coming weeks and treating early psychosis in order to try is down to individual endeavour and months, we will be carrying out extensive to prevent a recurrence. This consists of Overall I am left with an even deeper anything less than the highest grades in work in response to the report. medication, therapy (CBT and ACT), and sense of ‘not knowing’ – the human exams is failure, is it any wonder that so also community-based initiatives such mind and how it works – my own and many teenagers are suffering? ‘The British Association for Counselling as the Maudsley’s ‘Recovery College’ others, but especially others. While and Psychotherapy (BACP), British with workshops such as ‘Hearing Voices’ neuroscience and therapeutic models of ‘The British Psychoanalytic Council is Psychoanalytic Council (BPC) and UK and ‘Spirituality and Wellbeing’.4 I also the mind can help, they rarely seem to greatly concerned about the teenage Council for Psychotherapy (UKCP) saw many moments of ad hoc kindness capture the mystery and elusiveness of mental health crisis and about what the welcome the publication of the independent towards patients – a chat, a joke, a hug – human complexity. This lack of certainty legacy will be for these teenagers as they Mental Health Taskforce’s report. simple, basic human warmth. brings with it a loss of control which feels grow older.’ uncomfortable. I found my placement ‘As the report rightly emphasises, at the Maudsley humbling, and this has Longer-term therapeutic the human cost of mental health not ‘A lot of work led to a certain reticence which grounds approaches on the NHS being treated with equal importance goes into treating my clinical practice today. Just when I The BPC has had a letter published in to physical health is unacceptable, and think I might be getting to grips with the Guardian (26 February), written in the report presents an impressive set of early psychosis to something, I remember that angry patient response to an article by Richard Bentall. recommendations to transform the support try to prevent a who walked out – a useful reminder that Professor Bentall’s article, written in and care of those suffering from mental ill in this difficult and thought-provoking response to the BBC’s ‘In the Mind’ health. recurrence.’ work we never fully understand the series of programmes on mental health, complexities of the person before us. We contended that mental illness is primarily ‘We welcome the focus on psychological I was left wondering if psychosis could be just keep trying caused by misery and by traumatic life therapies and look forward to working reversed. Historically Kraepelin, who first experiences. The BPC’s letter picks up with NHS England, local commissioners, described dementia praecox, believed that in particular on the following lines from government departments and professional remission was a sign of wrong diagnosis, Carolyn Butler works as an honorary Professor Bentall’s article: colleagues to ensure that those who need whereas Bleuler, who invented the term psychotherapist in the NHS, has a private therapeutic support can access the right schizophrenia, held that some cases do practice in South West London and is ‘For one thing, many psychiatric patients in treatment at the right time.’ experience spontaneous remission – a currently undertaking a Masters degree at Britain feel that services too often ignore view that made me think again about the University of Exeter. their life stories. In the words of Eleanor those individuals who are not causing any Longden, a mental health activist, “They harm, but still end up on a section for not always ask what is wrong with you and adhering to medication. According to Dr References hardly ever ask what happened to you.” Olajide, between 14% and 30% of patients Patients are routinely offered powerful with first episode psychotic disorder will 1. According to a BBC report, mental health trusts in drugs (which clearly have a place but only 2015 recorded a 20% rise in unexpected deaths over have spontaneous remissions. He cites a two-year period. help some patients), but very rarely the research which suggests that in developing www.bbc.co.uk/news/health-35403827 kinds of psychological therapies that may countries the prognosis is even better 2. The Mental Health Act 1983 was amended in help them come to terms with these kinds 2007 to include Community Treatment Orders. These because individuals are often supported give mental health workers the right to re-hospitalise of experiences, or even practical advice within more cohesive communities.5 In patients for not taking their medication. (debt counselling probably has a place in www.legislation.gov.uk/ukpga/2007/12/section/32 Nigeria, for example, the lack of welfare the treatment of depression, for example).’ 3. The British company GW Pharmaceuticals has means that people in remission are recently published the results of its phase 2 clinical supported by families but also expected to trial on CBD as an adjuvant in the treatment of The BPC responded: ‘It has been schizophrenia. GW Pharmaceuticals plc, Press obtain employment. By contrast, he says, Release, September 2015. frustrating to see services which offer such the welfare system in the West provides a 4. www.slamrecoverycollege.co.uk therapeutic approaches suffer so many cuts safety net, but can also paradoxically trap 5. WHO. Report of the International Pilot Study of on the NHS in recent years. Clearly, there Schizophrenia, Volume I. Geneva, Switzerland: World patients in poverty and alienation from Health Organization; 1973. is a role for medicine and shorter-term 12 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

Reviews

Murdered Father: Dead Father: to kill the father and its concomitant Revisiting the Oedipus Complex expression in infantile sexuality. These Rosine Perelberg, Routledge 2015 scandalous notions of incestuous wishes, murderous fantasies even against those Rosine Perelberg characteristically we love, maternal seduction and patricide takes up the cudgels for a rigorously underpin Rosine’s theorising. She critiques argued psychoanalytic theory, never too some contemporary theory which views far away from the consulting room. In psychoanalysis, particularly in the her theoretical exposition she takes a central notion of thirdness, as a theory fundamental tenet of Freudian theory: of co-creation and symmetry. Her thesis, The killing of the father is in Freud’s by contrast, emphasizes a non-linear view a requirement for the creation of the temporality, disruption and challenge: social order that from then on prohibits all A profound dissymmetry, trauma killing. (p1) and violence inherent in the analytic situation (p70) She elaborates it: The father however has only to be And yet alongside the scandal of the killed metaphorically: the actual violence, disruption and discontinuity and exclusion of the father lies at the the centrality she gives to the traumatic origin of so many psychopathologies, nature of sexuality inherent in psychic ranging from violence to the psychoses development, Rosine traces how and perversions… (p1) …the desire to kill the father initiates the process of mourning. (pp41, 53) The shift from the murdered to the dead father represents the attempt echoing I guess her own paternal line to regulate desire and institutes the to André Green (dare I say the dead have recently been enjoying her inspired of her weaving, when he goes in search of incest taboo. (p36) father not the murdered father), who chairing of a series of Contemporary his father Odysseus? Telemachus declares, accompanies both author and reader as a Freudian clinical presentations, will know Her Freudian scholarship which, as sort of internal interlocutor throughout the scrupulousness and compassion of her My mother [he challenges not the Michael Parsons comments, means that the book. He famously writes how that attention to the patient’s lived experience. truth of her claim to be his mother] even the most knowledgeable of Freud’s which differentiates present day analyses says that I am Odysseus’ son, though of readers will come away from reading and those in the past course I cannot know that; no man can her book knowing Freud better, provides …surely would be found among the ‘Rosine takes ever be sure who his own father is… the bedrock. This is then honed by her problems of mourning. (Green 1986 her thesis (Homer’s The Odyssey translated by longstanding engagement with French p142) Stephen Mitchell 2013 p6) psychoanalysis which has, in collaboration and runs with with a number of other redoubtable In my view it is this link to mourning it through Nor woman either I might add! What British colleagues, so enhanced which returns us to what I said at the we can be sure of is that to alert Rosine, clinical theoretical debate in British beginning. Rosine is never far from the anthropology, perhaps even to challenge her with such psychoanalysis. consulting room, and the book attests to mythology, a conundrum redolent with consequences her commitment to a clinical technique for our clinical theory, she’ll run with it… Rosine takes her thesis and runs with which may be rooted in a metapsychology, theology…’ a sequel then to this wonderful new book it through anthropology, mythology, which includes disruption and violence, might be entitled: Whose Father is He theology, to the opera house and the art but is certainly not characterised by doing Whilst we are reading Rosine’s new anyway? gallery. It is a breathtaking endeavour. violence to the patient’s experience on the book, she of course will be venturing on One of my particular favourites is her couch. another psychoanalytic journey, so these Rosemary Davies revisiting the story of Abraham and Isaac last thoughts consider the next part of through the prism of her murdered father, She argues for a technique which her journey. One of the many fascinating This is a slightly edited version of a brief dead father lens. She invites us to view privileges the classical setting, threads in the book which I find very piece given at the book launch of Rosine Caravaggio’s and Rembrandt’s depiction …the rules of which both analyst and compelling is the allusion in a quotation Perelberg’s book Murdered Father Dead of Isaac’s near sacrifice and argues that patient submit. (p71) of Freud’s to the vital difference between Father, Revisiting the Oedipus Complex. the two painters differ: Caravaggio the maternal and paternal in its link renders the scene by inclusion of the She describes how the psychoanalytic with the differing challenges the child violence of Abraham’s act and Isaac’s pain, setting reflects the dead father complex: faces. She or he feels more certain of the References Rembrandt softens the image. Rosine It is present in the construction of the maternal line, knowing who his mother describes the extraordinary moment setting that requires the invisibility is (Oedipus excluded!), but always and Freud, S (1939) Moses and Monotheism SE 23. Green, A. (1986) The Dead Mother. In On Private where Abraham, wielding the knife, stops and silence of the analyst, the forever unsure of the paternity. Rosine Madness. London: Karnac Books. in mid-air. She argues that this abstinence (sacrifice) of both analyst quotes Freud in his last writing in 1939. Homer, The Odyssey (translated by Stephen Mitchell marks the passage from the rule of and patient. (p79) He writes: 2013) Phoenix Press. the murderous, tyrannical, narcissistic …this turning from the mother to father – God, who has the power of life Furthermore her clinical practice, the father points… to a victory of and death over his son – to the dead demonstrated throughout the book by intellectuality over sensuality… since symbolic father, the father of the law vivid clinical accounts, insists that there maternity is proved by evidence of the who forbids all killings. (p65) is no place for the omnipotent analyst, but senses while paternity is a hypothesis, rather the analyst who as she describes based on an inference and a premise. There are countless other examples ‘inaugurates a process’ (p76), characterised (Freud 1939 p113) and my intent of course is not to give by such things as the ‘open interpretation’, a resume of the book, but to whet your and the special form of listening. In her book, Rosine demonstrates her appetite or perhaps to excite your interest. pleasure in the interrogation of myths. So Her thesis inaugurates an adventure Any of those who have participated what about the link here with Telemachus abundant in scandal. She reminds us in Rosine’s much lauded teaching on as he contemplates leaving his mother, of the forever scandalous nature of psychoanalytic technique at the Institute Penelope, to the rabid ruthlessness of her the Freudian discovery of the desire of Psychoanalysis, or those of us who warring suitors and the interminability NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 13

When The Sun Bursts His 40+ years of experience are deeply If first-time sufferers do not get this vital and most of us manage, by and large Christopher Bollas, Yale University Press, grounded in the premise that there is opportunity; ‘if the self is not restored successfully, to do this on entering the 2015 method to all madness, and this latest to its history’, as Bollas poetically puts world of language. Words stay embedded book is his sensitive and imaginative it, then the psychotic process can start in their chain of signifiers rather than the Christopher Bollas’ new book, When the account of the psychotic mind’s methods. to take root. In Chapter 13, ‘Hiding the things-in-themselves they once were to Sun Bursts, is a refractory look at his long Mind’, Bollas elaborates this by showing our pre-verbal brains. Of course, this does career through the lens of schizophrenia. As human beings (unless we are midwives the allegorical nature of psychotic not mean we give up on experiences of It begins well before he trained as a or palliative care nurses) our encounters thinking. The ‘as if’ dimension of the ‘intimate connection’ between mind, psychoanalyst when, as a young man, he at the astral portal of birth and death thinking recedes; symbol and object body, existence and reality – what else are worked in a school for psychotic children, are usually limited but very profound. flatten one on t’other. For example, a our essential excursions into poetry, music EBAC, in Oakland, California. In a To witness the birth of a human being particular teacher to a psychotic child and art? characteristically practical fashion, he or to accompany them in their passing is ‘is’ security, so safety must be concretely recalls the day when instead of having to to be exposed to life at its very edges. An acquired by touching this person several The interesting point I think Bollas is wrestle his charge, Nick, to the ground essential aspect of ‘holding’ these liminal times a day. Or anger is the vacuum making is that, to quote Richard Lucas, upon arrival to prevent him attacking experiences – sewing them into our cleaner while the radio is communication. the ‘psychotic wavelength’ is a place anyone (which could involve restraining ongoing sense of ourselves – is the task of When fragments of the self start to on the spectrum of experience that as him on the cold, wet ground for an hour narrating the story to another. be assigned to physical rather than babies we all intimately knew – the or more), he discovered he could tell him interpersonal objects (always using an place of somatoform experience and a story about all the children and the When Nick demanded ‘Orange boat’ all underlying logic but the longer this representation. The schizophrenic seems teachers embarking on a big orange boat. those years ago, he was asking ‘Chris’ to goes on, the more hidden the threads to find a way back there and, once there, Nick, thenceforward, greeted ‘Chris’ with hold his mind together as a substitute for of meaning become), the person moves seeks to stay lost (and keep you lost an exclamatory demand for ‘Orange boat’. holding his body together. Bollas argues further along the trajectory of the with him) in his way of experiencing It might have got a bit repetitive, but at that the story can contain feelings which psychotic process towards a schizophrenic the world where he does not think least it kept his bum dry! threaten to fragment the self. It is no existence in which the fabric of the things but he does things. His difficulty coincidence that we all start as babies in scattered self has been so well distributed is that he is continuously flooded by Bollas’s central preoccupation in this swaddling blankets then progress to the around the physical environment that unconscious thinking which penetrates book, it seems to me, is to grapple with verbal containment of being told a story it can, tragically enough, never be consciousness – especially the rage and what communication is for and with what before we go to sleep. The same holding recovered. terror-filled aspects of the primal scene the psychotic mind is all about. Having function is at work, when like the Ancient – which arrive as vivid visual images, trained at the BPAS in London in the mid- Mariner before us, we are compelled to powerful bodily dispositions, the sound 70s under the post-Kleinian generation tell our own stories of encounters at the ‘Bollas’s central of accusing voices, or as a smelling of of psychoanalysts who felt the analysis astral portal. I have noticed a palpable preoccupation the world, shifting from moment to of psychotics was an essential aspect of sense with patients that if they don’t tell moment. The schizophrenic can find rest the psychoanalytic endeavour – Hanna me that story, they cannot re-inhabit the is to grapple either by controlling mental process and Segal, Herbert Rosenfeld, Henri Rey etc. self they were before it. with what restoring themselves to the everyday (at among them – Bollas also took these very which moments you cannot call them ill patients into treatment, in five times In like fashion, Bollas makes a plea for us communication is schizophrenic) or by outsourcing the mind weekly private practice. A decade later, all to recognise how essential is the need for and what the through projective processes in the hope in the mid-80s, he returned to America in the person who has had a psychotic of becoming mindless. The choice they to treat schizophrenic patients in the episode to tell the story of how their doors psychotic mind is make at such moments is critical to their residential setting of the Austen Riggs of perception opened. The nitty-gritty of all about.’ eventual destination as people. Center in Stockbridge, Massachusetts. what happened when, where and how, is absolutely Bollas argues that, ‘In the schizophrenic Bollas argues, convincingly I think, necessary if they order, a self fulfilled is a self endangered. that by being with a listening Other are to take up But a self intelligently emptied is a self trained in the psychoanalytic tradition, residence inside protected.’ He expands this by saying, the psychotic can be gently encouraged their former By connecting the self to things, by to discover ‘the generative potential of selves. All too thinking the self into an it rather intrapsychic change.’ The task, however, often, however, than an I, by abandoning the symbolic is far from easy, ‘since the schizophrenic is psychotic episodes are order, the schizophrenic tries to evade not trying to tell you something; instead ‘treated’ by mental health the perils of thought and language. he seeks to wrap you up, syntactically, in professionals in the sense that (p.143) his way of experiencing the world’, and anti-psychotic medication in doing so ‘…deconstruct[s] the defences is dispensed, but not Mindlessness is the objective, as having crucial to our own peace of mind.’ The in the sense Bollas a mind is felt to be far too dangerous. task before the courageous clinician is is passionately Why? In Chapter 10, Bollas introduces therefore a mighty and fascinating one; advocating. the helpful concept of ‘metasexuality’ the work demands a great deal of patience, to describe the ways in which ‘the imagination and sensitivity. Or, in a word, schizophrenic aims to eliminate the love disturbing psychic effects of the primal scene by incorporating it, thereby Annie Pesskin nullifying the reality of sexuality altogether.’ And there is seduction there Annie Pesskin is a psychodynamic too. He goes on, psychotherapist working in private practice At the very moment when he is cut in London and Oxford and also as a off from the I that might position reflective practitioner for Oxford Health representations of unconscious NHS Trust’s Forensic Services. thoughts into consciousness, he feels that thought, being, and action are bundling up into an extraordinary Readers can purchase this book at a special intimacy. Rarely have mind, body, price of £14.00 (rrp £18.99) when ordering existence, and reality felt so intimately direct from the Yale Books website: connected. (p.145) www.yalebooks.co.uk Please enter promo code Y1567 when prompted at the checkout We are all asked to give up the stage of your order. Free p&p UK only. ‘extraordinary intimacy’ of the Maternal Promo code expires 31 July 2016. Order when we enter the Symbolic Order 14 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

are not asked to question whether what and make Birdman 4 instead. Birdman Culture we see is ‘real’ in the constructed reality of in all his feathered glory stares down at the film (superheroes have super-powers him from a giant poster on the wall – an after all), but to be with and alongside alternative manifestation of the super-ego. Riggan and his experiences. Perhaps the fantasy of flying is another form of psychic retreat, a borderline From a psychoanalytic point of view, we state of mind where uncomfortable Birdman, or might see this as a manifestation of the reality can be avoided, and Birdman is character’s incipient psychosis or psychic part of the perverse organisation which retreat (Steiner 1993) as a response controls Riggan, restricts his professional the reality of to repeated experiences of frustration, development and attacks the part of him humiliation and powerlessness. It reminds which wants to connect with others in a me of the way we are asked to step into more truthful way (Steiner 1993). Riggan the worlds of our patients, no matter how both wants to rid himself of his character unreality mad or confusing these may be, in order and simultaneously longs to merge with to understand them, but how we also need him. To be Birdman is to possess super- to be able to step out again and regain our powers (be omnipotent), to be a hero By Clea McEnery-West own perspective in order to be of help. and to have certainty, but – in a contrast expressed through the tension between OW DID WE end up series of Batman films in the late 80s and There is a similar audience relationship popular culture and what is considered here?’ asks the voice of early 90s. set up here as in ‘A Beautiful Mind’, highbrow – it is also to be a figure of Birdman, the eponymous where the viewer is placed inside the ridicule. There is something about a feathered superhero from The film is shot to look as if it is one protagonist’s world at the start of the film search for authenticity here. aH series of popular films made over twenty long take seen mainly from Riggan’s and believes, as John Nash does, that he years ago. This comment, in a sense, sums perspective. At times the other characters has been given a special assignment by This difficulty tolerating reality reminds up the mood of a film which illustrates have a separate external existence, but the Department of Defence to thwart a me of a patient of mine who has an something about the lengths people will at others they appear to be parts of his Russian plot. The film was based on a true addiction cycle where he will get clean, go to – the defences they put in place – to internal object world. This is particularly story and the protagonist, Nash, who has start a new job and a new relationship, deny the painful feelings of regret and the case as the camera repeatedly follows paranoid schizophrenia, eventually learns engage in therapy, but when the ordinary loss that come with ageing and the Riggan walking anxiously through the to live with and recognise his delusions for frustrations of his daily life become too recognition that one’s ambitions have not narrow, windowless corridors of the what they are. much he retreats into a paranoid state been realised. The film blurs the lines theatre to or from the stage, the tense of rage and turns to substance abuse between external reality and the irregular drum beats on the soundtrack Alone in his dressing room we see Riggan where the object is constant and can be protagonist’s internal world, shifting mimicking the sound of his heart. In the move objects across the room as if using controlled. His destructive and neglectful between apparently psychotic states of corridors and the dressing rooms leading telekinetic powers, often smashing internal objects overwhelm him and no mind and a more reality-based perspective. off them relationships are enacted with them to the floor or against the wall in a good-enough ordinary object relationship primal intensity: here is love; erotic destructive infantile rage. These episodes is ever satisfying. The protagonist, Riggan Thomson, is an attraction; jealousy; rejection and Oedipal always seem to occur after experiences of ageing actor trying to reinvent himself on rivalry that spills over into violence. frustration where he feels powerlessness In the film, there are moments of insight Broadway with his own stage adaptation and impotent. Riggan even claims when Riggan’s anxiety levels are lowered of a Raymond Carver short story, ‘What The very first scene shows Riggan in his responsibility when a falling chandelier and some degree of authentic connection We Talk About When We Talk About dressing room levitating about a foot off hospitalizes the other male lead. The is possible, such as when he is visited in Love’, in which he has invested his life the floor while we hear the critical voice short-notice replacement, Mike (Edward his dressing room by his ex-wife (Amy savings. With a nod to the confusion of Birdman telling him, ‘This place is a Norton), displays the type of false-self Ryan). He tells her, ‘I have this voice between reality and fantasy, life and art, dump! We don’t belong here.’ As Riggan persona identified by Winnicott (1960 in my head. It tells me the truth about that pervades the film, Riggan is played is called to the stage he steps down onto p.150), who describes actors ‘who can things. Sometimes it’s scary. It’s me you by Michael Keaton who struggled to the floor and pulls on his clothes. The only act, and who are completely at a loss know.’ She replies, ‘I’m going to pretend restart his own career after starring in a viewer enters directly into his world. We when not in a role, and when not being that I didn’t hear that.’ Here Riggan appreciated or applauded (acknowledged acknowledges the internal splitting but as existing).’ it is not possible to maintain this state of integration. The message is that ‘voices’ – Mike is incapable of becoming sexually less acceptable parts of the self – must be aroused when alone with his actress/ ignored, perhaps because facing the pain girlfriend (Naomi Watts), but gets an and humiliation would be unbearable. This erection when he is playing her lover is like being with a patient who is able to on stage. This draws laughter – and tolerate the different parts of themselves a degree of admiration – from the as a whole, though only fleetingly. For audience in a way that Riggan, playing example, the client above who can briefly the jilted partner, experiences as acutely get in touch with the idea that, as well humiliating, disrespectful to the play and as using alcohol to escape from everyday a threat to his own potency. Mike becomes frustrations and disappointments, he also a catalyst for Riggan’s Oedipal rage, also uses it to get alongside, and perhaps even seducing and seduced by Riggan’s ex- become, his hated emotionally abusive addict daughter (Emma Stone). and heavy-drinking father.

The film is a fascinating study of the Riggan craves recognition as a serious tension between reality and fantasy and actor – he is recognised everywhere by the type of psychotic splitting that can take the public as Birdman, but this does not place under extreme levels of stress and satisfy him. The characters in his life are anxiety. This culminates in a scene where – objects in the original Freudian sense – to believing his play is going to be rubbished be used in order to release tension and by New York City’s most important and satisfy his libidinal desires (Freud 1905 influential theatre critic (super-ego), pp123-243). He ignores or attacks those Riggan flies over the city in a literal flight who care about him and ruthlessly gets rid from his fears of humiliation and the ruins of those who stand in his way. Although of his ambitions. Back in his dressing room he has already invested all of his life- later, Riggan hears the voice of Birdman savings in the play, he remortgages his suggesting he should abandon the play house – his daughter’s inheritance – in NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 15

earth for just one day, for multiple cups great deal of bodily fluidity, almost like a Interview of tea, and for a conversation in which he dancer. I hope that these sorts of details might provide the reader with a survey will help to bring the man alive for us. of his biography, the historical context in Tea with Brett 60 pages in and I almost forgot that which he worked, as well as a synopsis of How did the idea of the series come this was a fictitious work! his theories of human development and about? Well, I am not certain that I would of psychotherapeutic technique. Oliver Rathbone asked me, ‘Who else NA interviewed Brett Kahr in the hope describe this as a work of fiction, perhaps would you like to have tea with?’ I became of discovering the motivations behind the more an exercise in ‘imaginative non- You may know that I have been working very excited at the prospect of meeting creation of his new book series, ‘Interviews fiction’. I did try as hard as I could to on a much more extensive biography not only Winnicott but also some of our with Icons’, and of the first title in this bring Winnicott back from the dead for of Winnicott. Over the years, I have other great foremothers and forefathers. I series, Tea with Winnicott, just published one last ‘posthumous interview’ about his interviewed over nine hundred people blurted out that, after Tea with Winnicott, by Karnac Books. What we found is a life and work, in the hope that students who knew him personally, and in doing I would love to have Coffee with Freud. So passionate scholar, creative writer, and and colleagues might be able to meet so I have had a wonderfully privileged that will be the next title in the series. In advocate for the preservation of our the great man in a more chatty way. education. From talking to all of these that book, I have invited Freud back to the profession’s history and its key theories. Winnicott, you must understand, was a people, I really learned a great deal about Café Landtmann in Vienna – his regular marvellous, engaging raconteur. He spoke what he looked like, how he spoke, how Kaffeehaus – and we discuss his life and The informality of the prose and the access in such a beautiful and quirky fashion. he held his body – all the sorts of detail work. John Bowlby will follow thereafter, to the playful nature of the man who placed And having now studied his unpublished that one simply cannot find in published and I have already started working with play at the very heart of his thinking correspondence for many years, I sources. And I hoped to put as much of members of his family on that one. makes the book a joyous romp of a read. felt emboldened to try to capture his this information as possible into Tea with idiosyncratic speaking style. I also wanted Winnicott. There is an array of positive attributes By integrating the history of the field and to find a more playful way of writing a in the book for students. What kind the man behind some of the profession’s guidebook about Donald Winnicott. Years ago, Charles Rycroft told me, ‘I of benefits could such an in-depth cornerstone ideas, Kahr has provided not will never forget how Winnicott held his portrayal offer a practitioner? only an accessible insight into Winnicott The book is filled with archival cigarette. He would put his arm around It would be a lovely bonus if seasoned for a new generation, but has also given an nuggets; weaving this into a realistic the back of his head, and he would bring practitioners could find something of opportunity for contemporary practitioners conversation must have been difficult. the cigarette round to his mouth from the value in this book. I suspect that Tea to establish a more rigorous understanding Where did the idea come from? other side’. Other people have confirmed with Winnicott does contain a fair bit of some of our founding fathers and The concept emerged, quite literally, over to me that Winnicott did, indeed, hold his of material that will not be known mothers by exposing both the brilliance a cup of tea with Oliver Rathbone, the body like a pretzel, with his limbs in funny to most of our colleagues. Some of it and the blunders of these great thinkers. publisher of Karnac Books. We conceived arrangements. He never sat in a tight, derives from interviews that I undertook Personally, I cannot wait for the other titles the idea of inviting Winnicott back to stuffy way. He comported himself with a with his secretary, Joyce Coles. So there in this ‘Interviews with Icons’ series! will be plenty of previously unknown biographical nuggets. But I also hope that the book might serve as a useful refresher Birdman guide for those who already know his theories reasonably well. he was completely without fault eventually of his career, the loss of a relationship continued from previous page gave way to anxieties about having made with his daughter – he embraces the Throughout the series, I have endeavoured a terrible mistake and to thoughts about unreal, the omnipotent and narcissistically to pay great tribute to these truly order to keep the play going when the ageing, physical deterioration and fragility, isolated position in a final psychotic flight wonderful thinkers – these icons – but, money starts to run out. He cheated on and the loss of financial resources and in which his internal world becomes also, I have offered a glimpse into their his ex-wife, missed the opportunity to status that letting go of his professional reality. For our patients we hope to offer shadow sides as well. I hope that my develop a relationship with his daughter, identity and retiring would entail. something different – to help them work portrayal will be neither idealising nor and his girlfriend complains he has never through and accept painful reality and loss denigrating. To me, these ‘icons’ represent shown her any real affection. The words that flash up on the screen and to engage more deeply in relationships the apotheosis of rich, complex human at the start of the film, ‘And did you get with others: to have a better relationship beings from whom we can learn, both as In fact the film plays like an exploration what you wanted from this life, even so?’ with their internal reality as well as with role models and, also, in certain respects, of a disturbance in early object-relating, ‘I did.’ ‘And what did you want?’ ‘To call the external world, and to be able to tell as counter-role models. highlighting the difference between true myself beloved, to feel myself beloved the difference between the two intimacy, which is connected with a sense on the earth’, are part of a poem from a How worried are you about being of being loved for who you are, and a false late collection by Carver written shortly challenged on the authenticity of connection based on what you do or can before his early death addressing difficult Clea Mcenery-West is a Senior Tutor on these characters? give to others (Winnicott 1960). There questions about life and relationships. the MSc in Psychodynamic Counselling Fellow Winnicott scholars might well is a difficulty engaging with the other However, the film is full of characters and Psychotherapy at Birkbeck College, quibble with some of my observations; and defining the self in relation to the who are unable to connect, who ‘talk about University of London, and works as a they might even conclude that I have got other. Riggan has an insatiable demand love’ without really being able to love, or psychodynamic psychotherapist in private it all wrong. But I did research Winnicott’s for narcissistic supplies and when these who want to be loved without loving in practice. life and work as thoroughly as I could. are not forthcoming he retreats from return. The desire for emotional intimacy Certainly, I gave the manuscript to several frustrating external reality into a fantasy has been replaced by a sort of grandiose very senior colleagues who knew Winnicott world where he can control objects and fantasy which involves being seen in References personally, and they very kindly read the even fly. This is a world where he is a particular way, but not really known. text prior to publication and, happily, gave omnipotently in control; where he rises Later, as Riggan gets more in touch with Chilton, M. (2015) How the director of Birdman drew inspiration from the short story writer Raymond me the ‘thumbs up’. Also, Winnicott’s above and sees everything. He is alone but his feelings he says, ‘I wasn’t present in Carver. http://www.telegraph.co.uk/film/birdman/ famous child patient, ‘The Piggle’, now a magnificent – though actually cutting a my own life and now I don’t have it.’ True raymond-carver-the-baleful-star-of-birdman. Freud, S. (1905) 3 Essays on the Theory of Sexuality woman in her fifties, whom I have come rather forlorn figure with his old cream intimacy would involve facing up to and SE 7 pp123–243 to know, also read the book in typescript overcoat flapping in the wind. working through the embarrassment, Steiner, J. A. (1993) Psychic Retreats: Pathological form, and she, too, very graciously gave humiliation and shame that Steiner Organizations in Psychotic, Neurotic and Borderline Patients. London: Routledge me her approval. But of course, I hope I am reminded of an older client who was (2011) has identified as arising when one Steiner, J. A. (2011) Seeing and Being Seen: to be challenged and questioned and having difficulties at work because of a eventually emerges from a retreat and is Emerging from a Psychic Retreat. London: Routledge corrected. I trust that people will feel that difference of opinion between himself properly seen (or heard). Winnicott, D. (1960) ‘Ego distortion in terms of True and False Self’ in The Maturational Process and the they can let me know and his managers about how the rather Facilitating Environment (1965) Karnac Books challenging and risky work within the At the end of the film Riggan is Interview by Leanne Stelmaszczyk, BPC criminal justice system should be carried transformed by a desperate act of self- Development Officer out. His determination to hang onto his annihilation and, rather than managing job well after retirement age, despite the to finally engage with the painful realities risks involved, and his rigid insistence that of his life – ageing, divorce, limitations 16 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

3. We need to heal the tools to heal – climate change dysregulation have altered Opinion specifically if we are using traumatised, natural cycles and drastically increased dysfunctional, or problematic concepts the incidence and scale of disasters. This (especially working with similarly stressed was Diamond’s point, that, in careful individuals), modes of therapeutic review of many of the natural disasters, approaches, or similarly impacted modes the leadership and the prioritization for or models – all of these aspects will the political elites determined much of Turning a negatively impact on the efficacy and the directionality for the mitigating or the fullness of what we are capable of intensifying of these issues and their thinking about as well as in healing. resultant consequences. blind eye From a cross-discipline examination ‘We need to of these issues, besides a potentially heal the tools cataclysmic natural disaster, what is most By Richard Sherry likely to contribute to societal collapse to heal.’ is ecological mismanagement. Many of the climatology issues have begun to be Defining societal collapse understood in a greatly interconnected For the first point, looking at the worst way with seeing the severity of the SYCHOANALYTIC thinking leading the actions of change drawn from aspects of human functioning requires ecological impact upon our planet, and how is potentially undergoing a these insights. Namely, ‘Don’t just read defining highly unpleasant issues the leadership and conservation change transformation of the writing on the wall, follow through like social collapse. Some of the ways the directionality of the health of the relevance. Deeper to actually make the required changes.’ to describe these aspects of collapse environment and its supporting population. appreciationP of the fragility of the Within the psychoanalytic profession, reference Tainter (2003) and Diamond’s sustainability of societal as well biosphere even including the various professions (2005) seminal research. At its most For example, during the last decade, ecosystems is necessitating that we open we usually have before entering the basic level, this could include a reversal melting of the polar ice caps has increased up a very new approach in our thinking. therapeutic discipline, we are taught to or simplification of the social and over a thousand-fold, changing the This need is especially being seen with the work on these more direct and individual technological structures. An incorporation salinity and wind patterns, and ocean rock and a hard place that vulnerable levels and leave the social well enough or absorption into another more dominant ecosystems appear to be changing course. populations are increasingly facing. The alone. We are taught to predominately culture. Significant death or complete The increase of desertification has rapidly plight of the poor, the traumatised, and leave the daunting complexities required obliteration would also be another possible been reducing carbon re-banking and has the disenfranchised is daunting to in confronting interconnected social outcome. Diamond outlined in his increased temperatures. Our dysfunctional consider, especially how to begin to own a structures to the politicians or civic book Collapse the five-point framework neglect of our planet can be dramatically meaningful sense of responsibility in how planners. determining causal contributing factors to seen on land with massive deforestation to expertly address these interconnecting societal collapse: (in areas like the Amazon and Indonesia); problems. One of the clearest and most My hope is this article will create a 1. Human impact on the environment within our oceans, with floating islands relevant examples to illustrate the issues paradigm shift in the relationship as well 2. Climate change of rubbish (the Western and Eastern of social collapse would be the current as the imperative to properly address this 3. Relations with neighbors Garbage Patches – each is over 600 miles issue of Syria. issue of a type of societal indifference, 4. Relations with hostile societies across); and even outer space in Low-Earth to transform the very privileged training 5. Political, social, and economic factors Orbit is now littered with flying debris. Syria brings to the world stage the we have received to better apply these for problem solving or the quality of devastation that is happening within to the real-world problems that need thinking Reports of what has been happening to the country as well as the mass exodus – actually, require – real remedy and, are all key determinant factors. both the Syrians who have stayed within of refugees fleeing the region, and ideally, healing. Moreover, in actually their country and those who have fled how this affects the wider world. The testing psychoanalytic thinking with these Simply put, the degree of scarcity and show that their environment actually does increasing reports of Syrian state torture, greater challenges, it could open up and the quality of thinking significantly impact on their sense of safety, coherence, sandwiched between a hotbed of even possibly resolve many inconsistencies or determines where on the sliding scale of and ultimately on their well-being and worse militia and sponsored terror groups even unresolved theoretical and practical functioning a social group sits, as well as identity, individually as well as collectively. perpetrating rape, torture, and murder issues within the psychoanalytic field in which direction it will go: towards a Moreover, the leadership and care of how on the remaining Syrians, exporting itself. resolution of its difficulties, or towards the environment is looked after very much their violence around the world. The outstripping its sustaining environment, change every aspect of the well-being of vulnerable populations who are being I want to explore three key concepts that turning on others or itself, leading the population. Institutions like my own subjected to these atrocities encapsulate will need to change for us as a discipline ultimately to implosion. All of these (Psychological Systems), the Institute for an international humanitarian issue on an to truly evolve. The challenges offered aspects have haunting reverberations from Applied Social Innovation, the Green Belt unprecedented scale. Of the nearly three by deeply getting to grips with the issues psychoanalytic thinking. movement in Africa, and the Dicaprio million Syrian refugees who have been focused around societal collapse provide an Foundation, are helping to bring these able to leave the country, 51% of them are essential framework for us to adequately Returning to the focus on societal collapse, relationships between our environment under 18 years old, and there are increasing visualize these problems. Tainter’s earlier work focuses on balance and our overall health more to conscious questions of what will happen for an entire and sustainability where outstripping the attention. Therefore, if we are ignoring population of basically children. 1. By looking at the worst aspects of tipping point will overwhelm resiliency these difficult global realities, it carries human capability, without miring and the planet’s self-recuperative capacity. with it tremendous implications that are The very real horrors facing millions ourselves or getting lost within these One concept critical to this paper is that likely affecting us more than we actually of people may seem literally a world exemplars, we need (much in the way there are many ways to describe tipping realise. away from the germane application of an aircraft pilot trains for the worst points, and these are likely to link to psychoanalytic thinking. The traditional situations) as psychoanalysts to ‘grasp aspects of further variants of deeper Bringing in psychoanalytic thinking analytic, aloof reflective screen held the nettle’ and adroitly understand the ruptures and more catastrophic outcome In linking and reviewing the in the popular imagination, as well as nature of these transformative triggers types of societal collapse. It would be environmental context and the internal a professional self-identity, requires for collapse – whether this be on an missing an important link if I were to spectrum of functioning, we can better updating. There is tremendous value in individual basis or on a larger social level. ignore the similarity between the social underline and offer an understanding bringing the penetrating insights from and individual psychic functioning, where that such environmental circumstances psychoanalytic thinking into examining 2. As a discipline we need an integrated analogous ruptures or collapses can occur actually do affect people’s mental state, perhaps a new level of interlocking spectrum of illness and health, and with corresponding similar levels of their health, their intergenerational and complexity not previously appreciated this also needs to be environmentally disruption in both. even genetic well-being (Hosin, 2016). within human history. To update the contextualised. Without this real-world At its most extreme, these weakening or adage, ‘When you see the writing on the grounding, I argue, psychoanalytic World climatology and geological events vulnerable states of health can contribute wall, read it.’ However, I want to postulate thinking, never mind ethical frameworks, have always had some degree of impact to a profound health breakdown that can a further layer of process: namely not break down. on human populations throughout history. be both a contributing factor to and an just reading it, but understanding and However, factors that have contributed to NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 17

built to identify pathology. Developing 7. Progressive degradation of human a less shame-based focus provides a values and quality of life hopeful and more connecting context, one in which primary and tertiary To deeply understand the roots of how aspects of neurobiology and emotional these problems begin and interact, as neuroscience describe core aspects of well as how to profoundly ameliorate this human functioning, and could proffer dysfunctionality, has begun to force a sea a direction for what needs to be done to change in how we are modelling reality- help the person either on an individual or based responsibility towards addressing collective level. issues.

I would highlight these as the potential The benefit of thoughtfully being able to factors that could offer the biggest sit with the extremes of situations, such difference, enabling us to evolve to a as the implosion of society, is much like healthier capacity: the rigorous, real-time training that pilots Shame  Confidence are required to undertake to acclimatize Mistrust  Trust within simulation for both human factor Illness  Health issues and mechanical failure. Freezing  Action Distress  Joy There are few similar elements available Disconnection  Connection except within a military context, where Disfranchisement  Leadership the breakdown of the ‘social contract’ is synergized within the risk of political We know that the first column of uncertainty (for example MARO – Mass emotional responses can contribute to Atrocity Response Operations (Sewall et creating vulnerability. By improving these al., 2010)). But within the psychoanalytic factors, one can potentially change health sphere there is no clear pooling of and well-being, which will naturally collective evidence base or standardization, generate greater levels of emotional especially of a full spectrum of not response and capacity within the second only severe pathological states, but also column. what the corresponding opposite side of the spectrum, the healthier and higher The increasing centrality of climate states of consciousness, would look like change, even within psychoanalytic individually as well as collectively; or, how thinking (see Weintrobe, 2012), describes these would function. the interconnected indebtedness and dependency that comes hand-in-hand Returning to my earlier point, it is with being planet- and society-bound. In likely that a fully trained psychoanalytic more clearly understanding that we are practitioner may never come in contact, actually a part of nature, and not merely in his or her training, with thinking its assumed master, requires a significant about the causes, aspects, implications, depth of insight and contextualised and possible interventions for multiple perspective. These challenges escalate modeling in worst case scenarios. when the dynamics between power, Moreover, no such evidence-based link potential, and abuse crescendo. Bowles may be made to how the individual outcome of social collapse. For instance, have contributed to a threat multiplier et al. (2015), in a recent RSM Journal dysfunctional behaviour may have links disease epidemics such as with WWI and in continually tipping the country article ‘Climate change, conflict, and to these social collapses; for example, the 1918 Spanish influenza outbreak co- further into the outbreak of war and health’, connect the the relationship with a natural catastrophe. Yet it is worth occurred when there were extreme stresses greater degrees of societal collapse. between these factors for resource mis- highlighting that the psychological that significantly reduced resilience factors. These accumulated factors can spiral management and a resultant increase in trauma effected by war, societal collapse, into competition instead of cooperation, perceived or actual scarcity. This kind of epidemics, etc. all dramatically influence which changes the direction from care description begins to resemble a more long-term and intergenerational physical ‘Increasingly toward coercion, where usually the most nuanced psychoanalytic formulation, one and mental health stress responses. psychoanalytic vulnerable are worst affected. between the interpretation of subjective reality, and the negotiation of conflict Bowers and Yehuda (2015) have found thinking has been Standard psychoanalytic thinking, such as that actually determines which road of that these physical, behavioural, and required to look examining the psychic defensive processes reality is ultimately created. Will it be the epigenetic stress responses are indeed of projection, denial, splitting, and jealous direction of care or coercion? passed on intergenerationally. Equally, at vastly different or envious attacks, to name just a few, are the full range of more extraordinary aspects than it usually conceptualised as individual intra- In clearly articulating, for example, within higher capacities of human feats of psychic or dyadic processes. a spectrum of health (from very ill to mind and body would be just as likely to was originally profoundly healthy) it can be helpful be left without mention or thoughtful designed for.’ At least in psychoanalytic theorising, these to look at what are the best interventions exploration in decontextualizing this processes are limited in their number and to use to assist improving well-being. spectrum of functioning. But without By changing one aspect, an entire scope as identifying pathology instead of Increasingly the scale and complexity fitting an integrated spectrum together, directional shift can evolve in two very being seen in relation to what might be of psychoanalytic thinking has been a real sense of context and meaning will different directions, either toward illness required to heal or transform suffering in required to look at vastly different aspects naturally be lost, just like the personal or in the direction of health. To develop a more meaningful way; or perhaps what of impact than it was originally designed subjective narrative is shared with a a more recent example, the Syrian needs to be done merely just to survive. for. As Ross and Ross (2008) define, a larger social-political reality. This is, in conflict is the first war in history that It is also worth highlighting that social- commonly held notion of complexity its essence though, a powerful portion of scientist have explicitly linked to climate emotional processes share a ‘group-mind’ includes issues of: the psychoanalytic interpretation, which change. Syria has been and is very much that can function in many ways like a 1. Instability can help in assembling the métier of this the focus for the world fighting for oil stronger personality presence, and can 2. Unintended consequences context as well as helping to distill the reserves, and it provides clear indicators have many of the collective responses that 3. Vicious circles and error loops meaning. for social and political mismanagement might be present within an individual. 4. Problem of scale the world over, which has led to global 5. Non-robust solutions and redundancy rising temperatures. All of these factors In highlighting the traditional approach, 6. Cross-domain interactions psychological diagnosis has been purpose- Continues on page 19 18 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6

10 May 2016 4 June 2016 25 June 2016 Diary The value of things: Over the rainbow and beyond... Antisocial personality disorder – Political alienation and an exploration of sexuality and Treating the untreatable? APRIL psychoanalytic action psychoanalytic thinking in the Jessica Yakeley Robert Hinshelwood 21st Century WPF, 23 Magdalen Street, London SE1 Alessandra Lemma, Leezah Hertzmann 19 April 2016 Institute of Psychoanalysis, 112a Shirland http://wpf.org.uk St Alban’s Centre, Baldwins Gardens, psychoanalytic reflections on Road, London W9 London EC1 the work of Hanna Arendt http://psychoanalysis.org.uk/events 28 June 2016 www.birkbeckcounsellingassociation.org David Bell Psychoanalysis, Politics and 13 May 2016 Institute of Psychoanalysis, 112a Shirland Indifference Road, London W9 Working with Traumatised Children 4 June 2016 Joshua Cohen in Special Educational Settings http://psychoanalysis.org.uk/events Monsters ‘R’ Us: Do we create them Institute of Psychoanalysis, 112a Shirland Nina Wessels, Alessandra Cavalli or do they create us? Road, London W9 SAP, 1 Daleham Gardens, London NW3 Martin Weegmann, Gwen Adshead http://psychoanalysis.org.uk/events 23 April 2016 www.thesap.org.uk/sap-events IGA, 1 Daleham Gardens, London NW3 Assisted Reproduction: www.groupanalysis.org Emotional and Identity Implications JULY for Parents and Children 14 May 2016 Working analytically with 4 June 2016 Susan Golombok, Joan Raphael-Leff, 2 July 2016 Katherine Fine, Lesley Caldwell, Brian early relational trauma and The Effect of Omnipotence on the borderline states of mind A Jungian Approach to Early Feldman, Alessandra Cavalli, Julia Paton Analyst: Resonance, Dissonance Marcus West or Silence? Relational Trauma Wellcome, 183 Euston Road, London NW1 Friends Meeting House, 173 Euston Road, Francesca Hume, Ignês Sodré, Jane Marcus West www.thesap.org.uk/sap-events London NW1 Milton, Richard Rusbridger, John Steiner Friends Meeting House, 91 Hartington http://agip.org.uk/activities/cpd-events Royal College of Physicians, Grove, Cambridge CB1 23 April 2016 www.thesap.org.uk/sap-events Being and Doing: 11 St Andrew’s Place, London NW1 17 May 2016 From Theory to Technique www.melanie-klein-trust.org.uk/events Mary Morgan, Andrew Balfour, Psychoanalysis, Colonialism, Racism 2 July 2016 Susanna Abse, Catriona Wrottesley Stephen Frosh 7 June 2016 Bion’s Legacy: Twenty-First Century Transformations TCCR, 70 Warren Street, London W1 Institute of Psychoanalysis, 112a Shirland Fundamentalism Ronald Britton, David Tuckett, www.training.tccr.org.uk Road, London W9 John Alderdice http://psychoanalysis.org.uk/events Institute of Psychoanalysis, 112a Shirland Rudi Vermote, Irma Brenman Pick, Road, London W9 Chris Mawson 29 April 2016 21 May 2016 http://psychoanalysis.org.uk/events University College London Working with dangerous minds www.ucl.ac.uk/psychoanalysis and vulnerable bodies Archetypes: Hit or myth? The Notion of Archetypal Transference in 10 June 2016 Stanley Ruszczynski, Marcus Evans, Clinical Practice Today Stephen Blumenthal, Jina Barret, Freud’s Third Lecture on 5 July 2016 Martin Schmidt Psychoanalysis Steve Mackie, Razwana Jabbin, What’s Wrong and What’s Right Wellcome, 183 Euston Road, London NW1 Led by Sara Collins with MoneY Kate Bond, Geraldine Akerman, www.thesap.org.uk/events/annual-lecture BPF, 37 Mapesbury Road, London, NW2 Michael Rustin Felicitas Rost, Lorraine Maher www.britishpsychotherapyfoundation.org. Institute of Psychoanalysis, 112a Shirland Tavistock, 120 Belsize Lane, London NW3 24 May 2016 uk Road, London W9 http://tavistockandportman.uk/training/ Working in Fear: Memories of http://psychoanalysis.org.uk/events conferences-and-events Psychiatry and Psychoanalysis during the Argentinian Dictatorship 11 June 2016 Treading on egg shells – Working 9 July 2016 26 April 2016 Catalina Bronstein Institute of Psychoanalysis, 112a Shirland with the emotionally complex client Whither Oedipus The European Unconscious Linde Horseman in Traumatic Times: Some Road, London W9 Elizabeth O’Loughlin Psychodynamics in Hate and http://psychoanalysis.org.uk/events Enfield Counselling Service, St Paul’s GCS, 52/53 High Street, Stroud GL5 Prejudice Centre, 102A Church Street, Enfield EN2 www.gloscounselling.org.uk Jonathan Sklar 28 May 2016 www.enfieldcounselling.co.uk Institute of Psychoanalysis, 112a Shirland The Psychoanalytic Setting 10 July 2016 Road, London W9 and The Fate of Pain 12 June 2016 ‘Frida’ (2002, Julie Taymor) http://psychoanalysis.org.uk/events Jeff Eaton ‘Goya in Bordeaux’ (1999, Carlos Christopher Cordess Quaker Meeting House, Edinburgh Saura) ICA, The Mall, London SW1 MAY http://sapp.org.uk/events/ Peter Evans www.psychoanalysis.org.uk ICA, The Mall, London SW1 3 May 2016 28 May 2016 www.psychoanalysis.org.uk 12 July 2016 Climate Change in the Culture A Psychoanalytic Attitude: Conviction and Cooperation: of Uncare Becoming a Welcoming Object 14 June 2016 Facing the Problems We Can’t Solve by Ourselves Sally Weintrobe Jeff Eaton Psychoanalysis and Feminism: Institute of Psychoanalysis, 112a Shirland Quaker Meeting House, Edinburgh A Modern Perspective David Tuckett Road, London W9 http://sapp.org.uk/events/ Ruth McCall Institute of Psychoanalysis, 112a Shirland http://psychoanalysis.org.uk/events Institute of Psychoanalysis, 112a Shirland Road, London W9 29 May 2016 Road, London W9 http://psychoanalysis.org.uk/events 7 May 2016 A Psychoanalytic Process: Listening http://psychoanalysis.org.uk/events 14 July 2016 Understanding the Effects of to yourself listening to another Problematic use of Attachment Style on the Jeff Eaton 21 June 2016 internet pornography Teenage Years Venue tbc, Edinburgh The antisocial elements in society: Heather Wood Niki Reeves http://sapp.org.uk/events/ psychoanalysis and government WPF, 23 Magdalen Street, London SE1 GCS, 52/53 High Street, Stroud GL5 Stephen Groarke http://wpf.org.uk www.gloscounselling.org.uk JUNE Institute of Psychoanalysis, 112a Shirland Road, London W9 8 May 2016 19 July 2016 1 June 2016 http://psychoanalysis.org.uk/events ‘Lust for Life’ (1956, Vincente The Challenge of Change: Minnelli) Filming the Body in Crisis: Psychoanalysis and Trauma, Healing and Hopefulness Sue Harris 25 June 2016 contemporary culture Davina Quinlivan, Caroline Bainbridge ICA, The Mall, London SW1 THE EMERGENCE OF Margot Waddell Freud Museum, 20 Maresfield Gardens, SYMBOLIC IMAGINATION www.psychoanalysis.org.uk Institute of Psychoanalysis, 112a Shirland London NW3 Warren Colman Road, London W9 www.freud.org.uk/events/ SAP, 1 Daleham Gardens, London NW3 http://psychoanalysis.org.uk/events www.thesap.org.uk/sap-events NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6 19

Turning a blind eye But what would having an integrated, Dr. Richard Sherry, the founder of compassion-based and developmentally- Psychological Systems Ltd, has worked stepped sustainable approach look like? continued from page 17 for more than fifteen years treating aspects of psychological trauma. I propose it would would include: Within his work he has specialised in One of the hallmarks of psychoanalytic The Syrian refugee crisis demonstrates • Points of focus for meaningful change assessing and treating vulnerabilities thinking is that it is supposed to be able that most of the approaches previously • Integration of steps towards creating in both individual and organisational to think through issues and aspects of used do not actually address the compassionate change systems and their interactions. He’s a difficulty. However, has psychoanalysis psychological roots, nor for this matter • Establishing processes of Feedback Psychoanalytic Psychotherapist, Licensed been guilty of what is a shared blind the root problems at all. As Hosin (2016) and Dynamics Changes HCPC Clinical Psychologist, and expert spot – namely missing the larger outlines, issues such as the refugee crisis, in Psychological Traumatology. He has interconnected cycles of destructive the international escalation of terror and We need to acknowledge that change expertise in Neuropsychology, Ethics, acts, and their resultant creation of violence, and, as I am adding to this work, comes from: starting with single points of and Extreme Environments. He works vulnerability? environmental problems, appear to be intervention; building upon on creating now in private practice and runs the compounding and may even contribute stable sustainable blocks of work; these Institute he has founded, the Institute for What are the possible implications to increasing the scale of hyper- then need to establish cycles of positive Applied Social Innovation (IASI) where he for not looking at issues that could be dysfunctionality that could lead to further meaningful transformation, that then apples psychological and psychoanalytic fundamental determinants that can unintended knock-on effects. can be supported in dynamic process of approaches to improving health and well synergistically impact on the well- sustainable health. As such, psychological being around the world. being of the individual, never mind the ‘The Syrian crisis and medical health models actually planet? I believe this linked concept of need to link up with compassion-based conflict, environment, and psychic state demonstrates that ecological concepts to provide such a level References has not been adequately understood, or of integrated health. Weintrobe’s (2012) Bowers, M.E., Yehuda, R.Y., (2015) most approaches Intergenerational Transmission of Stress in actually addressed, within any aspect of collected work of opening up the dialogue Humans. Neuropsychopharmacology Reviews psychoanalytic conceptualisations, to the do not address describing the psychoanalytic defenses Neuropsychopharmacology (17 August 2015) degree that it appears this may drive actual doi:10.1038/npp.2015.247 against climate change is an excellent Bowles et al., (2015) ‘Climate change, conflict, and psychical conflict – never mind adequately the psychological example of how practical and applied health,’ J R Soc Med, October 2015; vol. 108, 10: understanding this phenomenon to develop roots.’ thinking can be developed to achieve such pp. 390-395 interpretations or interventions to try to Daniels, J.K., McFarlane, A.C., Bluhm, R.L., Moores, an aim. K.A., Clark, C.R., Shaw, M.E., Williamson, P.C., reverse these processes. To understand this perspective we face as Densmore, M., Lanius, R.A., (2010) Switching between executive and default mode networks a collective profession, change is required. Present models for Mental Health and in posttraumatic stress disorder: alterations in This brings in the third theme. What does If we can actually develop an awareness Vulnerability are in my understanding functional connectivity. Journal of Psychiatric it mean to heal a concept, a discipline, or and choice in what direction of health almost too limiting and potentially Neuroscience. 35(4), pp. 258-266. everything that needs to come from this Decety, J., and Cacioppo, J.T., (eds.) (2011) The we are heading, this is, to paraphrase the shaming for all concerned. Established Oxford Handbook of Social Neuroscience. Oxford: transformed reconceptualization? astronaut Neil Armstrong, ‘One small step psychotherapy or trauma models for Oxford University Press. for man, but one giant leap for mankind.’ treatment on this scale need significant Diamond, J., (2005) Collapse: How Societies Choose Creating a new compassion-based redevelopment. What I have briefly to Fail or Succeed. New York: Viking Press. leadership model for medicine and Donaldson, T., Durfee, T.W., (1995) Integrative Being cognizant of what kind of steps outlined with the ICDS model could Social Contract Theory. Economic Philosophy, vol. psychology – and therefore seeing how we are actually making could, in essence, be an enfranchising, sustainable way to 11. pp. 85-112. these innovations can stimulate valuable address these very real needs to develop a Hosin, A., (2016) Psychological Impact of Disaster ameliorate needless pain and suffering the on Displaced Populations and Refugees of Multiple developments within psychoanalytic work world over. more robust compassion-based framework Traumas. in Ciottone, G.R., et al (eds) (2016) – can better help us to understand our that will ensure better levels of care Ciottione’s Disaster Medicine 2nd ed. Elsevier: responsibility to vulnerable populations China. pp. 60-68 Increasing our individual as well as throughout the world. McGilchrist, I, (2009) The Master and his Emissary: and how to create a sustainable system collective thoughtfulness about these The Divided Brain and the Making of the Modern World. London: Yale University Press. for global health. Re-examining the ethical issues is essential to finding ways It is my true hope to reverse the incredibly complicated issues highlighted Northoff, G., Bermpohl, F., Schoeneich, F., and to compassionately resolve rather than destructive cycles in which ecological Boeker, H., (2007) How Does Our Brain Constitute through the Syrian refugee crisis compound them. Perhaps even on an damage and mismanagement have Defense Mechanism? First-Person Neuroscience could perhaps provide a new window and Psychoanalysis. Psychotherapy and individual level within psychoanalytic contributed to increased natural disasters Psychosomatics, 76, pp. 141-153. to compassionately re-conceptualise therapy, we may need to acknowledge and profound psychological distress; where Rawls, J., (2001) Justice as Fairness: A vulnerabilities into insight and strength there may be an unconscious incentive to at the negative edges, even psychoanalytic Restatement. Cambridge Mass: Harvard University. for meaningful change – perhaps have the analysand continue in therapy thinking begins to break down, with no Rogers, W., (2007) ‘Health Inequalities and the ultimately redefining an improved Social Determinants of Health’, in Ashcroft, R.E., longer than might be helpful, thus reciprocal thinking to be able to hold it Dawson, A., Draper, H., McMillan, J.R., (eds.) (2007) framework for better sustainable health, sufficiently to work within. The incredibly Principles of Health Care Ethics 2nd ed. Chapt. 80. creating counterproductive cultures of John Wiley: Chirchister. pp. 585-591. security, and improved leadership the privileged pivot point of positive change over-dependence. Ross, R.N., and Ross, D.E.B., (2008) Walking to New world over. exists where we can selfishly fight over Orleans: Ethics and the Concept of Participatory Regarding psychological health, we need resources and create needless conflict Design in Post-Disaster Reconstruction. Eugene The concept I have been working on for Oregon: WIPF and Stock. to be able to look at a spectrum of well- instead of work to nurture and heal each Sen, A., (2005) Ethics, Development, and Disaster. about five years (connected with 25 years being not in a way that shames, but in a other as well as the wider world. The Digital Library of the Inter-American Initiative on of research and study to arrive at this Social Capital, Ethics and Development of the Inter- way that highlights healthy directions for American Development Bank (IDB). January 11, place of thinking) is the idea of ‘Healing individuals as well as facilitating a path Psychoanalytic thinking needs to 2005. Washington DC: IDB www.iadb.org/ethics. Everything’. Everything can be hurt; for larger positive group change. We also assimilate these insights into the canon of Senior, C., and Butler, M.J.R., (eds.) (2007) The every thought, idea, concept, person, Social Cognitive Neuroscience of Organizations. need to understand the importance of analytic understanding. The very real dys- Annals of the New York Academy of Sciences. Vol organisation, even a society or planet can real relationships and interconnectivity functionality that emerges with destroying 1118. be damaged; equally, all can be healed. between the individual and effects upon the outer environment has just as Sewall, S., Raymond, D., and Chin, S., (Primary authors) (2010) MARO—Mass Atrocity Response the surrounding environment – healing devastating internal impacts as does vice Operations: A Military Planning Handbook. Boston: In a way it parallels an ecosystem, one will help both psychological and versa. If we are not thinking at this level The President and Fellows of Harvard College. in that a bidirectional system can be physical components. of interconnectivity, we will miss arguably Tainter, J.A., (2003, 2nd ed) The Collapse of created. In one direction (toward illness), Complex Societies. New York & Cambridge, UK: the most essential areas of understanding, Cambridge University Press. destructiveness uses force and violence One outcome of the work to innovate and therefore corrective intervention to Weintrobe, S., (ED) (2012) Engaging with Climate to create inequality and subjugation. greater levels of health has included change these cycles. Perhaps in being able Change: Psychoanalytic and Interdisciplinary Perspectives. London: Routledge In the other direction (of health), care, developing a new framework, such as the to actually address these root problems compassion, and nurturing creates a ICDS Model, which stands for Integration; we can create maybe the most fully thriving that positively transforms Compassion; Developmentally-stepped evolved and healthiest world we have yet potentially all aspects of environment and change; and Sustainability. imagined members of that ecosystem. 20 NEW ASSOCIATIONS ISSUE 20 SPRING 2 0 1 6