THE COUCH IN THE MARKETPLACE

THE COUCH IN THE MARKETPLACE Psychoanalysis and Social Reality

H. Shmuel Erlich First published 2013 by Karnac Books Ltd.

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CONTENTS

ACKNOWLEDGEMENTS ix

CHAPTER ONE Psychoanalysis: view from within the box, living out of the box 1

CHAPTER TWO Contributions from open systems, group relations, and systems psychodynamics 9

CHAPTER THREE Working on the boundary and analytic survival 17

CHAPTER FOUR Identity, reality, and inner experience 31

CHAPTER FIVE The identity of the psychoanalyst 41

vii viii CONTENTS

CHAPTER SIX Der Mann Moses and the man Freud: leadership, legacy, and anti-Semitism 45

CHAPTER SEVEN Crossroads of engagement: meeting of minds or isolationism? 61

CHAPTER EIGHT The discontent of the subject and the well-being of civilisation 75

CHAPTER NINE Discourse with an enemy 83

CHAPTER TEN The psychoanalyst between uncanny reality and factual reality 101

CHAPTER ELEVEN A beam of darkness: understanding the terrorist mind 113

CHAPTER TWELVE Paranoia and regression in groups and organisations 123

CHAPTER THIRTEEN The elusive subject and the psychoanalytic study of organisations 133

CHAPTER FOURTEEN Mental health under fire: organisational intervention in a wounded service 145

CHAPTER FIFTEEN Psychoanalytic societies on the couch 167

REFERENCES 177

INDEX 185 ACKNOWLEDGEMENTS

Chapter Three: “Working on the boundary and analytic survival” was originally published in the International Journal of Psychoanalysis (published by John Wiley & Sons in 2003), and is reprinted with kind permission of John Wiley & Sons. Chapter Nine: “Discourse with an enemy” was originally published in: The Inner World in the Outer World: Psychoanalytic Perspectives, edited by Edward R. Shapiro (published by Yale University Press in 1997), and is reprinted with kind permission of Yale University Press. Chapter Eleven: “A beam of darkness—understanding the terror- ist mind” was originally published in Psychoanalytic Perspectives on a Turbulent World, edited by Halina Brunning and Mario Perini (published by Karnac Books in 2010), and is reprinted with kind permission of Karnac Books. Chapter Twelve: “Paranoia and regression in groups and organisations” was originally published in The Systems Psychodynamics of Organizations: Integrating the Group Relations Approach, Psychoanalytic, and Open Systems Perspectives, edited by Laurence J. Gould, Mark Stein, and Lionel F. Stapley (published by Karnac Books in 2006), and is reprinted with kind permission of Karnac Books.

ix x ACKNOWLEDGEMENTS

Chapter Thirteen: “The elusive subject and the psychoanalytic study of organisations” was originally published in OPUS Vol. 2 No. 1: Organisational and Social Dynamics, edited by Laurence J. Gould and Paul Hoggett (published by Karnac Books in 2002), and is reprinted with kind permission of Karnac Books. Chapter Fourteen: “Mental health under fire: organisational intervention in a wounded service” was originally published in Group Relations, Management, and Organization, edited by Robert French and Russ Vince (published by Oxford University Press in 1999) and is reprinted here with kind permission of Oxford University Press. CHAPTER ONE

Psychoanalysis: view from within the box, living out of the box

his book brings together diverse writings of mine from different periods. They do cohere, however, around an underlying theme, Twhich sometimes is explicit and at other times is implicit. They deal with a theme that has preoccupied me throughout my professional career: the relationship between our internal world and external real- ity. We live in both worlds, and have usually become quite adept at integrating them seamlessly. As psychoanalysts, however, we have a somewhat skewed way of ordering and prioritising our perceptions and insights: we view life from within the box, so to speak. We typically place greater value on the internal, psychic world and tend to search for its manifestations in external reality, rather than the other way around. This skewed perception has become our specialty and trademark, and it shapes our understanding and interpretations in ways that are some- times not easily digestible by non-analysts. As a practicing psychoana- lyst, I am deeply committed to this stance. Yet this way of putting it is not entirely accurate. Since its incep- tion, psychoanalysis has coped with the tension between internal and external causation. It is enshrined in Freud’s shift from the more easily graspable, experience-near and trauma-centred “seduction theory” to the relatively experience-distant and more difficult to grasp “fantasy 1 2 THE COUCH IN THE MARKETPLACE theory”. This swing represents a shift in the locus of causality, in what “really matters”, and therefore has far-reaching ramifications that deeply affect one’s Weltanschauung in other areas of living as well. Yet even Freud never quite relinquished his hold on trauma and trau- matogenic causality, and this tension persists to this day. It manifests itself in the present controversies that mark the field of psychoanaly- sis; it is indeed a fair way to understand the divergence of approaches within it. Psychoanalysis has never abandoned the wish to provide its own view and comprehension of social processes. Beginning with Freud’s writings on social and cultural issues, this trend has continued unin- terruptedly, producing a respectable volume of work, and generat- ing fascinating hypotheses and theories. What needs to be addressed, therefore, is the need for yet another book in this area. In attempting to answer this question, I realise that I cannot avoid some sort of personal account if I do not wish to confine myself to a dry schematic answer. On top of my involvement in and curiosity about individual treatment, I have experienced fairly early in my training two additional influences: the importance of a therapeutic commu- nity in intensive in-patient treatment, and Bion’s work with groups as represented in Tavistock group relations conferences. I subsequently introduced a community programme, coupled with intensive indi- vidual psychotherapy, in the in-service adolescent unit I founded and directed in a psychiatric hospital in Jerusalem (Erlich, 1983). Several years later, I co-founded with colleagues OFEK—The Israel Association for the Study of Group and Organizational Processes—to establish Group Relations work in the Tavistock tradition in Israel. I directed and worked on the staff of many conferences in Israel and abroad. Still later, I co-founded and served on the faculty of the Program in Organizational Consultation and Development—A Systems Psychoan- alytic Approach, co-sponsored by the Sigmund Freud and Martin Buber Centers of the Hebrew University of Jerusalem; OFEK; and the William Alanson White Psychoanalytic Institute in New York. During the same time I completed my psychoanalytic training in the Israel Psychoana- lytic Institute and joined the Israel Psychoanalytic Society, where I am a training and supervising analyst, and have served as president and chair of the training committee. Undoubtedly, these parallel trends have informed my activities, my thinking, and my writing. Although at the surface they may represent PSYCHOANALYSIS 3 strikingly different modes of activity, conduct, and intervention, I never experienced them to conflict or contradict one another. On the contrary, I felt that they deeply enriched and complemented each other. Con- cepts from open systems theory served to highlight and make intel- ligible aspects of psychoanalytic practice (especially those pertaining to setting, boundaries, and role). Group relations experience underscored and informed the difficulties in managing boundaries, staying in role, and feeling authorised to do the work. It also served as a unique labora- tory for the interdigitation of person and role, of unconscious dynamics with observable phenomena. The group relations approach, welding as it does psychoanalytic and systemic understanding, has always been for me a convincing demonstration and implementation of psychoa- nalysis, provided that enough discipline is present so as to avoid “wild” psychoanalytic interventions. The psychoanalyst in his1 consulting room is often a very lonely per- son. This loneliness does not prevent him, and in fact may drive him to form ideas about the outside world. The analytic notions provided in this way may reflect the analyst’s understanding of personal dynam- ics, yet they do not take sufficiently into account the cross-operative forces and unconscious dynamics associated with and stemming from the social sphere—group, organisational, and institutional dynamics. It is not entirely accidental that psychoanalytic institutes tend to suffer from major difficulties at the interpersonal and group level—problems of an organisational nature that are often neglected, brushed aside, and typically attributed to personal dynamics and personality issues. In recent years, there has been a welcome shift for psychoanalytic insti- tutes to seek consultation by colleagues who are experienced in consult- ing to organisations and groups; I address this phenomenon in the final chapter. There is, however, a paradoxical side to the analyst’s loneliness. After all, the analyst lives and works within society. As much as he or she may feel shielded or secluded within the consulting room, the external world impacts upon the psychoanalytic enterprise, and its pressures and demands make themselves felt and impinge upon the privacy of the practice. Drastically changing external conditions increasingly ham- per and shape the practice of analysts: economic conditions, coupled with cultural changes, quick therapies, and readily available medica- tion adversely affect the availability of patients and their readiness to undertake the high-frequency analytic demand. In turn, these factors 4 THE COUCH IN THE MARKETPLACE exercise pressure on psychoanalytic practice, but also on training, and eventually on maintaining previously agreed-upon standards, leading to controversies, questioning, and re-examination of basic postulates. The combination of a fast-shrinking world and incredible mobility have resulted in rapid shifts of location and increasing geographical dis- tances, which, when coupled with advancing communication technol- ogy, have created paradigm shifts, like the newly introduced modalities of working at a distance—for example, by telephone, e-mail, or Skype. Last, and certainly not least, the impact of war, violence, and terror on psychoanalysis has yet to be fully explored and appreciated. The impact of external reality and its changing nature is, however, still deeper and more far-reaching. A great deal has been written since the 1960s about the changing character of analytic patients, their markedly different complaints, presenting symptoms, and personality makeup, all of which are attributable, among other factors, to vast cultural and social upheavals. Advances in psychiatric medication and innumerable new competing psychological treatment methods have severely dimin- ished (and in certain areas totally undermined) the status, appeal, and preference for psychoanalysis. In addition, there is a growing trend in many countries towards regulating mental health dispensers, and psychoanalysts traditionally are wary about coping with bureaucratic requirements and legal stipulations, preferring to leave such matters to others. The prevailing consumer culture fosters immediate satisfac- tions and rewards, seeking quick fixes and the ready alleviation of pain, all of which are diametrically opposed to a psychoanalytic approach. In many ways psychoanalysts feel they are all alone and, perhaps like salmon, swimming against the current, or even worse—in danger of finding themselves beached like whales. In addition to all these developments, we must contend with the changes within the culture of psychoanalysis, leaving aside for the moment the question to what extent these reflect the general and over- arching cultural shifts. The simultaneously widening scope of both psychoanalysis and the patients who enter analytic treatment has been equally codetermined by far-reaching theoretical shifts. The predomi- nance of narcissistic and borderline pathologies brought with it major alterations in theory and technique, culminating sometimes in the eradication and loss of previously gained experience and knowledge. Candidates whose analytic experience derives primarily on working with very difficult, nearly treatment-resistant patients, with whom they PSYCHOANALYSIS 5 often have to make heroic therapeutic efforts, tend to be unfamiliar with basic psychoanalytic concepts, so that gradually these become out- moded and anachronistic. I have had to point out and explain oedipal dynamics and intra-psychic conflict to candidates who were otherwise gifted and knowledgeable in much more esoteric areas, and I know of similar experiences of other supervisors. In view of all these shifts and changes, it should come as no surprise that the psychoanalytic identity has become seriously shaky and beleaguered. Identity is indeed one of the threads that run through this book, and for a good reason: identity is a concept that spans the gap between internal and external reality. I start, however, by elaborating certain contributions from other fields, mainly open systems and group rela- tions theory and practice, to the psychoanalytic understanding of exter- nal reality. I seek not only to describe them, but also, where relevant, to increase awareness of their similarity and congruence with certain psy- choanalytic concepts. These concepts are then applied to my conception of how the analyst does his or her work. It finds expression in thoughts about what it is like to live and work “on the boundary” and its implica- tions for the survival of the analyst and perhaps of psychoanalysis. I take up issues of identity next. I consider the relationship between the concept of identity and psychoanalysis, and review and appraise the degree to which it has, or has not, become integrated into the main body of psychoanalysis. I then make some observations about the iden- tity dilemma of the psychoanalyst. A study of an aspect of Freud’s Moses and Monotheism provides the springboard for reflections on leadership and legacy, continuity and change, as well as psychoanalytic identity and anti-Semitism. The theme of the following chapters revolves on the complex rela- tionships between psychoanalysis and some aspects of culture, with the university as a poignant example. I consider the implications of con- temporary cultural values for psychoanalysis, viewed primarily as an agent of change, as well as the role of psychoanalysis, within this cul- tural context, in affecting the well-being of the individual subject. The next topic, broadly defined, is psychoanalysis, enmity, and ter- ror. Terrorism and violence have become a major presence and influ- ence in contemporary living. Depending to some extent on where we live and travel, we are constantly faced with its residues and impinge- ments: in politics, the arts, and movies; in random attacks on schools and public institutions; in the security procedures to which we have 6 THE COUCH IN THE MARKETPLACE to submit whenever we board a flight and, in some places, go to the movies or supermarket. These aspects of modern living call for a better psychoanalytic understanding than merely attributing them to individ- ual psychological aberrations and pathology. Psychoanalytic under- standing can help fathom the nature of an enemy, what he represents, and how and when discourse and dialogue with him may be success- ful. We need a better understanding of the mind of the terrorist, and the way terror and trauma may be part of the identity formation of youth. We also need to reconsider the impact of terror on the analytic space and the analyst’s capacity to function psychoanalytically. The final portion of the book centres on organisational and institu- tional dynamics, understanding, and application. I attempt to demon- strate, along the lines I have developed, how psychoanalytic ideas can be applied to institutional understanding and social intervention. I begin with a study of paranoia and regression in groups and organisations. A particularly valuable concept, borrowed from psychoanalysis, is that of the subject, and I explore its possible meaning within the frame of organisational thinking. To illustrate how some of these themes mani- fest themselves in an actual intervention, I present a consultation to a mental health centre following the murder of several of its workers by a patient. Finally, I address the need, as well as the growing willingness, for psychoanalytic societies and institutions to benefit from consulta- tion, as well as the sources of resistance to seeking such help. This introductory chapter would not be complete without some elab- oration of what I referred to as “Psychoanalysis: view from within the box, living out of the box”. To my mind, this is the paradox that psy- choanalysis represents and speaks to in all its various facets. The dis- covery of the inner world, of psychic reality, constitutes Freud’s major leap of innovation and theory building (1900). The realisation that the only reality we actually know is what our mind is capable of present- ing to us may sound banal and obvious today. Yet it is still quite fresh, because in so many ways our minds persuade us not to believe it, and to trust implicitly what our senses and consciousness present to us. A well-known Talmudic saying states that “A person only has what his eyes can see.” It is the realisation of the restricted nature of conscious- ness that opens the way, albeit with considerable difficulty, to the ambi- ance of the unconscious. This is the pivotal issue for any consideration of internal vs. external reality. Freud’s Kantian pronouncement implies that we are as limited in PSYCHOANALYSIS 7 the perception of internal reality as in grasping external reality. In both instances, what we see is what we get—or better stated: what our mind receives, perceives, and presents to us. This is what makes the neu- ropsychological study of mind so immensely important. To no lesser degree, however, it makes the psychoanalytic study of the mind—that is, of subjectivity—an invaluable beam of light in these dark depths, to borrow one of Freud’s favourite metaphors. We live within the box provided by our body and created by our mind. This box establishes the frame, the contents, and the vectors that define and describe our subjectivity, both conscious and unconscious. This box circumscribes our existence in the numerous, barely told ways which psychoanalysis helps us to comprehend. In turn, and more often than not, such understanding changes something in the nature and makeup of the subjectivity that defines us. We are seldom content, however, with this solitary “in the box” existence. There are inner forces that drive us, often compel us to seek something in external reality—to search for the other who will comple- ment and complete us with his or her otherness. Whether this quest is weighted towards the sameness or the difference of this other is a clinical subspecies of the phenomenon. At the same time we are, of course, the other whom others seek. And so, mutuality and reciprocity of closeness, relatedness, and emotional investment develops. From the psychoanalytic vantage point we may say that while we view life from within the box, we also very much live out of the box. The expression “out of the box” has the additional connotation of breaking out of the confinement of what is habitual, reflexive, and uncreative. It is precisely what I have in mind and am trying to com- municate: I believe that the more we realise how much we live and view things from within the box, the greater our chances to live out of it. To put it in terms of the ideas I put forward in this book: the more we can understand the nature and role of internal reality, the better we may understand its inseparable Siamese twin—external reality.

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