What's Our State of Mind?

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 21 SUMMER 2016

Brexit, The interpretive Where does Publicising project fear, laboratory psychotherapy our 3 and the other come from? profession 8 16need, conflict, trauma, disadvantage and 22arguments in favour of the importance distress. Good services tried to function of preserving ‘deep’ rather than ‘shallow’ as ‘containers’ for whatever came their welfare, and an evolution of purposes What’s our way, and through attentive, containing that was internally driven by service responses, to offer hope of alleviation user and professional experience rather from conflict, distress and need. The than only externally cultivated through book was well aware of how frequently the instruments of an efficiency-seeking state of inadequately this ambition was realised, and cost-conscious state bureaucracy. But but the analysis of these deficits had not why engage in an argument unless you moved much beyond the premises of believe someone is listening? Even in 2005 Menzies Lyth’s theory of social systems both of us were too long in the tooth to mind? as a defence against anxiety. Chapter 3 of consciously suppose that the book would BW, ‘The State of Mind We’re In’, was ‘change the world’, but unconsciously searching for a new way of articulating perhaps we did assume that we were By Andrew Cooper and Julian Lousada the intersection between task related intervening in a world where promoting defences and the pervasive impact of the rational debate about irrational and new audit, performance inspection and destructive forces and developments was a N 17 JUNE we convened a We started writing Borderline Welfare regulation regimes which were a central cogent thing to do – as though somewhere, one-day seminar to revisit around 2002 when the Blairite project feature of the Blairite ‘modernisation’ a sane and thoughtful parent was alive the arguments and thinking was in full swing, and its impact on our project. and potentially available to see sense. We of our book Borderline public sector, mental health services, think we no longer believe this. WelfareO, published in 2005. A week later and indeed everything we know (or is ‘They know exactly what…’ ‘Are we still living we all awoke to the news that Britain had it ‘knew’?) as the British welfare state voted to leave the EU, precipitating what was manifest as both a political project in a Borderline Our own stance resonates with Ken many have called the greatest political and as a lived experience. It was the Welfare world?’ Loach’s comment on his new film I, crisis in the UK since at least the second connection between the two – how it felt Daniel Blake: and what it meant day to day to be a part world war. Our economic and political In using the term Borderline Welfare we of this transformation, and the political It is not an accident that the poor are future now feels, at best, profoundly sought to describe a systemic oscillation forces and visions driving and shaping punished for their unemployment. uncertain. Given the manifest national between the fear of dependency on the the project – that was a central theme of That’s their project, that’s the point, anxiety of the days immediately following one hand and a sense of purposelessness the book’s methodology and argument. that’s what has to happen because the vote, the rapidly engineered and loneliness on the other. We argued We say the impact was ‘manifest’, but their model of society produces coronation of a new Prime Minister has that that borderline welfare is rooted in that is not quite the same as saying we unemployment and if people question generated a strange sense of superficial a breakdown of the capacity to tolerate ‘understood’ it. Indeed, the writing of the that model then they are lost… calm on the one hand, and a deeply ‘unreasonable’ emotional experience, a book was in part an effort to achieve such There’s no point in showing the film troubling suspicion of national illusion fear of complexity which leads to a loss understanding. to them. and somnolence on the other. We have of the capacity for creative thinking and been provided with what we all crave in action that flows from holding onto and Ten years after its publication we are There is no point because ‘they’ are circumstances of group existential anxiety reflecting upon emotional experience. – a seemingly ‘strong leader’. struck by the fact that Borderline Welfare simply not interested in ‘evidence’ of seems to have a continuing relevance in the destructive consequences of their However, we think our underlying belief people’s minds and thinking. It is still It is far too early to say what impact all state was that it would be worth mounting Continues on page 4 this will have on the direction of travel frequently cited, quoted and referenced, of our health and welfare systems in the and from time to time we encounter UK, but notwithstanding Theresa May’s people who regard it is something of a protestations on behalf of the interests touchstone text. But the times have moved of the whole population, the likelihood on, and we wonder whether the book’s is that our deep social inequalities will main arguments and descriptive premises persist, the NHS will remain underfunded are still valid. Or have new forces, and and vulnerable to privatisation, and lived realities and experiences shaped by statutory mental health and social care these forces, entered the picture? Are we services will continue functioning in crisis still living in a Borderline Welfare world, mode. only more so, or are we inhabiting and by virtue of our daily activity sustaining (or In a recent essay called Hope is an sometimes resisting) a different kind of Embrace of the Unknown, Rebecca Solnit organisational and social order than the says: one we tried to describe? It is important to say what hope is not: it is not the belief that everything was, So, what were the main features of the is, or will be fine. The evidence is all welfare environment we described and around us of tremendous suffering and conceptualised in 2005? destruction. The hope I am interested in is about broad perspectives with No contest any more? specific possibilities, ones that invite or First, we believe we thought we were demand we act. It is also not a sunny in a struggle, a contest over something, everything-is-getting-better narrative, perhaps best described as ‘the possibility though it may be a counter to the of meaningful mental health and social everything-is-getting-worse one. You welfare activity’. Our assumption was could call it an account of complexities that the postwar health and welfare and uncertainties, with openings. settlement was predicated on an idea of social and professional responsiveness to

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and there is possibly some truth in that evidence base in the upcoming BPC Editorial stereotype. seminar series, outlined in the article by Ann Scott and Jessica Yakeley. It is easy to understand why many in our profession who work in the public Yet some in our profession remain sector have become disillusioned with suspicious and unconvinced of the merits what has been two decades of increasing of being able to demonstrate that what we Now is managerial (often perceived as ‘right do actually works. Peter Fonagy, perhaps wing’), target driven approaches to our profession’s most prominent advocate service delivery. As Cooper and Lousada for the need for evidence, illuminatingly argue, the profession feels under attack comments how he continues ‘to be the time and wants to mount arguments in surprised by the coexistence of the favour of the importance of ‘preserving inspired thinking of psychoanalysts with “deep” rather than “shallow” welfare… the institutional neglect by psychoanalytic By Gary Fereday driven by service user and professional organisations of scientific activity that experience rather than only externally might ensure the long-term survival of cultivated through the instruments of an our treasured insights into the human efficiency-seeking and cost-conscious state mind.’ HAT WE ARE LIVING BPC’s Future Strategy Working Group bureaucracy.’ through some of the most articulates, while our profession has We need to talk about the evidence, so extraordinary political become ‘adept at keeping our patients’ ‘Little did let’s debate how good the evidence really times since the Second confessions private, we often apply that is and whether more needs to be done, WorldT War is an understatement. When very same sense of protectiveness and we know and let’s discuss how our profession feels we planned this extended 21st edition of silence to all aspects of our working lives, beleaguered in the public sector and New Associations, little did we know that and consequently, we fail to speak with the political debate what we can do to change this. the political and constitutional landscape the general public as fully as we might, landscape would But from that debate we need to build of the United Kingdom and Europe would often to our detriment.’ a confident voice that can speak to the be undergoing so much anxiety and be undergoing public, to politicians, and to policy makers change. Meanwhile across the Atlantic we We need to find our collective voice. But so much change.’ of all political persuasions in a way that are witnessing an equally extraordinary care must be exercised when we find that they hear what we have to say. campaign for the White House. voice to ensure it is heard. In a passionate So how do we take our messages about the piece, David Fanthorpe, a good friend of value of psychoanalytic work to politicians I’m delighted this ‘coming of age’, 21st Andrew Cooper and Julian Lousada, in our profession, argues that as someone on and policy makers of all political extended edition of New Associations their article on borderline welfare, and the political right, he has found reading persuasions? How do we make the carries such a wide breadth of articles Graham Music, in his article on Brexit, New Associations ‘at times a rather painful argument for deep rather than shallow that demonstrate just what our profession argue how high levels of anxiety and experience,’ and cautions us not to ‘dismiss welfare, or respond to our Future Strategy has to offer; whether as a treatment, a stress are leading to a loss of creative right-of-centre policymakers who do Working Group’s challenge to ensure that theory of mind, or an insight into the thinking and, worse, the growth of the support the value of psychotherapy, or engaging in public debate ‘must no longer world of culture and the arts. Long may fear of the other. We are living in very other talking therapies, as seeking only to be regarded as an option but, rather, as an New Associations continue to showcase uncertain times. bolster “neoliberal individualism”.’ obligation’? the extraordinary work that is going on, to help facilitate debate in our profession, Surely now is the time for psychoanalytic Of course the BPC is a politically neutral To be heard we need use the words those and to help us and others navigate and thinking to find its voice. We after organisation and we work to ensure we outside the profession use. ‘Evidence’ is understand the uncertain and anxious all deal with uncertainty with great build dialogue with all political parties. one such word and yet we seem hesitant times we are living in expertise when working with our clients. But as a profession our image can tend to use it, almost as if worried or ashamed Yet somehow we often find it hard to at times to be one of predominantly what it might tell us. Yet there is evidence find that voice. As the article by the left-leaning liberal Guardian readers, of the value of what we do, and we are Gary Fereday is Chief Executive of the exploring the value of research and the British Psychoanalytic Council.

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Society Brexit, project fear, and the other

By Graham Music

No man is an island, on the left have more activity in areas against vulnerability and dependency of rope dangling peril. Maybe more Entire of itself, involved in curiosity, self reflection and could be successfully hitched to another worryingly, watching this led them to Every man is a piece of the continent, empathy (Kanai et al., 2011). set of theories, those based around have stronger anti-immigration and A part of the main. social ranking and its power. In the prejudiced attitudes. If a clod be washed away by the sea, Sadly humans have an in-built propensity psychotherapy world Gilbert is probably Europe is the less. to prefer others who look like us or the person who has emphasised this Thus fear, anxiety or anger generally turn As well as if a promontory were. sound like us, something seen even most as a perspective too often lacking down our empathy circuits, and lead us to As well as if a manor of thy friend’s in babies of a few months old or less in psychotherapy theory (Morrison and function from what are often considered Or of thine own were: (Kelly et al., 2005; Liu et al., 2015). Gilbert, 2001; Gilbert, 2009). Gilbert’s more primitive brain pathways, those Any man’s death diminishes me, Thus the potential for racism and a fear work fits well with an evolutionary that we share with our less sophisticated Because I am involved in mankind, of difference seems to be engrained in frame, and links with research reported mammalian and reptilian ancestors. When And therefore never send to know for whom human nature, but is exacerbated in by Wilkinson and others (Wilkinson, our backs are against the wall we need to the bell tolls; the face of fear and uncertainty, which 2005) concerning how, in stratified fight or flee, not to be interested in other It tolls for thee. is when most of us tend to cling to the social groups, a hurt, insult or upset people’s feelings. John Donne 1572-1631 known. This presumably made a lot of gets handed down the line to another sense in terms of increasing survival in of lower rank, like an ongoing sequence Lots of other research is pointing in a dangerous situations in our evolutionary of ‘kick-downs’, often accompanied by similar direction (Schreiber et al., 2013; past. Such an innate fear of the other can ‘kisses up’ to those of higher status. As 2009). During the risk-taking tasks, ANY OF US WERE be reversed, though, with exposure to Wilkinson and others have emphasised, Democrats demonstrate much greater shocked to the core by other races, even in infancy (Anzures et this happens much more in unequal activity in the left insula, a region the referendum al., 2012), and it is no coincidence that it social settings and societies, and at times associated with social and self-awareness. result, and even more was the most multi-racial conurbation, of stress, pressure and uncertainty. As Republicans on the other hand use their Mso by the campaign and the way it was London, that came out so strongly against Gilbert also emphasises, the social ranking right amygdala more, a region involved conducted, especially its racist undertones. Brexit. We have seen the possibility for system is more highly triggered when in the body’s fight-or-flight system. In many ways this was a protest vote, and more empathy and openness, for example our threat system is activated, while more Amazingly, brain activity in these two whatever the weaknesses of their analysis in the changing attitudes towards gay rights cooperative, compassionate states of mind regions alone predicted whether a person and campaign, Corbyn and his allies had and sexuality in general; change is possible only come online when we feel more at is a Democrat or Republican with 82.9% understood that inequality, uncertainty but less so when we feel threatened. ease and safe, without which we feel less accuracy, which is much better than any and the increasing power of smaller elites trust of others. The affiliative systems, other predictors we have, whether looking have impacted powerfully. What seems ‘Stress and which psychoanalysis works so hard to at genes or parental political allegiance. not to have been learnt from history develop, that allow us to feel dependent, lessons is how at times of serious crisis worry wire vulnerable, uncertain, trigger many of the This kind of research has been coming people become inward and conservative our brains for brain regions involved in trust, emotional through thick and fast recently. Another and, indeed, often xenophobic and regulation and reduced fear. It is not a study (Newman-Norlund et al., 2013) distrustful of the other. This makes more distrust.’ huge leap to make links between highly found that Democrats tended to have sense when we understand just what fear, triggered stress systems, paranoid-schizoid higher activation in brain areas central anxiety and anger does to the brain. The psychological processes involved of anxieties and distrust of the other. to understanding other people’s points course are just those that psychoanalysis of view, such as the inferior frontal We know that stress and worry wire our has thrown such convincing light on. We are learning that those on the political gyrus, supramarginal gyrus and angular brains for distrust. When the chips are Lesson one in psychoanalysis, and for most right tend to have more highly triggered gyrus. Republicans tended to process down and danger looms we can’t afford of us in our own experiences on the couch, fear systems and more easily become social experiences in brain areas which to be open and trusting. Very anxious is that when we are feeling bad, upset or rigid (Carraro et al., 2016). Some research suggested a tighter, less outward focussed fearful children, as well as abused and threatened we often try to project that (Renshon et al., 2013) on the effects of attitude, one which relied more on loyalty traumatised ones, are much more anxious, badness, uselessness or upset into others. anxiety on political attitudes showed how and tradition. This is what Jonathan Haidt and suspicious of difference (Williams et Of course those who are different to us fear tends to make us more suspicious found as well in his study of the morality al., 2015), and the parts of their brains and can be painted as ‘outsiders’ often and wary of others. In one study 138 men and politics (Haidt, 2012). involved in fear, such as the amygdala, are have the perfect valency for receiving such from Cambridge, Massachusetts, watched highly active (Teicher et al., 2014). People projections. It is all too clear from the films and then answered questions. This might also explain why we see with more social fear tend to be more news that these are flying around thick Some watched relaxing images such more conservative political views as anti-difference, anti-immigration and and fast in very worrying ways, with many as of beaches and palm trees, or heard well as racism in those who also have pro-segregation (Hatemi et al., 2013). It is more reports of racist attacks, for example. soothing music. Others had to watch guns at home in America, and are more no coincidence that the research done so Sylvester Stallone’s rather terrifying opposed to lenient immigration and far has shown that people on the political I have often wondered whether film, Cliffhanger. The latter group not right tend to have higher activation in psychoanalysis’ emphasis on early object surprisingly had heightened physiological reactivity after watching two minutes such fear-related brain areas whilst those relations, attachment and defences Continues on page 6

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just a concern to hit the ground running One of the ambitions of a fugitive is Our state of mind and meet the targets. In addition, the to find another place, not an idealised government’s intention to outsource and place, but a place where some prospect continued from front page regionalise adoption work within third of hope can be found. Paradoxically sector ‘hubs’ threatens to uproot and one of our weaknesses might be in the project of social transformation. As 1984 ‘miner’s moment’; the government’s unravel her entire initiative. This is the difficulty of no longer being able to rely Slavoj Žižek once said, it’s not a case project was to break the power of this problem of systematic ‘dismemberment’ on our privileged locations in places like of ‘Father, forgive them, they know not most prestigious, and well organised, of organisational systems and networks the Tavistock, in psychoanalysis, in the what they do,’ but ‘They know exactly public sector professional group – they that previously provided relatively stable security of our professional identities, all what they are doing, and still they carry long ago won the day in relation to social conditions in which therapeutic work of which face a challenge. Perhaps we on doing it.’ Put more mundanely, we workers and teachers. at the ‘coal face’ – the link between need to explore the degree to which we have accepted that the neocon project is damaged pasts, current reparative were caught in the grip of a complacent simply and straightforwardly ideological. Lost and found interventions, and hopeful futures – could defence in which we idealised our At some level this project is also centrally It’s one feature of any true ideology that be made and sustained. standards and thinking, our NICE if you about breaking the spirit, and the it is a closed system of thinking and like, in the belief that our privilege is such action. It may be in crisis, or teetering, integrity, of public sector professionals Fugitive welfare? that we will and should survive regardless themselves in their individual and or shot through with contradictions, but In summary, if the original idea of of what is happening around us. Rather collective role as guardians of the arguments won’t affect the tenacity with borderline welfare we tried to capture on the late side have we had to face that project of a socialised health and welfare which its adherents and propagators cling was about a state of oscillation in a health what once protected us is now at risk and system. Once they can be positioned to its precepts. They cling either because and welfare project, pulled by a range concerned with other things. they ‘do not know what they are doing’ as greedy, non-compliant, backward of forces towards deep and intimate and so other people’s critiques just make looking, incompetent, any defence of their engagements on the one hand, and away no sense, or because they ‘do know what values and practices can be successfully from these on the other, then we now ‘The they are doing’ and have no intention of subsumed within this denigratory think the predominant state of mind is being deterred by the opposition. discourse. predominant one of flight, characterised by: state of mind Ideology, ideology Corralled within industrialised, efficiency- • A retreat in the whole system from now is flight.’ Second, we argued that the impact of driven, digitalised work spaces and the principle of universal, state most policy making was attenuated, systems, hyper-alert to the survival sponsored, compassionate care for the One of us was very taken by a Professor weakened by a failure to engage with anxieties of their organisations and vulnerable and disenfranchised. the emotional and relational complexity the threats of regulatory, performance of Nursing talking at the recent Wounded Healer conference, describing her research of the social processes it is attempting management, inspection, and audit • A flight in the whole system from the to steer, influence or promote. Again, regimes, they enter our ‘space’ as fatigued into nursing careers. She described a principle of equality of need in the process of how the idealism that prompted our assumption was that someone out victims of the logic of the market. face of ‘social suffering’. there might be listening, available for choosing a nursing career necessarily enlightenment, persuadable. Once again In providing a ‘space for thinking and but painfully becomes compromised • A flight in the workforce from by experience at work; however, what sadly we no longer think this is the case. reflection’ about themselves and their any sense of confidence in the On the one hand, engaging in research, relationship to their work, we also enable she noticed was a transition from reparative and relational roots of compromised idealism to crushed idealism argument and policy struggle about them to understand something of the their vocational and career choices – the evidence for one or another variety political as well as the task-related origins in her trainees that was most difficult to people’s ‘true’ professional selves are prepare for. of mental health treatment or social and meaning of their injured state. Their in hiding, conserved mostly as a lost intervention still does seem worthwhile. depression emerges first, then some aspiration, sustained and nurtured There is no one model or culture of The rationalist instruments of the state of their anger, and because we model in a few public sector enclaves, or with respect to evidence-based practice do a ‘space for thinking’, a revival of their ‘meaningful welfare’. The propensity to revived in new and emergent sites in generate creative variety in social life is create some space for meaningful struggle. creativity, determination and belief in the ‘third sector’. On the other hand, we have little faith the possibility of carving out spaces a mark of what it is to be human. Our any more in the idea of evidence-based for relationship-based work in their question is whether we have entered a • A retreat from conditions that sustain genuine and real period of dehumanised policy making. Policy making seems to organisations usually follows. In essence organisational and professional have been entirely subsumed by politics, they recover a sense of vocationally welfare – ‘anti-social welfare’ as one memory, and thus the possibility of participant in the seminar characterised it. and that means ideology. grounded fight. A number of them pursue ‘re-membering’ ourselves. innovative and courageous doctoral If there seems to be something inhuman about the contemporary culture of 1984 revisited? research projects that influence local The difficulty the fugitive faces is in We saw the world through the lens of the welfare and mental health, it is in part and even national practice. These are mounting any effective resistance to the public sector – a belief that instruments because of the suffocating influence of important retrenchments, but if our forces of acculturation and conformity. of the state can and in some form should market rationalities which at worst are analysis is accurate, also small victories on This is an experience many of us be the answer, embodying as they do a a kind of perversion of enlightenment a battlefield where the war is being lost. are encountering, but it is not a clear commitment to principles of universality universalist principles. The struggle we experience because the question that and a thoughtful relationship to the Memory loss face is how to first of all understand comes to mind is whether the fugitive whole body politic, however imperfectly Here is an example of how it feels to be well what is happening to us, for us, and state of mind is a description of our enacted these principles might be at ‘losing’. in ourselves; but second, how we can exclusion or whether it’s a description of any one time and place. Does anyone mobilise hope and political will in the our flight from the complexity of where still believe in the state as conceived by In a recent paper one of us described the search for new forms of meaningful we find ourselves. Put another way, are the postwar British settlement? Is this innovative work of a very skilled and welfare engagement. We are in a damaged we fugitives in welfare or from welfare? a useful point of reference for thinking experienced practitioner in the Adoption state, but in the here and now our task is If that was not confusing enough, how and action in the current period? The field. She has worked for the same local to rediscover reparative drive in pursuit of do we manage ourselves when we find market state seems to have won out over authority for 16 years, and her work is a different and more decent future ourselves both in and in flight from…? the nation state, and the true situation predicated upon this embeddedness of health and welfare now appears to be within an organisation that respected For those of us who were brought up and understandable only if we accept this. We her, supported her practice wisdom, and Andrew Cooper is Professor of Social Work decided to work in the public domain it are not arguing that this is palatable, just which she knew how to influence. But a at the Tavistock Centre and University of is very hard to imagine any other form that it is true. The consequence is that, recent conversation with her disclosed a East London. With Julian Lousada he co- of resistance other than the recovery of for example, the ‘core professions’ are new dimension in the struggle to sustain authored Borderline Welfare: feeling and what we knew and believed in. Clearly we no longer likely to be a site of effective meaningful and engaged welfare work fear of feeling in modern welfare in 2005. cannot abandon the public domain, but struggle for a better world. The junior with vulnerable populations. A sudden perhaps, and uncomfortably, this may for doctors mounted a rather heroic defence recent increase in staff turnover at various Julian Lousada is an organisational the time being at least not be the site of of their cause, but ultimately were levels has resulted in an influx of new consultant with Peopleinsystems and resistance or the site of new ideas. defeated. It dawned on many of us during workers and managers with no apparent former Chair of the BPC. their dispute that this was a contemporary interest in ‘history’ or local innovation,

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satisfaction is always fleeting, and then References Society desire continues on its journey, towards the next thing, the one that, as each of Carrington, A. (2014) (ed.) Money as emotional currency. London: Karnac one wishes, will offer that elusive lasting Carrington, A. (2016) Money matters: Lacanian satisfaction. ‘Currency’ is a word that does clarifications on the functions of money in the psychic economy. Journal of the Centre for Freudian not just refer to money, but to a flowing Analysis and Research (forthcoming) Money movement, too. Freud, S. (1908). Character and anal erotism. SE9. Freud, S. (1917). On transformations of instinct as A devoted follower and daring disciple of exemplified in anal erotism. SE17. Freud’s, Jacques Lacan (e.g. 1994), was Krueger, D.W. (ed.) (1986). The last taboo: Money as symbol and reality in psychotherapy and matters the one to clarify the rather troubling psychoanalysis. New York: Bruner/Mazel Publishers. connection between desire and the death Lacan, J. (1994) Le seminaire. Livre IV. La relation drive, between the prohibition that the d'objet. Paris: Seuil Warner, S. (1989) Sigmund Freud and Money. By Anca Carrington Oedipus complex offers and the more Journal of the American Academy of Psychoanalysis, disturbing impossibility that lurks beyond 17(4): 609-622 the pursuit of satisfaction in pleasure, that is what operates beyond the pleasure principle. Satisfaction is not just forbidden, Postscript: the place of money in the psyche, Freud kept out of reach, under the veil of Brexit and the disruption of phantasy VEN IN TODAY’S almost unwritten yet powerful rules, but rather cashless and increasingly did it within a developmental framework, impossible, other than in the terrifying The recent referendum vote in favour digital and contactless famously linking it to the anal stage and lack of tension that death may bring. of the UK ending its membership of world of exchange, money proposing the well-known equation money the European Union, after 43 years, Eremains a defining component of human = faeces. For Freud, money begins its life has created a great deal of emotional experience. Whether present in material in connection to relatively early bodily ‘Money becomes disruption, as something about it suddenly form or not, it operates as the placeholder concerns, later superseded by the more became represented in very personal and of a third position, opening up the challenging preoccupations of Oedipal a vehicle for painful ways. I encountered this response possibility of desire and the promise of considerations. navigating almost universally, among friends, satisfaction. What can become easily patients, in social media contexts, and the overlooked is that the promise is more My main thesis is that it is particularly triangular more traditional media channels. important than the satisfaction. on this Oedipal level that money takes configurations.’ its well rooted place in the psyche, as Having spent close to a quarter of my life The psychoanalytic literature has, it becomes a vehicle for navigating In that sense, money is best placed to studying and working on matters related now and again, approached the subject triangular configurations. It does this by keep the flow of movement going, from to the economics of the European Union, of money, primarily with a view to offering the buyer, with each transaction, one wish to another, from this promise to I feel inspired to reflect on this response. elucidating the place it occupies in the a way of eliminating the third (say, a the next. It fails each time, as the thing For the same reason, perhaps, I feel more economy of the clinic. In this respect, hat seller), and gaining direct access to that we are all looking for is never quite curious than emotional about the impact considerations around the setting up and the desired object (say, a new hat). This the one we manage to find. This is very of this event on the individual psyche. payment or non-payment of fees have manoeuvre also suits the seller, who can important, as it keeps the search going. prevailed (e.g. Krueger, 1996). use the money to link into to their own The next hat is bound to fit better, the triangular configuration, and to cut the tie A bit of background. The European Union next book could well be the one that of today started life soon after the second The alternative line of exploration between another third (say, a bookseller), answers all the questions. And so, we world war, as a condition of the Marshall I propose (Carrington, 2014, 2016) and a book he or she may desire. The continue our search for that something Plan, bringing together the management is that which seeks a psychoanalytic move from barter to a monetary economy that seems difficult to reach but remains of the coal and steel resources, such that understanding of money in ordinary life, is not simply a collective development that impossible. What really matters is no more weapons could be made and rather than as an element of pathology. benefits society, but a kind of personal not what is missing, but the fact that liberation, a readily available solution to a turned on each other, as the reconstruction something is missing, that a gap is there work got under way (The European Coal Freud (1908, 1917) approached this difficulty about one’s position in the world such that movement and therefore life and Steel Community established in 1951 topic with a degree of hesitation, and that never quite gets resolved. become and remain possible. A bit like in by the Treaty of Rome). some argue that this was because his the number slide puzzle which can never own relationship to money was largely I argue that money offers a promise, be complete, but which would not work The version joined by the UK in 1973 difficult and unresolved (Warner, 1989). because one triangle is never enough, without a missing piece. was one where the gains from free trade On the few occasions that he considered neither are one hat or one book. The were openly pursued, and where ‘in was Money works because it fails, and we better than out’, but not necessarily a first need its failure as a silent guide in our choice. Indeed, soon after joining, the UK continued search for a satisfying path that held a referendum about the continuation remains on the side of life of this membership. The UK navigated this second best scenario by being both in and out, that is to say in, but with Anca Carrington is a psychotherapist who exceptions, special terms and footnotes. trained at the Tavistock Centre in London, One notable exception was not taking after a career as an economist, both in part in EU’s most poignant development, academia and the civil service. After several the introduction of the single currency years of working in the NHS, first at the (Carrington, 2003). While guided by Tavistock and Portman NHS Foundation carefully designed economic criteria, this Trust, and then at the South London and move remained purely political, as in the the Maudsley NHS Foundation Trust, she run up to the introduction to the euro the is now a psychotherapist in full-time private so-called convergence criteria were strictly practice. Contact: [email protected] met by only one country, the smallest of all: Luxembourg.

The options of in and out were, and remain, of a second best kind. Neither is free of consequences, which could be translated into costs and benefits, some

Continues overleaf

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Brexit Money matters

continued from page 3 continued from previous page

other liberal policies, as Kerry O’Brien fear about economic ruin and the like, easier to articulate than others. Remaining EU, the enemy, danger and target is the found in a recent study (O’Brien et al., devices bound to stir up conservative would have involved being included in a idea of further members leaving, the so 2013). A state of mind in which fear fear responses. Unfortunately too few changing organisation, in which the usual called risk of contagion. is prominent often gives rise to more were standing up and fighting for how UK position of selective exception would suspicion and less likelihood of caring for we are better together, for what we gain become harder and harder to negotiate The outcome of this vote constituted an others. Perhaps this links with the Brexit- from immigration, multiculturalism, and and to sustain, as the European Union action on a scale that disrupted established related arguments of Kaufman, writing being part of a greater whole which can, continues to move into unknown territory, phantasies, as it raised the question of recently for the Fabian Society (Anon, whatever its weakness, fight for a better as it is confronted by new challenges, both one’s position (individually, as a voter, n.d.). He showed how Brexiters were also and safer world internal and global. Leaving involves collectively, as a country), made one’s more likely to be supporters of capital another kind of uncertainty. position something that can be questioned. punishment, and also more likely to want to harshly punish those who commit Graham Music (PhD) is Consultant The choice presented was not between Leave or remain, each offered the illusion sex crimes. Kaufman argues that there Psychotherapist at the Tavistock and change and the absence of change, that change can be avoided. But the is a ‘close relationship between feeling Portman Clinics and adult psychotherapist but between two kinds of change. The difficult truth is that change remains fearful of change, desiring certainty, and in private practice. His publications include referendum provided a brusque reminder inescapable, and that the future is calling for harsh penalties for criminals The Good Life (2014) and Nurturing that the world we live in is ultimately uncertain. and discipline for children. These are Natures (2nd edition 2016). He has uncertain, and brought to the fore a sense people who want a more stable, ordered a particular interest in exploring the of feeling unprepared and bereft. Messages are addressed, reproaches, world. By contrast, those who seek change interface between developmental science pleas and threats are made in turn: to the and novelty are willing to embrace and psychoanalysis,, particularly with It may well be that the EU, the one phantastic Other that provides or allows immigration and the EU.’ regard to clinical work with maltreated without the UK, will change in such a for freedom, the horrible Other that robs children and adults. He broadcasts and way that it would make it desirable to the or deprives, the cruel Other who prohibits. What much research is suggesting is that teaches, lectures and supervises on a range UK again, but also change in a way that An overheard conversation sums this all when people are suspicious, fearful and of trainings in Britain and abroad. would not have been possible without this up: ‘I woke up thinking that nothing would things are going badly, they tend to have disruption. change, and now everything has changed.’ more activation in areas of the brain such as the insula, central to disgust and fear, We know, clinically, that a new phantasy and less activation in brain areas to do References ‘Leave or remain, cannot be created overnight, that it takes with empathy, curiosity, trust or openness each offered the time to find a way that makes being in Anon n.d. Brexit Voters: NOT the Left Behind. Fabian to novelty. Society [Online]. [Accessed 3 July 2016]. Available the world into a stable and rewarding from: www.fabians.org.uk/brexit-voters-not-the-left- illusion that construction, and that it is dangerous to I am not arguing that ‘it is our brains what behind/ expose abruptly the impossibilities that Anzures, G., Wheeler, A., Quinn, P.C., Pascalis, change can be did it’, quite the opposite. Our brains are O., Slater, A.M., Heron-Delaney, M., Tanaka, J.W. remain, threatening and impassable, profoundly sculpted by and responsive to and Lee, K. (2012). Brief daily exposures to Asian avoided.’ behind the phantasy. What deserves females reverses perceptual narrowing for Asian our experiences. Research about the brain faces in Caucasian infants. Journal of experimental attention is the function that the and trauma, abuse or stress (Schore, 2009; child psychology. 112(4),pp.484–495. While a member, the UK occupied a arrangement lost through this vote Perry, 2002; Bluhm et al., 2009; LeDoux, Bluhm, R.L., Williamson, P.C., Osuch, E.A., Frewen, rather hysterical position, where the desire offered, so as to learn something about its P.A., Stevens, T.K., Boksman, K., Neufeld, R.W., of the other was to be sustained while its 1998) has shown how when our threat Théberge, J. and Lanius, R.A. (2009). Alterations in configuration and place. systems are engaged, when we sense default network connectivity in posttraumatic stress satisfaction frustrated. With the decision danger, then the bodily and brain areas disorder related to early-life trauma. Journal of to leave, the UK is moving more towards One of the first visible impacts was on psychiatry & neuroscience: JPN. 34 (3),pp.187–194. a more obsessionally neurotic position, central to social engagement (Porges, Boehm, C. (2012). Moral Origins: The Evolution of the £ exchange rate, as the British pound 2011; Ogden, 2006) are turned off. This is Virtue, Altruism, and Shame. New York: Basic Books. where there is (in phantasy) no other became the rejected currency, pushed basic survival. However, the brain areas Carraro, L., Castelli, L. and Negri, P. (2016). The whose demands to be impinged upon by, away, as it suddenly became perceived as hand in motion of liberals and conservatives reveals a potentially destructive vision of self- that are dominant in fear, anxiety, threat the differential processing of positive and negative an invalid avenue to lasting satisfaction. or anger in fact work against those that information. Acta Psychologica. 168, pp.78–84. sufficiency. The territory is difficult and the journey are central to cooperation, empathy or Gilbert, P. (2009). The Compassionate Mind. London: disrupting. Change is trouble, but change Constable-Robinson. The world as we knew it until the 24th of caring for others, and they can rather Haidt, J. (2012). The Righteous Mind: Why Good is also the flow of life give rise to much more small-mindedness People are Divided by Politics and Religion. London: June was the foundation of a rather stable and conservatism. I suspect this is the Allen Lane. phantasy. Now both the UK and the Hatemi, P.K., McDermott, R., Eaves, L.J., EUare searching for a new target for their explanation for many of the findings which Kendler, K.S. and Neale, M.C. (2013). Fear as a Reference suggest that just when you might think Disposition and an Emotional State: A Genetic and resentment. Internally, this seems to take Environmental Approach to Out-Group Political the form of intergenerational or locational Carrington, A. (2003). European Union: Deeper people might be protesting, and wanting to Preferences. American Journal of Political Science. integration or wider membership? A multivariate join together to fight for a better world, in 57(2), pp.279–293. war: the young blaming the old for their statistical analysis. New York: Nova Science fact they often become more conservative, Kanai, R., Feilden, T., Firth, C. and Rees, G. (2011). vote, London blaming the north. In the Publishers Political orientations are correlated with brain more suspicious and less politically active. structure in young adults. Current Biology. 21(8), pp.677–680. Kelly, D.J., Quinn, P.C., Slater, A.M., Lee, K., Gibson, However there is hope. As Christopher Biased Attitudes in US Whites May Influence Policy Red brain, blue brain: Evaluative processes differ A., Smith, M., Ge, L. and Pascalis, O. (2005). Three- Decisions. PLoS ONE. 8(10), p.e77552. in Democrats and Republicans. PloS ONE. 8(2), Boehme found (Boehm, 2012), while we month-olds, but not newborns, prefer own-race faces. p.e52970. too easily fear the other and in fear we Developmental science. 8(6), pp.F31–F36. Ogden, P. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy 1st ed. W. Schreiber, D., Simmons, A.N., Dawes, C.T., Flagan, LeDoux, J. (1998). The emotional brain. New York: also become more conservative, we also W. Norton & Co. T., Fowler, J.H. and Paulus, M.P. (2009). Red brain, Simon & Schuster. Perry, B.D. (2002). Childhood experience and the blue brain: Evaluative processes differ in Democrats have an evolved legacy to fight for justice Liu, S., Xiao, W.S., Xiao, N.G., Quinn, P.C., Zhang, expression of genetic potential: What childhood and Republicans In: American Political Science and not to let injustice be tolerated. He Y., Chen, H., Ge, L., Pascalis, O. and Lee, K. neglect tells us about nature and nurture. Brain and Association annual meeting, Toronto. Available online (2015). Development of visual preference for own- showed many examples of autocratic, mind, 3(1), pp.79–100. at http://fowler.ucsd.edu/red_brain_blue_brain.pdf versus other-race faces in infancy. Developmental Teicher, M.H., Anderson, C.M., Ohashi, K., and greedy or unfair leaders in our hunter- psychology. 51(4), pp.500–11. Porges, S.W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, Polcari, A., (2014). Childhood Maltreatment: Altered Morrison, D. and Gilbert, P. (2001). Social rank, gatherer past being overthrown, and the attachment, communication, and self-regulation. Network Centrality of Cingulate, Precuneus, Temporal shame and anger in primary and secondary roots of this lie in cooperative joint action, New York: Norton. Pole and Insula, in: Biological Psychiatry, 76(4)pp. 297- psychopaths. The Journal of Forensic Psychiatry. 305. banding together to fight for a belief. This 12(2), pp.330–356. Renshon, J., Lee, J.J. and Tingley, D. (2013). Physiological Arousal and Political Beliefs. Political Wilkinson, R. (2005). The impact of inequality: How Newman-Norlund, R., Burch, J. and Becofsky, K. is what we see in all social movements, Psychology, Vol. 36, No. 5, 2015 to make sick societies healthier. London: Routledge. (2013). Human Mirror Neuron System (hMNS) Williams, L.E., Oler, J.A., Fox, A.S., McFarlin, from Occupy to major revolutions, and specific differences in resting-state functional Schore, A.N. (2009). Attachment trauma and the D.R., Rogers, G.M., Jesson, M.A., Davidson, R.J., connectivity in self-reported Democrats and developing right brain: Origins of pathological maybe that is what we need to galvanise Pine, D.S. and Kalin, N.H. (2015). Fear of the Republicans: A pilot study. Journal of Behavioral and dissociation. Dissociation and the dissociative Unknown: Uncertain Anticipation Reveals Amygdala in this moment. A sadness for me is that in Brain Science. 3, p.341. disorders: DSM-V and beyond. London: Routledge, the campaigning Project Fear ruled both pp.107–141. Alterations in Childhood Anxiety Disorders. O’Brien, K., Forrest, W., Lynott, D. and Daly, M. Neuropsychopharmacology. 40(6), pp.1428–1435. sides’ arguments, with Remain spreading (2013). Racism, Gun Ownership and Gun Control: Schreiber, D., Fonzo, G., Simmons, A.N., Dawes, C.T., Flagan, T., Fowler, J.H. and Paulus, M.P. (2013).

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Society The shadow of the Facebook

By Brent Thompson

T TIMES I HAVE thought melancholia. Melancholia, which we ‘What would Freud’s would now call depression, was described opinion be of Facebook?’ by Freud as having similar characteristics ‘What would he think of to mourning except by which the loss configuration for the pre-existing we can always be ‘Friends’ online, and theA internet?’, ‘What would the was unconsciously characterised by dynamics of depression to unfold. also even a manic quality to triumphing implications be for his Metapsychological idealisation and self-reproaching hatred. over mourning itself – dismissing it, or as works?’ The psychodynamics of Facebook Freud distinguished the Melancholic from Individuals psychically predisposed to Freud put it, having no need for the object usage and other social networking services the Mourner, in that the Melancholic the narcissistic basis of depression will to be given up; sure I can always look (SNS) are undoubtedly complex and may be able to recognise whom they inherently project their inner world into them up on Facebook. beyond the scope of this article to assess in have lost but not what they have lost, the Facebook matrix. Facebook may act full. I do think that psychoanalytic whereas the Mourner can recognise both. as an externalisation of a narcissistic Unfortunately it is beyond the scope theories have a lot to say about, and Reasons for this according to Freud were retreat, through regression according of this article to include the clinical contribute to our understanding of recent due to splitting of the ego, whereby the to Freud – via a pseudo or illusionary examples which inspired the link in technological changes and the ego unconsciously identifies with the form of object-relating. In other words, my mind between Freud’s theory and digitalisation of our lives. ‘abandoning’ lost object, giving rise to the I share my thought/photo with you, Facebook, and of course I have not famous quote, ‘The shadow of the object but you are not there; instead it is the given due attention to other theoretical Over 1 billion, or 1 in 6 of our total fell upon the ego.’ Through the process unconscious representation of you that is explanations of the psychological population, use Facebook, making it the of regression, a narcissistic identification there, or rather a lost object. This is then complexity of Facebook usage such as most successful SNS to date. It has had replaces object-cathexis so that the love- met with another unique configuration borderline processes and issues with unprecedented success and is a global relation has no need to be given up and of this matrix – the Like button. The intimacy and isolation. But I do hope this phenomenon. Facebook is a free SNS that the lost love object has been incorporated Like button may in turn further the article has sparked your own thoughts allows you to create an account whereby under the regressive pull to the oral processes of splitting already present in regarding internet and SNS usage. In you can make ‘friends’, upload photos and cannibalistic phase of development (an the ego and lead to further depletions in summary I have put forward that it is not videos, and make comments to ‘friends’ on economically advantageous position). the individual’s mind through projecting Facebook per se that causes depression, your ‘feed’ and see other comments, photo ‘good/loving’ or ‘idealised’ aspects onto but rather that it provides a unique matrix and video that ‘friends’ have posted. A ‘Facebook Facebook. This may take the form of which may heighten the propensity of hallmark feature of Facebook is the ‘Like’ viewing the other’s post in the distorted pre-existing psychodynamics that lead to button, whereby you can ‘Like’ other may act as an idealised fashion in which they may be occurrence of depression, but that also things people have shared, or they can externalisation perceived by the person, and in turn this may also act as a warning for all of ‘Like’ things that you have shared. may lead to idealising distortions in the us with regards to the depressed aspects of a narcissistic person’s own communications, leaving of self, and to maybe err on the side of Psychological research has not ignored the retreat.’ the ego only with the ‘bad/hated’ aspects caution when using Facebook, or the implications of internet usage, and has to unconsciously identify with, and to Shadow of the Facebook may fall upon on brought our attention to a link between paraphrase Freud’s famous quote, The us too. Facebook and depression. Morrison and Through difficulties in the conflict generated by ambivalence, hate towards Shadow of the Facebook has fallen upon Gore (2010), who conducted a study the object. However, we don’t always hear I hope you my article investigating Internet Addiction (IA) the object becomes turned upon the self, and further splits in the ego fuel what about the positive aspects of people on with a large sample, found that those Facebook, either from themselves or from higher in IA or those who used Facebook Freud described at the time as a critical agent (Superego), and we can see the others, so what becomes of idealisation Dr Brent Thompson is a Clinical more frequently were significantly more in this case? Quite often we can see and Psychologist and BPC Trainee, likely to report high levels of depressive self-reproaches, and love is attributed to significant others or the world. With hear others saying negative things about Psychological Therapies Service, Northern symptoms. The causal effects of this were themselves which I would put forward Health & Social Care Trust yet to be determined; however could we the melancholic, the ego becomes impoverished, whereas with the mourner, may be a different form of the same say that Facebook usage causes depression? unconscious process of idealisation. This In addition to this was an association the world has become impoverished. Freud goes on in his paper to give a brief may represent a simple inversion of the between individuals deemed higher in idealisation; perhaps one could say being narcissism and lower self-esteem with account of mania, stating that the content ideally worse than the other. This may References greater online activity (Mehdizadeh, of mania is no different from that of melancholia. However in a manic state, suggest to us other aspects of theory need 2009). A concerning conclusion which to be called in, such as masochism, in Freud, S. (1917). Mourning and Melancholia. SE XIV could be drawn from these papers is that triumph is characteristic over the lost (1914-1916): On the History of the Psycho-Analytic understanding this inversion more fully. Movement, Papers on Metapsychology and Other people higher in narcissism and lower in object, through a dismissal of it. Works, 237-258. self-esteem will use Facebook more and Mehdizadeh, S. (2009). Self-Presentation 2.0: I would put forward that to say Facebook Arguably, another facet of this unique Narcissism and Self-Esteem on Facebook. will report higher levels of depressive Cyberpsychology, Behavior, and Social Networking, usage causes depression is not reflective matrix is that of object permanence. symptoms. Naturally in life we make and break 13, 4, 357-364. of the complex psychodynamics at play, Morrison, C.M. & Gore, H. (2010). The Relationship and that more consideration needs to be relationships with others as time passes, Between Excessive Internet Use and Depression: A In his Mourning and Melancholia some stay some go, therefore mourning Questionnaire-Based Study of 1,319 young people paid to Facebook’s unique contribution and Adults, Psychopathology, 43 (2), 121-126. paper, Freud (1917) was concerned with is an advantageous and adaptive process explaining a pathological disposition to of providing a matrix for a propensity or hypercathexis through its particular for us to engage. But Facebook provides loss to that of healthy mourning, namely an omnipotent quality over loss, whereby

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Theory and practice today: Research The interpretive laboratory

By Bob Hinshelwood

Clinical practice as psychoanalytic research.1

ETER FONAGY ONCE called the support from other disciplines of the psychoanalytic setting psychology, biology and neuroscience. For the ‘interpretive laboratory’. a proper investigation, we should always In fact, he warned against it keep an open mind to weaknesses and Pas unacceptably unreliable. That was a flaws that are irredeemable, so that we brave criticism for a psychoanalyst to should all give up and learn a new trade. make, but it is more easy and common for Criticism has not in fact been lethal so far, those who are not psychoanalysts and and it is worth rehearsing the criticisms This is a single case experiment. It was schools of psychoanalysis to refer to the want to discredit psychoanalysis. and the debates as often and as widely as enough to give a confirmatory nod to the same phenomenon, or whether they possible. theory of relativity. In a very different were used to describe actually different Nevertheless criticisms should always mode, it only required one Columbus occurrences. be listened to, and certainly those that So first, what are the important criticisms in 1492 to sail over the horizon and challenge clinical research. Quite a which we should investigate? find landfall on San Salvador Island The point is that it is potentially possible time ago, Henry Ezriel made a spirited in the Bahamas. That one occurrence to decide quite general questions with defence of the psychoanalytic session as Leaving aside the ad hominem slights established that land existed beyond the a single case, both in natural science an experimental setting. He did so in a on Freud’s character and honesty, there western horizon. The logic of both these and in psychoanalysis. It is not always paper in 1956 at a meeting to celebrate are three criticisms that are most telling. discoveries is the single case study design. necessary to have large samples, and a the centenary of Freud’s birth. Here I First, all psychoanalytic treatments are In natural science the single case study control sample. This is partly because want to indicate the way our clinical unique so we cannot create samples that works. It relies on a rather precise yes/no the psychoanalytic setting is so precisely research is criticised and how we should allow an adequate generalisation. Second, question. Either light rays are bent or they designed and managed, rather like a defend it. The psychoanalytic setting has though there are few cases, they produced are not. There is no in between. Either laboratory experiment. And that, in turn, been the fount of nearly all knowledge large amounts of material over the course there is land beyond the western horizon means that it is more practical to isolate for the psychoanalytically based therapies of a treatment, and thus give limitless or there is not. the single experimental variable, than in that claim insight into the unconscious possibilities for selecting just the right most psychology experiments. as therapeutic. It is the ‘laboratory’ from material to prove whatever you want which Freud produced his discoveries to prove. And the third criticism is the ‘The 2. How to select data though he also used dreams, jokes, subjective bias of any clinical researcher psychoanalytic Traditionally Freud selected his data from everyday slips etc., for support of his view who has to use his own experience as the the free associations and dreams of his that the unconscious and its contents are instrument for understanding his patients’ setting is the patients in a fairly liberal manner. He active determinants of peoples’ lives, experiences. “laboratory” gathered common themes, or sometimes experiences and behaviour. contrasting themes when two clashing I would like to put forward the beginnings from which Freud associations came together (contiguously), He did not publish his major case histories of a debate that will handle all these produced his or he played inventively with puns, because they were successes necessarily, criticisms, so that in the best traditions of and so on. He tried to see narratives in but because they pointed to some new criticism, we will be provoked to improve discoveries.’ acting-out, and biological impulses in discovery. Dora forced Freud to elaborate the rigour of our observations, data and wishes. Unfortunately, his inventiveness his ideas about the transference, and research analyses. There is no reason why such critical in processing his data has given an introduce the notion of a negative form questions should not occur in psychology implicit license to use data in any way of transference; the Wolfman prompted 1. Psychoanalytic research as and in psychoanalysis. In my book, convenient – with the risk of conveniently Freud to postulate the trauma of the unique single case studies Research on the Couch (2013), I showed selecting the finding you prefer to find. primal scene. You cannot get more vital In 1919, the physicist Arthur Eddington that it is possible to look at historical Typically the criticism is that a favoured discoveries for the theory and practice went to India to observe a solar eclipse. It debates in the literature in these terms, theory becomes a yardstick for selecting of psychoanalysis then those. So, if we was three years after Einstein published and find similar crucial cases which can data which are then used to support agree with the critics of our knowledge- his general theory of relativity which decide a much more general point of the favoured theory. It was a criticism production in the clinic, we would have predicted that a ray of light would appear contention (see pages 112-114 of the used by Popper in his condemnation to agree that everything we depend on to bend when passing close to the sun’s book, on nervous tic). I have also given of psychoanalysis as a pseudo-science. daily is suspect and therefore it might be gravitational field. Because of the sun’s an example of a comparative study of The imperative therefore is to ensure 2 ethically dubious to use it in practice. brightness, stars whose light passes close repression and splitting (2008 ) in which that selection of pieces of data is as to the sun can only be seen and located the design used a critical question with unbiased as possible, and can be argued I want to draw attention here to some during an eclipse. In fact Eddington did see two mutually exclusive answers (I called it for independently of the theories being valid responses to the criticisms to a displacement of the stars’ positions when a ‘binary’ question). With that question I evidenced. clinical research, although this is not at close to the sun, and thus confirmed the could then investigate whether ‘repression’ all to decry extra-clinical research, or prediction arising from Einstein’s theory. and ‘splitting’ were used by different

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In my view it is once again possible to after a specific intervention are compared This paradigm gives the psychoanalyst Bob Hinshelwood is Professor Emeritus take this criticism seriously and both with those before, in order to show the a very precise method of making a in the Centre for Psychoanalytic Studies, refute it, and in the process pinpoint effect caused by the intervention. In prediction of what sort of change counts University of Essex; and previously elements of clinical practice which can therapy, we expect to make a difference as a confirmation of the interpretation Director, The Cassel Hospital. He has be made more rigorous. In my book on in the condition of the patient with our (and of the theory on which the written widely on Kleinian psychoanalysis research mentioned above3, I revisited the interpretive interventions. The symptoms interpretation is based). Equally it gives and its application. Currently he is literature around 1950 which reclaimed and the patient’s relationships are a precise indication of what change is not interested in comparative research amongst countertransference as a valuable expected to change as an effect of the indicative of a correct interpretation. It the psychoanalytic schools and published instrument. Later the literature included work of interpretation. Ezriel, mentioned is possible then to identify false positive the recent book Research on the Couch: a degree of caution in the face of the wild above, asserted reasonably: ‘only such indications. Not all changes mean that Subjectivity, Single Case Studies and use of countertransference. To clarify, I forces as exist at a certain time can have an interpretation has had the correct Psychoanalytic Knowledge (2014). quote from Paula Heimann’s second paper, effects at that time’ (Ezriel 1956. p. 35)4. therapeutic leverage. Changes can occur in 1960: Hence we must expect some direct effect after an interpretation simply from the of the insights an interpretation gives. analyst’s tone of voice, from the fact he Notes I have had occasion to see that Again there is an involved description has shown an interest, from the patient’s of this to be given which can be found fear of criticism, and so on. There is 1. In this short article, wherever I use the term my paper [Heimann 1950] also ‘psychoanalysis’ the reader should understand caused some misunderstandings… elsewhere (in Ezriel’s paper). The gist is therefore a considerable power in this I include psychoanalysis and psychoanalytic [some analysts] referring to my that the psychoanalytic understanding of model’s ability to produce significant psychotherapy, and all forms of therapy that respect the ideas of a dynamic unconscious. the unconscious recognises that anxiety results, i.e indications of the value of the paper for justification, uncritically, 2. Hinshelwood, R.D. (2008) Repression and based their interpretation on their provoking and traumatising experiences interpretation and its therapeutic effects. splitting: towards a method of conceptual are held outside of consciousness by one comparison. International Journal of Psychoanalysis: feelings. They said in reply to any 89: 503-521. query ‘my countertransference’, and or other (or combination of) defence 3. Hinshelwood, R.D. (2013) Research on the Couch: seemed disinclined to check their mechanism. This pattern of anxiety- Conclusions Single Case Studies, Subjectivity and Psychoanalytic interpretations against the actual data defence manifests itself in the immediate In perhaps a rather condensed form, I knowledge. London: Routledge. 4. Ezriel, H (1956) Experimentation within the of the analytic situation (Heimann present, the here-and-now, in the form of have tried to show that psychoanalytic psychoanalytic Session. British Journal for the 1960, [1989] p.153). the relationships set up in the therapeutic clinical work can form the basis for our Philosophy of Science 7: 29-48. session. subjective research, which can compare Implicitly Heimann instructs the analyst with other scientific research. I have to check his countertransference. Equally also conveyed that our methods are not it could be read as measuring the material ‘We use a above criticism, but that psychoanalytic selected from the actual associations subjective knowledge.is not invalidated. Rather against the countertransference. Or in criticism serves to help us to refine our other words we might quite explicitly instrument – basic research follow a technique which matches both the mind of the material and countertransference against each other. This process of comparing I psychoanalyst.’ have called ‘triangulation’, a term taken from surveying where a position is located Ezriel then described how the relationship more accurately when observed from a patient constructs is aimed unconsciously two points of view simultaneously. If to avoid some other anxiety-provoking the associations, or a dream, form, shall contact with the psychoanalyst. The we say, a narrative, then that narrative constructed relationship he called the can be compared with the implicit (or ‘required’ relationship, and it is intended unconscious) narrative played out in precisely to avoid an ‘avoided relationship’; the transference-countertransference the latter is unconsciously felt to provoke relationship. some disaster or catastrophe. Ezriel gave an example of a man, at a time in his This is a quite rigorous selective youth when he had been rebellious, requirement and deliberately removes whose father had died; strikingly in the the alternative possibility of measuring therapeutic setting the patient set up a the material (or the countertransference) particularly compliant and un-rebellious against a favoured theory. This relationship. The compliance was triangulating condition is not an easy required in order to avoid rebellion and one to apply in actual practice during a catastrophic outcome – i.e. the death the pressures and pace of an ongoing of the analyst that was unconsciously session. No-one of course has claimed expected to result from rebellion. that psychoanalytic work is ever going to be easy. And the skills recommended Ezriel said that interpretation of that here can be developed, and the best narrative will give an insight, and a psychoanalytic work does seem to respect more robust willingness to face the that condition. rebellion and catastrophe. That increased willingness will take the form of a 3. Indicators and false positives move towards the avoided relationship. The field of psychoanalytic research is the Ezriel’s example was of his patient field of subjective experience. Whereas who had been complaining about the the field can be investigated with objective Government, but after the interpretation methods and objective instruments, it is of his rebelliousness began talking of his characteristic of therapeutic work that we complaints about the Tavistock Clinic use a subjective instrument – the mind of (where Ezriel worked) – his aggression the psychoanalyst – to display and collect had become significantly closer to the the data. analyst (and thus less terror of the unconscious catastrophe). So, in the In fact, the design of this subjective session a prediction can be made of a researching, in line with natural science, change after a correct interpretation involves a cause-effect chain of events, towards material more flavoured with and this resembles exactly an experiment the avoided relationship than before the in the physical sciences. The conditions interpretation.

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place in mental health services, and 260 post-traumatic stress disorder, obsessive- Theory and practice today: Developing theory affirming its centrality. compulsive disorder, bulimia nervosa, or drug dependence. The strongest evidence How can we reconcile the popularity of a is for relatively long-term psychoanalytic set of ideas with the very real criticisms treatment of personality disorders that it faces? As someone who has been (particularly borderline personality involved in this field for over 35 years, disorder). Innovations and I continue to be surprised by the co- existence of the inspired thinking of psychoanalysts with the institutional ‘There is a development in neglect by psychoanalytic organisations welcome increase of scientific activity that might ensure the long-term survival of our treasured of tests of psychoanalysis insights into the human mind. psychoanalytic Of course the canons of scientific treatment.’ acceptability are as culture-bound as all By Peter Fonagy human pursuits. Late 20th and early 21st But just as we are joining this project century culture has prioritised randomised there is every indication that scientific control trials (RCTs) as the gold standard culture is ready to move on. (Readers could with profit consult a recent article The role of evidence for psychodynamic work of clinical research. It is easy to forget that this is a recent development. The by Brothwell et al (Bothwell, Greene, first RCT was performed just after World Podolsky, & Jones, 2016).) There is War Two by Austin Bradford Hill to general disappointment with RCTs in provide an unbiased test of the usefulness relation to their fundamental purpose N 2012, A DEBATE was held at of no continuing value.’ (Salkovskis & streptomycin in tuberculosis. Because – freeing clinical evaluation of bias. the Institute of Psychiatry with Wolpert, 2012, p.1) the approach of randomly assigning RCTs tend to be funded and carried the title ‘Wake Up to the patients to placebos or active drugs is out by treatment developers, especially Unconscious.’ The topic: ‘This In defence, Lemma and I argued that quite cumbersome and expensive, this pharmaceutical companies. In a review of Ihouse believes that psychoanalysis has a psychoanalysis points to key psychological new British invention was hardly used SSRIs for adolescents with depression we valuable place in modern mental health phenomena – limitations of consciousness, for some decades – not until the epidemic showed that published studies were far services.’ The proponents of the motion defences, resistances to treatment, of stillbirths and phocomelia caused by more likely to show favourable outcomes were Alessandra Lemma and I, opposing transference and countertransference. the massive uninformed prescription to this medication than unpublished Sir Lewis Wolpert and Professor Paul If effective psychological treatment is to of thalidomide to pregnant women, ones (Whittington et al., 2004). Elevated Salkovskis. Salkovsksis and Wolpert were be offered, we cannot do without such which led to the mandating of RCTs by risk of suicidal ideation was hidden in unequivocal: basic truths – ‘if psychoanalysis is thrown the US Food and Drug Administration unpublished papers. Analogously, in the out, these aspects of mind will have to in 1970. Very many RCTs followed psychotherapy literature, the outcome ‘…we propose that it is no longer be rediscovered – just like Greco-Roman in pharmacotherapy and soon in of RCTs is well predicted simply from defensible to continue ideas whose culture was rediscovered after the Dark psychotherapy, some small, some large, knowing the therapeutic orientation of time has come and gone and which Ages.’ (Fonagy & Lemma, 2012, p. 2) some well-designed, some shockingly the first author of the publication. have been succeeded by more unscientific. appropriate ones in an area as The debate was the best attended of any Many have also criticised RCTs for only important as health care. It would not Maudsley debate in the 12-year history of Psychoanalytic psychotherapy was late to showing whether a treatment can work be tolerated in cardiology or oncology; that series. The organisers turned away as the game of extending RCT methodology in principle, giving little information why should it be in mental health? many people at least as filled the 350-seat to psychosocial interventions. There was about likely effectiveness in particular In evolutionary terms, psychoanalysis Wolfson Theatre. The votes at the end? no theoretical or practical reason that clinical settings. RCTS are cumbersome; can be regarded as a metaphorical There were 31 abstentions, 38 believing justified this. Psychoanalysts probably by the time the results have appeared, appendix; vestigial and unfortunately that psychoanalysis had no valuable felt reluctant to submit their patients the field has moved on. RCTs should to trial protocols that felt produce generalizable, widely applicable emotionally and ethically clinical knowledge: in reality evaluations incommensurate with are confounded by economic, political their treatment approach. and cultural considerations. Less than Although we are beginning 4% of NIMH’s budget for CBT is spent to become active in this on psychoanalytic therapies. (Those field – there are perhaps distributing research money have explicit more than 180 trials of or implicit views about the value of tests psychoanalytic treatment in of psychoanalytic therapy.) the literature – the number of trials of psychoanalytic Most importantly, RCTs speak to the psychotherapy probably expected outcomes of the average patient amount to less than 5% in a particular diagnostic category. But of the total number of both the categorisation of the disorders trials for CBT. There is and the meaningfulness of an average however a welcome and are brought into question by the rising steady increase of tests of prominence of genetics and precision psychoanalytic treatment, medicine. helpfully summarised in influential journals such But notwithstanding profound as the Lancet and World limitations, RCTs are necessary above all Psychiatry. The bottom to assure ourselves that what we are doing line? Compared to controls, is worthwhile. Until a well-designed RCT, psychoanalytic therapy generations of surgeons and oncologists tends to be effective for recommended radical mastectomies depression, some anxiety to women who would have been disorders, eating disorders equally well treated by far less invasive and somatic disorders. lumpectomies. There are many similar There is less evidence to examples. For psychoanalysis the issue support its application for of RCTs is less about proving our worth

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to funders but rather to assure ourselves a particular individual for a particular that the treatments we are undertaking treatment. We require new person- achieve the goals that we have set and that oriented methodologies for identifying the outcomes justify investment (in terms what works for whom. This is in no sense of energy and opportunity costs to the discouraging; it calls on us to redouble patient, as well as finance). our efforts to use all the tools that science can offer. If the field is to advance, we I do not accept the riposte that patients have to do more than talk about the global can judge for themselves. This is exactly effectiveness of a heterogeneous category what they are unable to do. None of us can of approaches offered to a heterogeneous compare our outcomes to an alternative group of patients. There is much that life scenario. Nor do I accept that we, we can achieve by building on what we as therapists, can observe benefit to our already know and we can learn much patients in routine clinical practice. I more by ‘playful’ experimentation, partly think unconscious doubts about our driven by advances in bioscience, new own value significantly contribute to disciplines like computational psychiatry, our reluctance to undertake scientific the exploration of Big Data, digital investigations. The recent Tavistock interventions and just more systematic Adult Depression Study (Taylor et application of methods already in use al., 2012) may illustrate the intrinsic (outcomes monitoring and measuring limitations of our knowledge as clinicians. early treatment responses). We are at the In this RCT, patients with treatment beginning of a road. And it is an exciting resistant depression were randomised to journey ahead psychoanalytic psychotherapy or control treatment. Although psychoanalytically treated patients improved, they were no Peter Fonagy is Head of the Research better off than those who were managed Department of Clinical, Educational and in primary care with a combination of Health Psychology, at University College medication and other psychotherapies. London. It was not until 18 months after the end of treatment that differences favouring the psychoanalytic approach emerged. Bibliography

Without a trial, the clinician would not Bothwell, L. E., Greene, J. A., Podolsky, S. H., & have been aware of this difference. It was Jones, D. S. (2016). Assessing the gold standard: Lessons from the history of RCTs. New England the continued relative wellness of those Journal of Medicine, 374(22), 2175-2181. randomised to psychoanalytic therapy that doi:10.1056/NEJMms1604593 generated the difference. Fonagy, P., & Lemma, A. (2012). Does psychoanalysis have a valuable place in modern mental health services? Yes. BMJ, 344. doi: 10.1136/bmj.e1211 ‘It will give Salkovskis, P., & Wolpert, L. (2012). Does psychoanalysis have a valuable place in modern us confidence mental health services? No. BMJ, 344. doi: 10.1136/bmj.e1188 that what we Taylor, D., Carlyle, J., McPherson, S., Rost, F., Thomas, R., & Fonagy, P. (2012). Tavistock Adult are doing is Depression Study (TADS): A randomised controlled trial of psychoanalytic psychotherapy for treatment- resistant/treatment-refractory forms of depression. of value.’ BMC Psychiatry, 12(1), 1-13. doi: 10.1186/1471- 244x-12-60 We are about to analyse the results of our Whittington, C. J., Kendall, T., Fonagy, P., Cottrell, trial of dynamic interpersonal therapy D., Cotgrove, A., & Boddington, E. (2004). Selective serotonin reuptake inhibitors in childhood (DIT). As with the TADS trial, we have depression: Systematic review of published versus endeavoured to undertake the long-term unpublished data. Lancet, 363(9418), 1341-1345. doi: 10.1016/S0140-6736(04)16043-1 follow-up because we suspect that it is the way individuals with psychoanalytic psychotherapy cope with life, its tribulations and trials, that is most likely to reveal the benefit of an approach that is not focussed on symptoms but rather on an individual’s conceptualisation of their life, their relationships to others, their capacity to tolerate affect, to feel more emotionally alive, to understand themselves and others in nuanced ways, to live life with greater freedom and flexibility, to clarify their reasons for living, their values, ambitions and expectations for life.

In summary, we need the unbiased examination of long-term outcomes which RCTs are able to provide. In the short term this will also ensure that we meet the minimum criteria for publicly funded treatments. But it will also give all of us confidence that what we are doing is of value. In the long run I am sceptical about RCTs. They show treatments to be reasonably effective for certain conditions, but they cannot assure the suitability of

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Theory and practice today: Research Research: the current debates

By Ann Scott and Jessica Yakeley

AST YEAR, under the main, seminars are compulsory but not auspices of its Advisory formally assessed. In some cases, research Group on Research and the teaching was introduced to accompany Evidence Base, the BPC the development of a professional Lsurveyed its member institutions on the doctorate. In one institution the students complex topic of research teaching. The expressed an interest and there was a aim was to find out what the Member proposal from the seminar leader; in Institutes (MIs) were offering their another the Training Committee took trainees in this area, and what their views the initiative. In general the range of of research in relation to clinical work topics is wide and varies according to the might be. The survey tells us that most institution. Teaching on the evidence base MIs now include research teaching in is varied: some MIs reported that it was their curricula, but that there is ‘not explicitly’ or ‘not directly’ taught, considerable variation in the provision. although it does seem to be covered in the majority of cases. ‘There was perhaps some tension about Seminar 2: Neuropsychoanalysis. The BPC’s 10-part seminar series, this – particularly [in relation] to more Mark Solms (BPAS) is Chair of Research: The Current Debates, which ‘Most institutes quantitative research when we became Neuropsychology at the University runs from this October to June 2017, more psychoanalytically identified, but of Cape Town and co-founder of complements the work of the MIs in include research this has lessened’; ‘There has been some the interdisciplinary International the research arena by providing an resistance from staff because research Neuropsychoanalysis Society. He will opportunity to showcase and engage with teaching, has not been part of their own training give a presentation on neuroscience the differing approaches to research in but there is experience and it is an area they are not and neuropsychoanalysis that will set psychoanalysis and psychoanalytic and familiar with.’ out the current state of research on the psychodynamic psychotherapy. By means considerable relationship between mind and brain, of linked presentations, this innovative variation.’ The BPC’s series aims, then, to contribute consciousness and the unconscious, and series aims to identify and debate the to a greater familiarity with the principles their implications for analytic practice. range of approaches that are now being Perhaps most revealing are some of the of research in our field, and to stimulate (Event date: 4 November 2016) taken in what, as the survey shows, comments MIs made about trainees’ or interest in the contribution that well can still be a contested arena. We are colleagues’ attitudes towards research, designed research can make to clinical Seminar 3: Psychosis. Brian delighted that leading researchers in the showing a movement from detachment practice. The seminars range widely Martindale (BPAS) is past chair of the field will be presenting their own work, or mistrust to a keener engagement: – of course, not exhaustively – across International Society for Psychological and their reflections and perspectives on ‘Some admit to having enjoyed it despite neuropsychoanalysis, psychosis, child and and Social Approaches to Psychosis and current debates. themselves and want to do more’; ‘Initially adolescent psychotherapy, the single-case worked in the NHS for 40 years as a there was a somewhat negative reaction study, attachment, the comparability of consultant psychiatrist in psychotherapy Looking more closely at the survey, but when trainees and colleagues became different analytic models, the nature of a and latterly as the psychiatrist to an early what are we learning? The amount of aware of what research and the findings randomised controlled trial, and outcome intervention in psychosis service. In his time given to research varies widely, can demonstrate in relation to clinical and effectiveness studies. presentation, ‘Psychoanalysis, Therapy and the format is variable also – in one work there was a more positive attitude’; and Psychosis – Research Perspectives’, he organisation trainees have to undertake ‘when introduced there was… a sense To take each seminar in turn: summarises psychoanalytic research into a small piece of research; in another, the of having to endure something. But the psychosis and asks whether psychoanalysis view is that graduates should be able to culture has changed now and there is Seminar 1: Ann Scott and Jessica is losing its foothold even more within ‘read, understand… and use’ the results much more interest from trainees.’ Yakeley. We start with an introductory the field of psychosis than in other of research studies, but not necessarily evening in which the co-organisers of the mental health disorders. (Event date: 25 carry out research; in another there is When asked specifically about resistance series, with the BPC, will speak to the November 2016) collaborative working with a university to the development of a research culture, series’ aims and offer an overview of our department to develop research teaching; responses were mixed. One organisation areas of debate, beginning a conversation Seminar 4: Children and Young in yet another there is no teaching as said: ‘I see no resistance, other than with our audience which we hope will People – The Evidence Base. Nick such but an encouragement to ‘link with an awareness of the difficulties due to be sustained throughout the series. The Midgley is a child and adolescent international bodies doing research.’ the nature of the work’; another: ‘No, introductory seminar will also identify psychotherapist based at the Anna Freud There is also wide variation in the length a number of members are involved in questions and themes to be posed to our Centre, London, and academic course of time over which research teaching research through other (generally NHS) subsequent speakers. (Event date: 21 director for the professional doctorate has been offered – ranging from the institutions’. Others were candid about the October 2016) in child and adolescent psychotherapy last 25 years to the last two. In the more difficult dynamics on the ground: at the Psychoanalysis Unit, UCL. His

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presentation, ‘The challenge of developing therapeutic relationship. (Event date: 24 Seminar 9: Outcome and By bringing clinicians together – whether the evidence-base for psychoanalytic February 2017) Effectiveness Studies. Mary Target qualified or in training – we hope therapy with children and young people’, (BPAS), Professor of Psychoanalysis that the series will have enhanced the is based on his experience working on a Seminar 7: The Comparability of at UCL and Professional Director of development of research awareness and large-scale randomised controlled trial Analytic Models. David Tuckett the Anna Freud Centre from 2003 research understanding in the profession, of psychoanalytic psychotherapy (the (BPAS) is Professor and Director of to 2013, has a longstanding research while giving an opportunity to engage IMPACT study). (Event date: 2 December the Centre for the Study of Decision- involvement in processes and outcomes of and debate with pre-eminent figures 2016) Making at UCL. He set up the European psychotherapies for children, adults and in the field. We look forward to your Psychoanalytic Federation’s Working couples. She has developed and evaluated participation in this exciting initiative Seminar 5: The Single-Case Study. Party on Comparative Clinical Methods short and medium-term therapeutic Bob Hinshelwood (BPAS), Emeritus and, as Editor of the International Journal modalities in public mental health Professor at the Centre for Psychoanalytic of Psychoanalysis in the 1990s, hosted the services. In ‘Outcome and effectiveness of Ann Scott is a member of the BPC Studies at the University of Essex, looks Journal’s seminal debate on clinical facts. psychoanalytic psychotherapy’, she brings Advisory Group on Research and the at ‘Case study research and conceptual In his presentation, he returns to these these different strands together. (Event Evidence Base; Senior Member, British research’. Basing his presentation on core debates, asking how we know when date: 12 May 2017) Psychotherapy Foundation (Psychoanalytic his widely noted Research on the Couch: what is happening between two people Psychotherapy Association); Literary Single-Case Studies, Subjectivity and should be called psychoanalysis. (Event Seminar 10: Reviewing Where We Executor, Isabel Menzies Lyth; Trustee Psychoanalytic Knowledge (2013), he date: 3 March 2017) Are At. Our last meeting is with Peter and Executive Member, The International defends Freud’s claim that clinical Fonagy (BPAS), Freud Memorial Society for Psychological and Social material constitutes research data Seminar 8: The RCT and Professor of Psychoanalysis and Head Approaches to Psychosis – UK Network; while acknowledging the criticisms of Psychoanalysis. David Taylor (BPAS) is of the Research Department of Clinical, Editor-in-Chief, British Journal of single-case studies and the problems a Visiting Professor at the Psychoanalysis Educational and Health Psychology at Psychotherapy. of researching human subjectivity and Unit, UCL, and was clinical director of UCL. His clinical and research interests personal experience. (Event date: 20 the Tavistock Adult Depression Study centre on issues of early attachment Jessica Yakeley is chair of the BPC January 2017) (TADS). Of his presentation, ‘High relationships, social cognition, borderline Advisory Group on Research and the Stakes: Random Allocation Controlled personality disorder and violence. He is Evidence Base; Consultant Psychiatrist Seminar 6: Attachment. Jean Knox is Trials of Psychoanalytic Treatments’, he well known for an innovative research- in Forensic Psychotherapy; Director, Associate Professor at the University of writes: ‘Properly designed, Randomized based dynamic therapeutic approach, Portman Clinic; Director of Medical Exeter and a Senior Member and Training Controlled Trials are a wager. They Mentalization-Based Treatment. His Education, The Tavistock and Portman Therapist of the British Psychotherapy involve placing a bet.’ He will discuss presentation will summarise the work of NHS Foundation Trust; Fellow of Foundation and former Editor-in-Chief of the rationale of TADS in this light, and the series and consider where our research the British Psychoanalytical Society; the Journal of Analytical Psychology. In examine by what means RCTs can or future lies, and will engage the audience Editor, Psychoanalytic Psychotherapy. ‘Neuroscience and attachment’, she will cannot offer evidence of the effectiveness in a closing discussion. (Event date: 9 June explore the interpersonal processes that of psychoanalytic therapies, and evidence 2017) underpin early relational trauma and how for or against the ideas and theories that this contributes to adult psychopathology, underpin them. (Event date: 28 April 2017) as well as discussing the neuroscience that underpins two forms of empathy in the

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was of humble beginnings and had had fallen, then been reinstated through a Culture illegitimate children from different specific encounter that saved her. lovers. She first fell in love with Verdi’s work, then she fell in love with him. He What Mary Magdalene’s character withstood the moral indignations levelled achieved by means of theology, her at his liaison with Josepina and became namesake, Marie Duplessis, many particularly irritated by hypocrisy. Thus centuries later, achieved through art. In La Traviata: he peopled his operas with anti-heroes her case it was a transformation through and outcasts, and what better a complex insight and understanding, rather than outsider than a fallen woman, whose moral judgement, realised by means of transgressions are sexual. But, unlike artistic expression. Following its premiere morality, the lone castaway, a high class prostitute in La Fenice in Venice, the London acts in a couple. Her indiscretions can performance of La Traviata took place be accomplished only with the intimate in 1856, less than 10 years after the ‘true Freud, and complicity of another person. life’ courtesan died. It caused a great stir when first put on the London stage, but The ‘fallen woman’ it was the London performance that gave La Traviata, ‘the fallen woman’, echoes it worldwide acclaim. However, at the female the Biblical notion of the ‘fall from time there was indignation. Reviewers Eden’, a metaphor for loss of innocence dubbed it ‘a show of harlotry upon the and moral failure. The ‘fallen woman’ is London stage’, voicing the very hypocrisy a particular notion too. In both cases the that Verdi was exposing in his art. Aspects masochism woman, being feeble in the ethical sense, of Victorian life, steeped as it was in is tasked with receiving the projections of duplicity, were shown in the theatre, and By Sara Collins moral weakness. In European Christian the people flocked to see it. There, they culture it takes its place through the story were shown some truths that could not of Mary Magdalena. Interestingly, her otherwise be told. very name implies a high place, not the reverse. The word ‘Magdalena’ derives Morality in Freud’s time The real La Traviata Life transforms into art from the Aramaic ‘Magdala’, Aramaic Freud was born in the same year that La This short and tragic life, a disturbing and being the spoken language at the time of Traviata was first performed in London. ASED ON THE TRUE story disturbed individual tale, held a mirror Christ. The Hebrew equivalent would be During his time Austrian society could of Rose Alphonsine Plessis, to an age of crushing moral duplicity. A ‘Migdal’, meaning an elevated space, a suitably be described as Victorian. While a French country girl poignant narrative, shot through with tower. So her very name is an allusion to England’s duplicitous moral standards turned courtesan, Verdi’s threads of glamour, this was an irresistible a higher status, from which she had first operaB La Traviata charts the short life and story that had to be communicated. It turbulent emotional arc of a 19th century was as well a plot about how beauty, woman. In continental Europe, this was a femininity and sheer survival instincts time when some young women were serial assert themselves. This, in a way, is also mistresses of powerful men who provided what art does. Novelists, composers them with shelter, luxuries and a shadowy and choreographers have repeatedly place in society. In the Parisian demi- fictionalised the biographical facts of Miss monde of the 19th century this was quite Plessis. By means of aesthetic forms they the norm. But English life was steeped in re-shaped its raw ugliness to make the hypocrisy typical of the Victorian age, as underlying truths palatable. But it started was the case in Freud’s Vienna. with an artist who was himself part of the intricate narrative. We know of the beautiful Rose Alphonsine that she suffered a neglectful, Alexandre Dumas the younger’s novel, abusive childhood. A few years after the The Lady of the Camellias, was a thinly death of her mother, her father sold her, veiled account of his liaison with Marie aged 13, to a seventy-year-old wealthy Duplessis. His book was quickly turned bachelor who kept her for a year. Then into a stage play. A while later, the Italian she was sent away to fend for herself. composer Giuseppe Verdi came upon If this sounds Dickensian, it was. She the story while visiting Montmartre arrived in Paris aged 16, alone. By then Cemetery in Paris, where Marie Duplessis she had learned from her harsh early was buried. His inspiration came from life what other girls in her position had the inscription on the tombstone, which known, that at the very least there was he read it in the company of his fellow power in their beauty and youthful musician and mistress, soprano Josepina femininity, and that these were assets Straponi. Immediately he set about on which they could trade. Compliance putting the intriguing yarn to music. to men already an established pattern in Miss Plessis’ life, being paid for it in The work was entitled La Traviata, ‘the material comforts had an attractive twist. fallen woman’ in Italian. Marie Duplessis Submission and a phantasy of protection, became Violetta Valery, and now this it seemed, went hand in hand. She gave up opera is said to be the most performed working in a dress shop for little money opera of all time. Here too was a case of and refashioned herself as a courtesan, art echoing life; in this instance it was re-named Marie Duplessis. In her short that of the composer’s private affairs. life as a mistress she knew a string of Verdi met Josepina after the death of his influential figures in the European art wife and two children in a short space of world, including the young Alexandre time. A celebrated prima donna, Josepina Dumas. She died of consumption aged 23, alone. After her death, Dickens is said to have been present at the public auctioning of her belongings, where he took notes.

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were constantly caricatured and sent up, and repressed, but also because unfulfilled father, who comes the Viennese bourgeoisie were serious Oedipal wishes are at the very core of to interrupt the about theirs. There were rigorous attempts its state of evolution, and are vital to its sexual couple. But to regulate the sexual behaviour of civility. when Violetta women and children, such as suppressing accepts the father’s masturbation. Aware of the dangers Oedipal triangles in La Traviata offer ‘to cry on of syphilis, they associated it with the Three main characters occupy this opera: his shoulder’ and promiscuity of women. Freud understood Violetta the courtesan, Alfredo, the man suggests she is this toxic mix of conflicted morality, with whom she falls in love, and his like a daughter repression and sexuality. Whilst Freud’s father Germont. It takes place in the to him, the pair theories were aimed at the universal, French demi-monde. Unlike London or becomes that of transcending specificity of time and place, Vienna, in Paris at the time the mistress the (pseudo) union it would be interesting to link his social and her patron were part of the fabric between father background to his thinking. of bohemian society. Frequented by and daughter, and writers and painters, these French the lover, Alfredo, women provided a link between art and is left out. ‘Verdi peopled transgression. his operas with When the father softens, acknowledging In La Traviata, we can view Violetta in The opera opens with a party scene in her plight, and displays tenderness her initial merriment and idealisation anti-heroes and a 19th century Paris salon, and Violetta towards her, in fact another seduction of the lifestyle she calls ‘free’ (when it is outcasts.’ is in a state manic gaiety. She hides her takes place to which she succumbs. This, anything but ‘free’) as a desperate manic chronic illness from the guests and in the and her response to guilt prompted by attempt to ‘big herself up’ into a grown Perhaps it was because of that specific famous ‘drinking song’, she celebrates Germont, results in Violetta’s decision. It up independent woman. We can wonder social backdrop that Freud’s ideas felt as partying and fleeting pleasures. Idealizing is an expression of regression to a more whether she needs to insist on that, in radical as they did to the Europeans of her state of so-called freedom, Violetta infantile state, in which a fantasy of a order to avoid mental disintegration were his time. When in 1905 ‘Three Essays on denounces love, of which, she says, she dyadic union accompanied by seeming she to get in touch with the psychic pain Sexuality’ was published, what seemed knows nothing. This musing on life as relief from culpability dominate. connected with the reality of her situation perverse and unthinkable became ‘free’ is interrupted by Alfredo’s pursuit of Her longing for parental love having as a courtesan, and, importantly, with her normative developmental processes. For a different take on matters, in a moving overwhelmed her, Violetta succumbs childhood. Falling in love with Alfredo example, component instincts governed duet/discourse on love and frivolity. to the powerful pre-Oedipal longings, and the short spell of living with him, early stages, and appeared as perverse Because Alfredo has fallen in love with which, given her appalling early life, while severing ties with her previous life, aspects in neurosis. The sexual drive was Violetta. He persists in telling/singing is not surprising. Combined with the is Violetta’s one short-lived attempt at a the crucial element in early psychic life, to her his version of things, namely, that internal dynamics of masochism, in which mature relationship. But the arrival of the but it was repressed. Disowned erotic life is essentially all about love. And he unresolved guilt over aggression turns father Germont triggers the onset of pre- desire lead to conflict, especially to a clash wins her over. Now she allows herself to against herself, the balance is irrevocably Oedipal conflicts featuring guilt that she with guilt associated with morality, and experience love for the first time in her tipped towards regression. She moves is not equipped to deal with. She collapses symptomatology ensued. Thus Freud life, she leaves her ‘glamorous’ lifestyle away from adult sexual love, and gives up under the pressure of paternal moralising (1910) argued for the liberalisation of behind, and the couple establish a the one good thing she has achieved – her beatings and no doubt much internal education, and for the diminution of household in a quiet rural part of France. life with Alfredo. The fate of Violetta, blame. And so she ends up inflicting pain the power of the superego. In fact, he then, represents female capitulation to on herself, yet again, dragging down described talking to patients and telling Then enters Germont, Alfrdo’s father. His superego pressure, voiced by the father Alfredo with her. them, in so many words, to accept the task, essentially, is to break up the couple. Germont, and her own anxiety about rejected wish, and to not feel as guilty as His reason is a moral one: Alfredo’s sinful aggression. Crushed, she masochistically In Verdi’s La Traviata, the emotional arc they did. And, indeed, in his Fifth lecture life with Violetta, a union not blessed by yields to the view of herself as the ‘fallen of the fictional Violetta in many respects Freud (1910) equates the necessity to the church, will bring ruin on his family’s woman’ and re-enacts both the guilt and echoes that of the real life Marie, whose satisfy sexual needs to that of a horse name. It will spoil the marriage prospects the punishment. The opera ends with life and death inspired the composer. having to eat oats in order to carry out its of his chaste daughter, Alfredo’s sister. Violetta’s ultimate sacrifice. She dies However, it is through art that the story work. Violetta resists for a while, imploring that of the illness she had battled all along, of these women is given center stage, so it is only with Alfredo she ever found love, leaving the two men grieving. that their powerful inner drama, as well as The Oedipus complex was the arena in but then she relents under the parental their place and function in society, is seen which infantile sexuality determined moral pressure. She promises to leave ‘Here the and heard the content of repressed memories and Alfredo, who, about to be deserted, is left desires, that of the child’s inexorable out of the discussion. Oedipal sexual wish for the parent of the opposite Sara Collins is a psychoanalyst in private sex. Hence his/her rivalrous aggression Is this a simple case of ‘the tart with a constellation practice. he is a Training and Supervising toward the parent of the same sex. This heart’? Not so. This, the second act of dramatically analyst, and the Director of Training of too was deemed outrageous. the opera, gives us a brilliant display the British Psychoanalytic Association of deep emotional change. In it the alters.’ In a later phase of his thinking, guided by protagonist’s internal psychic alteration Freud and female masochism new theoretical discoveries and evidence is put under artistic examination. An References While Freud’s (1924) writing on ‘feminine gathered from his case studies, Freud’s unexpected shift takes place. It starts as masochism’ arguably was gender specific Haag, M. (2016). The quest for Mary Magdalene. theories progressed. When Civilization a bitterly antagonistic dialogue/duet to men, and related to his views on the HarperCollins Publishers, London and its Discontents was published in 1930 between Violetta and her lover’s father; Freud, S. (1905). Three essays on the theory of sexual development of boys, it can also Freud developed the second topology, the this argument represents two opposing sexuality. SE 7, 125-245 be used as a paradigm for masochism Freud, S. (1910). Five Lectures on Psychoanalysis. structural theory of the mind, in which sides of a conflict between love and social in general. Steyn (2009) noted that the SE 11, 9-55 the superego became a clearly delineated norm. But then it turns into a tenderly recourse to masochism in the clinical Freud, S. (1924). The economic problem of agency. sad duet between a paternal figure and masochism. SE 19, 157-7 his daughter. Violetta comes down on the situation can be an escape from conflicts Freud, S. (1930). Civilization and its discontents. SE associated with the Oedipal situation in 22, 57-146 In this seminal publication, Freud placed side of social decency, as voiced by the general, and a lapse into concerns with Steyn, L. (2009). Is feminine masochism a concept the origins of the superego in human moralising father. She must suffer for her worth reviving?. Int. J. Psycho-Anal., 90:867-882 pre-Oedipal issues. At its core, masochism civilisation. It is aggression (linked to impropriety and accept the punishment, is aggressive sadism, an aspect of the the Oedipus complex) that the superego which is giving up her life with Alfredo, ambivalence towards the mother, turned controls, but it also employs aggression and she leaves her distraught lover. against the self as a result of anxiety and in the service of control. Hostility breeds Here is where the Oedipal constellation guilt. Therefore, seen in a broader sense, violence and vice versa. Thus the human dramatically alters. Whoever is part of the masochism is a regressive pull towards being is an unhappy animal. That is so, pair and who is kept out gets re-formed. a more primitive level of integration, at not only because sexuality is unconscious It begins with the outsider being the which anxiety and guilt prevail.

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Culture Where does psychotherapy come from?

By Johnathan Sunley

A classic of European literature suggests some unexpected answers

HAT WAS THERE of ‘evidence-based medicine’ that tends that this is not what his happiness hinges Several hundred years later, Boethius, the before psychotherapy? to view the past with condescension, this on. His feeling of being imprisoned has author of The Consolation of Philosophy, Did the people we now seems to me a good time to be asking such other causes. consciously based his work on their refer to as clients or questions. example. Like them he was no stranger to Wpatients suffer without respite while Readers may recognise this as a summary sudden reversals of fortune. Having held waiting for our profession to be invented? So consider the following. A man sits in of The Consolation of Philosophy, a work high office at the tail-end of the Roman Or did they have ways of thinking about prison fuming at his fate. Until recently written in Latin in the sixth century AD Empire, and also been greatly admired for and treating what distressed or disturbed he was a prominent public figure and a that became extraordinarily popular and his learning, his life was turned upside- them that were genuinely helpful – and noted scholar too. But this is a period of influential across the Western world. Just down when he fell under suspicion of to which we perhaps owe more than is great upheaval, a rival has denounced him, in this country Alfred the Great, Chaucer disloyalty and was arrested. Awaiting trial sometimes acknowledged? and he has been charged with treason. His and Elizabeth I all made translations of it, in prison, he set about writing a book in life looks to be in ruins. Then a visitor and such was the enthusiasm with which the form of an imagined conversation As New Associations comes of age with appears in his cell who proceeds to engage those in need turned to it for emotional between himself and a visitor who helps its twenty-first issue, and as the BPC him in a deeply-felt discussion about what and spiritual guidance, that it might well him to bear his experiences. In that continues to uphold the importance he is going through. She doesn’t bring be regarded as the first self-help book. sense, it is a fantasy – but one whose particularly of psychoanalytically- with her the key to his freedom in a literal According to CS Lewis: ‘It is historically power derives from the reality of what informed ideas and practice in an era sense. But as they talk it becomes clear certain that for more than a thousand Boethius was having to endure at the years many minds, not contemptible, time. Someone reading the Consolation found it nourishing.’ today I think will also be struck by the background against which it was written: What was it about the Consolation a time of collapsing empires, large-scale that made it so nourishing? And what migrations and conflict between different relevance, if any, does that have to religious worldviews. psychotherapists working today? We don’t generally think of ourselves as offering our clients ‘consolation’, after all. That ‘We don’t think sounds too much like tea and sympathy of ourselves – only without the tea. Psychic change is seldom what the people who come to us as offering ask for. But it is usually what we believe is “consolation”.’ best for them. The name of the visitor is Lady Dictionary definitions of consolation Philosophy. To begin with she reproaches reveal surprising depths to the term. Boethius for distracting himself with ‘Alleviation of sorrow or mental distress’ is the muses of poetry and for failing to one of the meanings offered by the OED. recognise her. ‘Then she drew nearer, and Still more therapeutic-sounding is the last sat at the foot of my couch. She gazed part of Dr Johnson’s take on ‘console’: ‘to on my face which was heavy with grief comfort; to cheer; to free from the sense and bowed to the ground with sorrow.’ of misery.’ Definitions like these draw on This stirs something in the prisoner that the literary genre of the consolatio that enables Philosophy to diagnose what’s developed out of the speeches orators once wrong with him. It’s serious, yes. But gave at funerals to comfort mourners. In perhaps not in the way he’d thought. classical times much-prized contributions Her formulation is as follows: ‘But his to this tradition were made by Cicero condition is not dangerous. He is suffering and Seneca, both of whom wrote from from loss of energy, a weakness common a Stoic perspective that set expressions to duped minds. He has forgotten for of sympathy for the bereaved in a wider the moment who he is, but he will soon context of philosophical reflections on the remember once he has identified me first.’ universe and the human condition that emphasized the inevitability of suffering If this marks the end of the period of and death. assessment, then treatment – Philosophy explains to Boethius – will have two phases to it. She can see that right now he

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is too aggrieved to hear interpretations executed – but no longer consumed by words, for the kind of sickness from which consolation which is drawn from truth, that might under other circumstances be it. His suffering acquires a universal Boethius was suffering, what we nowadays if any there be, is solid and durable; that mutative. She will concentrate on building significance it lacked before and which refer to glibly as self-help is likely to be no which may be derived from errour must an alliance with him while respecting appears to make it more bearable. help at all. be, like its original, fallacious and fugitive.’ his defences. ‘This welter of disturbed I suspect Boethius would have agreed emotions weighs heavily upon you; grief, It would be wrong to overdo the parallel Even allowing that he comes to feel anger and melancholy are tearing you between this and the kind of inner genuinely consoled by Philosophy, we apart. So in your present state of mind, journey that might be made today by might still balk at the notion that Johnathan Sunley is a psychodynamic you are not as yet fit to face stronger someone in therapy or analysis with a nowadays this is a task for psychotherapy. psychotherapist in private practice in remedies.’ For roughly the first half of the BPC-accredited practitioner. For one Maybe ‘consolation’ was once an integral London. book, Philosophy encourages Boethius to thing, the partly Christian but mainly part of our culture. To us it is more likely lead the exchanges they have, with the Neoplatonist vision of reality that to sound insipid at best and insulting result that these keep returning to the Philosophy stands for (and which was at worst. Consolation prizes don’t go to Bibliography figure blamed by him for his downfall, a far cry from the simpler Stoicism that winners, do they? Bion, W.R. (1970) Attention and Interpretation. i.e. Fortune. After a while she notes how many Romans of the time still leaned London, Tavistock persecuted by this pitiless harridan he towards) is not one I think many BPC This raises the issue of success, and Boethius [c. 524] The Consolation of Philosophy [De seems to be. But whoever imagined that registrants would say they share. Surely presumably not every attempt at Consolatione Philosophiae]. Trans. Walsh, P. Oxford, OUP (1999) Fortune was all-beneficent, Philosophy psychoanalysis has left all that medieval consolation is successful. That can Freud, S. (1917) Mourning and melancholia. SE 14. remarks. Isn’t it part of her nature to give metaphysics behind? certainly be said of psychotherapy and London, Hogarth Press one moment and withhold the next? psychoanalysis as well. But recognizing Lewis, C.S. (1964) The Discarded Image: an Introduction to Medieval and Renaissance that might itself be regarded as a sign of Literature. Cambridge, CUP Boethius acknowledges that it is so. He ‘Forgetting or health. This is a point that Bion makes appears at this point in the text to be close being unaware of in Attention and Interpretation, where to what we would term the depressive he discusses what a patient can expect to position. There is less evidence of what has been lost receive from a psychoanalyst as opposed paranoid anxiety on his part and a move keeps the mind to a doctor. For Bion it’s about knowing towards whole-object relating. He also the truth, and here he quotes from a letter seems more appreciative of Philosophy stuck in a prison written by Dr Johnson that stresses the herself. ‘“You are indeed the greatest of its own making.’ value of consolation – or rather of those comfort for weary spirits,” I said. “What forms of it that enable such knowledge. refreshment you have brought me with Fifteen hundred years later, there are ‘Whether to see life as it is, will give us the depth of your judgements and the two features of Philosophy’s way of much consolation, I know not; but the sweetness of your songs!”’ To our ears this working with her patient that I feel might sounds perhaps a little too appreciative. nonetheless resonate with us based on With Fortune now viewed more our own practice. First is her emphasis on realistically by Boethius, has Philosophy loss and mourning. These are central to come to be idealised by him instead? the understanding she brings to Boethius’ Are there even the makings of an erotic condition – even if, initially at least, he transference here? is adamant about wanting everything he has been unjustly separated from Philosophy decides that her patient is returned to him again. For Philosophy now ready for the stronger medicine she this is proof of the even greater loss he is has talked about. After a solemn prayer suffering from and is in denial about, that to the ‘Father of all things’, she begins is of his very identity or self. ‘Forgetting to explain to him where true happiness who you are has made you confused’, resides – namely in that unity of goodness she says to him, ‘and this is why you are and being that is identical with God. At upset at being both exiled and stripped first Boethius struggles to make sense of your possessions.’ Now this is not quite of this. Perhaps he was expecting his how Freud puts it in ‘Mourning and expressions of devotion to Philosophy to melancholia’. There it is the ‘shadow of be reciprocated in a more direct fashion the object’ that falls upon the ego, whereas and now feels rejected by her? If so then here it seems to be almost the other way at least he is able to get in touch with the round. But for Boethius as much as for any disappointment and anger prompted in contemporary object relations theorist, it him by her unswerving neutrality and to is forgetting or being unaware of what has voice it. For an entire paragraph he rages been lost that keeps the mind stuck in a against the person who in his eyes has prison of its own making. now become cold and unfeeling. ‘“Are you making sport with me?” I asked. “You are How is remembering or increased weaving a labyrinth of arguments from awareness possible? This brings us to which I cannot find my way out.”’ But the second area of overlap that I see Philosophy has seen and survived attacks between psychoanalytically-informed like this before. Rather than retaliate by psychotherapy and the relationship presenting Boethius with yet more proof described in The Consolation of of her superior wisdom, she offers a gentle Philosophy. For all the ideas that circulate reminder of what he and his wellbeing in it, Boethius’ book is largely about the mean to her: ‘Then Philosophy said: “This sometimes gratifying and frequently is no game we are playing; far from it.”’ challenging relationship he finds himself having with Philosophy. It is this that This is not quite the end of the book but leads to the psychic change the reader to my mind represents a turning-point witnesses him undergoing – even if his in it that is also a turning-point in the actual circumstances remain the same. prisoner’s recovery. Although he continues And it is for this reason that I would to question Philosophy, sometimes sharply, hesitate to call it a self-help book. To from now on he seems to be concerned ‘know thyself’ is indeed possible, says by his fate – historians think that after a Philosophy: but only through knowing few years in prison Boethius was probably and being known by another. In other

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what impact this addition has on the My interest in technological mediation Theory and practice today: Developing theory intense nature of close relationships. began in 2008 when I moved from the UK to a remote part of the United States. Does actual presence vs simulated/ I was enthusiastic to use technology for mediated presence, two different treatment. I was hopeful that Skype experiences and brain states, have would solve the dilemma of distance and significant clinical consequence for separation, allowing me to transcend space Technology psychotherapeutic treatment? I believe and time. If I were not dependent on a they do. physical consulting room or co-present colleagues then the only instruments I Presence is not the same thing as needed were myself and my computer. in the room emotional engagement, absorption or the degree of technological immersion. For But back in 2008 I sleepwalked into the researchers in informatics, presence is a use of technology for treatment, and since By Gillian Isaacs Russell core neuropsychological phenomenon: then, the vast majority of clinicians and a sense of presence comes from an patients I have interviewed confirm that organism’s capacity to locate itself in the they did too. We did not anticipate the external world according to the action fundamental clinical challenges posed it can do in it. For humans these actions by this type of work. So, as enthusiasm specifically include the person’s capacity turned to disenchantment, I began to ELISSA] mixed Computer-Mediated Psychoanalysis and to interact with an Other in a shared ask questions: Can a highly effective ‘ herself a mojito, Psychotherapy (Karnac, 2015). external environment. The sense of therapeutic process occur without physical added a sprig of presence enables the nervous system to co-presence? What happens when we mint, put on her Embodied shared experience is being recognise that one is in an environment reduce our therapeutic relationships to sunglassesM and headed outside to her sacrificed in both our personal and work that is outside one’s self and not just a two dimensions bound by a screen? friend’s pool. Settling into a lounge chair, lives for the economy and convenience of product of one’s inner world (i.e. being she tapped the Skype app on her phone. screen relations. awake, not dreaming). ‘We did not Hundreds of miles away, her face popped up on her therapist’s computer monitor; Screen relations are human interactions A blind patient told me: ‘Despite the fact anticipate he smiled back on her phone’s screen… mediated through communications that I am unable to see my analyst even She took a sip of her cocktail. The session technology. The choice of screen during live sessions, I feel a loss when we the clinical began’ (Hoffman, 2011, p. ST1). relations based treatment, part of are not together. I was very interested to challenges posed the techno-cultural tidal wave, is also realise that, no, it’s not just being able to So begins Jan Hoffman’s article, ‘When accelerating. Many analysts are making “see” the person. There’s something about by this work.’ your therapist is only a click away’, on claims for a functional equivalence being in the room with them. There’s To answer these questions, since the front page of the Fashion and Style between technologically mediated and something not visual, and not necessarily 2012 I have done hundreds of hours section of The New York Times. co-present treatments. Some even opt to auditory.’ of interviews with clinicians and use mediation exclusively. Others, while patients about their experiences with Melissa goes on, ‘I can have a Skype not explicitly claiming a functional As with emotions, the ability to feel technologically mediated treatment. I’ve therapy session with my morning coffee or equivalence between the two, still practice varying degrees of presence is essential examined the technologies of mediated before a night on the town with the girls. as if there is no difference. This trend to our survival. The basic experience of communication and how they affect our I can take a break from shopping for a is, at best, premature: psychoanalysts/ Presence evolves in humans to contribute relationships and change how we practice. session. I took my doctor with me through therapists are staking claims on the to the development of the self, leading to And I have found that eliminating being three states this summer!’ ‘new digital frontier’ before it has been the recognition of the Other as a separate bodies together largely confines the mapped. If we add technology to the self with its own goals and purposes: that therapeutic process to ‘states of mind’ As extreme as this sounds, it is not at all psychoanalytic mix – and we want to do is, an intentional self. This is the case both rather than ‘states of being’. It is only far from stories that I have been told in it responsibly – we need to ask the people in the developing infant and in the adult when one can dwell in a ‘state of being’ five years of ethnographic interviews who have worked in communication as the sense of self and one’s boundaries that one can take part in the therapeutic with clinicians and patients for my studies, computer science, and technology, between self and other are continually book Screen Relations: the Limits of long before we enter the mediated scene, being redefined throughout life.

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process of conversing with oneself and the The characteristics of the sense of that emerging other (Parsons, 2014, p.125). presence as defined by researchers selfhood depends. in virtual reality dovetails with the A patient said to me: ‘When you share psychoanalytic description of development Patients reported a physical space, there is always the of self. The experience of presence that the journey to potential to touch, even if you don’t enables the beginning of a sense of and away from the act out, whether that means kicking or separate self which depends on the ability consulting room is kissing.’ Winnicott wrote in his major to distinguish between what is ‘me’ an important aid to paper, The Use of An Object: ‘The object, and ‘not-me’, and inside and outside by remembering the if it is to be used, must necessarily be real enacting with the Other within a shared session. Turning in the sense of being part of shared reality external world. off the computer (1969, p. 711).’ The development of the is not a journey. A capacity to use an object is part of the The experience of embodiment, both our patient said to me: maturation of the individual in a good- own and that of the other, in a shared ‘[Leaving a Skype enough facilitating environment. He states environment is central to our experience session] with a click that the subject experiences the reality of of being. Clearly, the experience of of a mouse is like the object, when the object is perceived as presence in a mediated environment having a Caesarean outside of the subject’s omnipotent control, is a function of the possibilities for instead of a natural that the subject creates the object in the interaction, in the same way that feeling birth.’ Analysts, sense of finding externality itself. present, ‘being there’, in the physical too, reported world is grounded in perception, action unusual difficulties In other words, to develop the patient and the body. Presence affects how we in remembering must be enabled to perceive the analyst behave, what we pay attention to, and how both the times as someone who is a separate person, not we understand and remember events. and actual content just a receptacle of projected fantasies and of sessions when expectations from the patient’s internal Yet informatics researchers say that using technology world. This development happens through creating a sense of presence remains for treatment. For the subject’s experience of destroying a major challenge with our present example, people the object and the object surviving the technology. For example, the embodied who never took destruction. The analyst keeps on living, aspect of presence is filtered by the notes in co-present keeps on thinking, does not retaliate or physical properties of the mediating sessions found themselves taking notes in non verbal communication – and more withdraw in the face of the patient’s technology. Depending on the quality of mediated sessions. than 60% of our communication is non intense feelings and fantasies. Winnicott computer, speed of connection, volume verbal – is what happens between the says that without the experience of of internet traffic, and the stability of a The three scientists who won the 2014 lines. Psychic growth does not result solely maximum destructiveness (object not power source, technologically mediated Nobel prize in Physiology and Medicine from understanding which can be put into protected) the subject never places the communication software can vary wildly suggest that navigation, knowing how to words. analyst outside, and therefore can never in the quality of audio and video service it find one’s way in physical space, is closely do more than experience a kind of self- provides, sometimes in the space of a few related to the way memories are created What does this mean for technologically analysis, using the analyst as a projection seconds. Audio/video mismatches, speed/ and stored (Moser & Moser, 2014). The mediated relating? Psychoanalytic of a part of the self (1969, p.714). When pitch changes, timing misalignments, and same neural systems support both physical psychotherapy is a very particular kind the analyst continues to survive despite delays have the potential of interrupting travel and the mental travel of memory. of relating: it is not just an exchange of the impact of the patient’s love and hate, and attenuating the subtle nonverbal ‘Place and memory are intimately information or task-orientated. How can the patient discovers the limits of his/ exchanges between people. In addition, related,’ says University of Pennsylvania embodied non-verbal communication be her omnipotence – and the analyst can our attention is not merely focused on the computational psychologist Michael J. carried digitally and comprehended on be experienced as whole, separate, and other, with whom we are communicating, Kahana. ‘Space forms a powerful context a two-dimensional screen? If there is no available for interaction in a shared but also on the mediating technology, in which our memories are encoded external person in a shared environment reality/environment. The companion compromising our capacity for reverie. (Healy, 2014, par. 10).’ with whom to interact, can a patient come piece to this development is that the A striking example of this is research to understand a relationship with another patient him/herself also feels separate showing that the mere presence of a This may go some way to explain the in external reality? and whole, with a discrete inside and mobile phone, turned off and laid on a uncharacteristic lapses of memory outside, situated in a shared reality. table between two conversing subjects, analysts have both about the times of Let me share with you some recent lowers the quality of connection in their sessions and the content within them and research: scientists doing further Another patient who works both co- relationship, particularly their empathy patients’ difficulty internalising their investigation based on the Nobel research presently and with mediation told me: ‘I (Misra, Cheng, Genevie, & Yuan, 2014). sessions. If one is not moving in space one on the neurons connected to navigation always felt that if anyone knew me as I is not actually confirming these things in and memory found that those navigational really am, they would be really shocked memory. neurons in the brain react differently to and probably abandon me. It has been ‘Bodies need virtual reality than they do to real-world crucial that I saw my analyst in person in to be together to Neuroscience has had a paradigm shift environments. Neurophysicists measured order to work that out. Being on a screen from Cartesian mind-body dualism, with the neurons firing in a rat’s brain as it was just not the same. I needed to see that test the analyst’s the body considered peripheral to our maneuvered in an intensely immersive he didn’t flinch, wasn’t afraid of me, or capacity to understanding of the mind. New research virtual environment and also in a real disgusted with me in person… that he suggests that we think not just with our room that looked exactly like the virtual didn’t need the protection of Skype to be survive.’ brains, but with our bodies. What goes on room. The scientists were shocked to find with me… and stay with me.’ in the brain depends on what’s going on in that the results from the virtual and real The ease of computer use, ‘when your the body as a whole, and how that body is environments were entirely different, In screen relations the patient can never analyst is only a click away,’ presents a situated in its environment. The brain is even though – significantly – the rats truly test the analyst’s capacity to survive dilemma: The speed and convenience of now regarded as part of a broader system seemed to behave perfectly normally the patient’s intense feelings. The extent connection fails to reproduce something that critically involves perception and in both the virtual and real worlds. In to which you can ‘imagine’ your impact on meaningful and useful that the effort of action as well. the virtual world the rats’ neurons fired the analyst is limited when at some level moving in space provides. completely randomly as if the they had you know you are acting in a simulation Not having the potential to move in Mediated interaction is missing subtle no idea where the rat was, and although protected by distance and the concrete space eliminates that experience of elements that are essential for intimate the neurons were highly active in the barrier of the screen. Bodies need to be intentional interacting with others in a communication. Neuroscience provides real-world environment, more than half together to test the analyst’s capacity to shared framework in space and time, the clues to what might be missing. There is those neurons shut down in virtual space survive. It cannot be done with two minds very experience upon which investigators powerful scientific evidence that finely (Wolpert, 2014). alone. across the board in human-computer nuanced and implicit bodily interactions interaction, cognitive and neuroscience, form the core of intersubjectivity (Schore, infant research, and psychoanalysis agree 2011; Beebe, 2005). This psychobiological Continues on page 21

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Theory and practice today: Developing theory A world of groups

By Marion Brown

ROUP ANALYSIS is projected into this individual, or that one perhaps better known as an part of a family is holding something for analytical clinical the rest. The same dynamic can take place intervention; however, it in other groups, and this may be a familiar Gwas born from a merging of analytic and if unwanted role for the individual or psychosocial influences. At the root of subgroup who is left in this position. group analysis is the belief that human beings are essentially social beings whose We repeat interpersonal dynamics, but lives are inextricably linked with others for some the resulting internal conflicts in manifold ways. We start life in a group, can develop into symptomatology or a family, which sits within a society and unconscious processes impacting heavily not just talking here of analytic groups, of massive trauma. While trauma at culture, perhaps multiple cultures. We on relationships with others or on one’s but of groups in general, of society and an individual level can overwhelm the continue our lives alongside peers in view of oneself. This can be problematic the social, of organisations, of culture, psyche, traumata in groups can break nursery or playgroups, schools, when patients are brought into groups or indeed any grouping where people share a down the social structure, causing groups universities, social groups, religious in getting teams to work together. People common understanding or purpose. of people to act in ways that at other times groups; the list could go on. Each of these with difficult experiences of groups may be out of character. groupings is likely to contain more avoid groups; however if the disturbance The social unconscious is an important intimate personal attachments and originates in a group context, for instance concept in group analysis, initially Vamik Volkan speaks of ‘chosen trauma’, cultural influences, all of which impact the family or peers, then the resolution influenced by the work of sociologist whereby a historical fact can begin to on the developing individual’s internal is within that group or a stranger group. Norbert Elias, in particular his thoughts define the group and its boundaries. world, forming an internal group If the problem is within the team, the on the importance of cultural and Members impacted by a traumatic event template (personal matrix) from which resolution is within the team. This historical continuity in interpersonal whose memories of it are similar become we make sense of the world around us realisation can be a shocking one. interactions. The internal world of part of a group; those who experience it and our position within it. infants and children is impacted by or remember it differently are perceived To make sense of this it may be important cultural and historical factors through to be outside of the group or may be This unique understanding, the to look back at some of the factors which their immediate environment, their expelled by the group. Volkan emphasises individual in the context of their family, helped forge group analytic theory. S. H. family or carers, who carry within them the importance of historical trauma in the society, culture and the world to Foulkes, the founder of Group Analysis, the values, norms and beliefs of the the perpetuation of inter-group conflict which they belong, holds the analytic was influenced in the 1920s and early society and culture of which they form and this can be seen in large groups such and the psychosocial together as equally ’30s by leading figures of the Frankfurt a part, or, conversely, from which they as nations or ethnic groups, whereby important parts of a whole. However, this School, particularly by the holistic feel alienated. Intergenerational factors the historical trauma re-emerges and is is where we hit the first challenge. While approach of neurologist Kirt Goldstein, add to this; for instance second and third re-experienced despite being dormant many are comfortable in groups, many and by the ideas of Max Wertheimer generational trauma can leave individuals for perhaps an extensive time period. are not, and a considerable proportion on Gestalt Psychology. Foulkes’ most or communities feeling alienated, isolated, An example would be Northern Ireland would not be comfortable with the creative metaphor, that of the group as disenfranchised and attacked. where historical trauma re-erupted in the thought of such strong interdependence. a network of communication rather like ‘Troubles’, leading to massive splitting, This can make dialogue with those the neuronal network of the brain, was ‘We start life in a projection and multiple projective outside the field difficult, for although at least in part derived from Goldstein’s identifications which became re-enacted it can be recognised that society and work on neural functioning, which was group which sits on the ‘enemy’. These writers take us well based on the premise that the organism culture impact on the individual and the within a society into the psychosocial, bringing a group individual can have an impact on society, as a whole could influence the opening analytic understanding to situations of it is harder to accept the level at which up of new neural pathways. Foulkes and culture.’ social unrest and warfare. this happens and the extent to which it thought of the group as doing just this, impacts. of each individual as a nodal point in a Communities, societies or cultures can Group analytic thinking is about the social network who is not just touched by alienate or reject those who for whatever complexity of conscious and unconscious Yet it is difficult to exist outside of a but is literally permeated by the group. reason do not appear to fit with the norm, processes which occur simply by being group. Even those who try to separate The individuals in turn influence the or can massively project onto those who a person alongside of others. What is themselves from groups are inevitably dynamic matrix of the group, the group appear different, particularly at times of internalised or disowned and projected, influenced by them. Much internal and the individual moving between social unrest, social trauma or deprivation. what people activate in each other and in conflict can be experienced by the foreground and background depending Earl Hopper, a psychoanalyst, sociologist themselves, how this is played out in the individual who finds themselves at odds on the prevailing need. The group is and group analyst, further expanded on inter-relational, social and cultural levels with their group/s, or ends up holding more than the sum of its parts, more than Elias’s thoughts on socio-genesis and and at an intra-personal level. How and something on behalf of the group. It is the individuals who comprise it. This is psycho-genesis; the chain of cultural why it can become pathological. This is not uncommon to discover that a troubled why group analytic theory and practice events that links us to our pasts, and of why group analytic thinking has such a or disruptive family member is expressing focus on both the group as a whole and the probable reversals and breakdowns broad range of application. Group analysis something which belongs to the family as the individual, for each powerfully and inherent within this process, by advancing in its applied form is practised widely, in a whole but which has been disowned and inextricably influences the other. We are a model of social regression in the face

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Technology in the room

continued from page 19

Different dynamic brain states can While making therapeutic treatment yield moments of experientially similar available via mediation to those who have conscious experience (the rats appeared no other option is certainly better than to behave perfectly normally) but with nothing, it shouldn’t be offered with the completely different consequences understanding that it is the same thing (neurons fired randomly and shut as co-present treatment (and this has down). When conducting relationships implications for such things as obtaining requires embodiment, involves implicit informed consent and how we set our fees). communication, and a sense of presence, can we assume that screen relations based We can’t justify modeling to our patients treatment (especially on a non-immersive that our bodies are just incidental. Neither two-dimensional screen) is effective, can we allow them to think that the path because, as with the rats, it sometimes to authentically being alive can travel appears to be so? along cables and be confined to two- dimensional screens. At some point, they Professor Sherry Turkle, clinical need to test the analyst’s capacity to bear psychologist and director of the the impact of their love and their hate in Massachusetts Institute of Technology the flesh and not protected by the barrier Initiative on Technology and Self, recently of a screen. The truth of these experiences asked me: ‘How is it that psychoanalysts, needs to be lived, not simulated the “experts of empathy”, can routinely use this [treatment modality]?’ What makes therapists who have had years Gillian Isaacs Russell, Ph.D., NCPsyA, is of training and experience about the a member of the British Psychotherapy requirements for effective therapeutic Foundation. process jettison what they know and normally do? References Todd Essig describes ‘simulation Beebe, B., Knoblauch, S., Rustin, J., & Sorter, D. entrapment’ as ‘the unwilled loss of (Eds.) (2005). Forms of Intersubjectvity in Infant distinctions between the simulation and Research and Adult Treatment. New York: Other that which is being simulated (Essig, 2012, Press. Carr, N. (2014). The Glass Cage: Automation and Us. p. 1177).’ One enacts inside the simulation New York, NY: W.W. Norton & Company. and expects consequences for one’s actions Essig, T. (2012). The addiction concept and that are exactly the same as in the real technology: diagnosis, metaphor, or something else? A psychodynamic point of view. Journal of world environment. One forgets that the Clinical Psychology: In Session, 68(11): 1175–1184. simulation has limits and that there will Healy, M. (2014). Nobel prize honors researchers’ discovery of the brain’s GPS system. Los Angeles inevitably be losses. As we have seen, the Times, October 6, 2014. Accessed at: http://www. consequences for acting in a simulation latimes.com/science/sciencenow/la-sci-sn-nobel- are neurologically very different than prize-medicine-20141006-story.html Hoffman, J. (2011). When your therapist is only a acting in a real world environment. As click away. New York Times, September 23, p. 1 prisons, approved premises, therapeutic we are going to actively engage and make Nicholas Carr, author of The Glass Cage, Isaacs Russell, G. (2015). Screen Relations: The communities, schools, universities and sense of what we see around us. Yet it writes: ‘“A map is not the territory it Limits of Computer-Mediated Psychoanalysis and colleges, with teams and organisations, in remains a small proportion of what needs represents,” the Polish philosopher Alfred Psychotherapy. Karnac Books: London businesses. Some of our members work Misra, S., Cheng, L., Genevie, J., Yuan, M. (2014). to be done to disseminate group analytic Korzybski famously remarked, and a The iPhone effect: the quality of in-person social with refugees and victims of torture. thinking into public awareness and public virtual rendering is not the territory it interactions in the presence of mobile devices. Our trainings have attracted students policy Environment and Behavior, 1–24: doi: 10.1177/ represents either. When we enter the glass 0013916514539755. who use an in-depth understanding of cage, we’re required to shed much of our Moser, E., & Moser, M. B. (2014). Mapping your group analytic process to understand the body. That doesn’t free us; it emaciates us’ every move. Cerebrum: The Dana Forum on Brain Science, 4: 1–10. Accessed at: http://www.dana. dynamics of orchestras, dance groups, art Marion Brown, M.Inst.G.A., is Chair of (p. 220). org/Cerebrum/2014/Mapping_Your_Every_ groups. the Institute of Group Analysis Board of Move_1_/ Trustees. Scholars of automation refer to the Parsons, M. (2014). Living Psychoanalysis. East Group analytic thinking has a lot to offer Sussex: Routledge. substitution myth: whenever you automate Schore, A. N. (2011). The right brain implicit self to society, and we are bringing it into the any activity you simply substitute the lies at the core of psychoanalysis. Psychoanalytic public arena through developments such discreet technological activity for the Dialogues, 21(1): 75–100. as café psychologique, film nights, join the Winnicott, D. W. (1969). The use of an object. human activity. However, a labour-saving International Journal of Psychoanalysis, 50: 711– debate evenings. There are a multitude of device doesn’t just provide a substitute 716. workshops and courses across the country, for some isolated component of a job or Wolpert, S. (2014, November 24). Brain’s reaction to many of which are open to the public. virtual reality should prompt further study, suggests other activity. It alters the character of new research by UCLA neuroscientists. UCLA The Institute of Group Analysis (IGA) has the entire process. Just as rats’ neural Newsroom. Retrieved June 26, 2016, from http:// been developing collaborations with other newsroom.ucla.edu/releases/brains-reaction- processes are altered by virtual reality, in to-virtual-reality-should-prompt-further-study- organisations through its bespoke training psychotherapy, when communication is suggests-new-research-by-ucla-neuroscientists and consultation service tIGA, and within automated by computers, it seems that other forums. More recently the IGA and the entire process may radically change in APS (Association of Psychosocial Studies) ways we don’t yet fully understand. held the first of two workshops to share Two minds together are, only half the psychosocial thinking. story. Bodies cannot be left out of the equation, although it does interest me that All of this feels important as we need human beings persist in wishing to do dialogue to engage with others, be they so. If we are going to use technology for patients, professionals, organisations, treatment we can’t sleepwalk into it: we teams or at a societal and cultural level, if need to have our eyes wide open.

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Theory and practice today: Developing theory

How to publicise the most private profession

By the Future Strategy Working Group

EW PROFESSIONS demand in 1921 the American journalist Hans débuted in 1926 to great acclaim, who have worked with the media have more privacy and more von Kaltenborn published an article in and which brought new audiences to often done so as lone agents. Many protection from the outside the Brooklyn Daily Eagle about his visit psychoanalysis (Chodorkoff and Baxter, psychoanalytical colleagues who have world than psychoanalysis. to Freud’s office on Vienna’s Berggasse 1974; Ries, 1995). Nevertheless, in spite had the opportunity to comment on OnlyF by providing a confidential, and reported, quite slanderously, that of the success of the film, both Abraham radio or to write for a newspaper have sequestered atmosphere in our consulting the father of psychoanalysis kept some and Sachs risked grave disapprobation for failed to complete such assignments, rooms will patients or clients dare to thirty or forty patients queuing up in his having dared to work for Pabst without perhaps in part due to a fear of being articulate their most terrifying fears and waiting-room at any one time! (Hale, Freud’s benediction. envied by colleagues or due to an anxiety anxieties, their most troubling thoughts 1995). In consequence, Freud became about being regarded as narcissistic or and memories, and their most shameful increasingly wary of any attempts at Donald Winnicott, of course, made huge exhibitionistic in some way. wishes and desires. Perhaps for this very popularisation through the press. strides as a pioneer of media psychology reason the American poet Hilda Doolittle, by delivering a significant number Fortunately, the tide has begun to turn who had undergone analysis with ‘We have missed of radio transmissions for the British due, in large measure, to the powerful Sigmund Freud in Vienna during the Broadcasting Corporation between the need to publicise our professional work in 1930s, wrote that Freud’s ‘old-fashioned opportunities late-1930s and the 1960s, and even a ferociously competitive field. horsehair sofa’ had, in its time, ‘heard appeared on television – perhaps the more secrets than the confession box of to collaborate in first British psychoanalyst ever to do The psychological ‘marketplace’ has any popular Roman Catholic father- making our work so. Winnicott also produced a book for become more crowded than ever before, confessor in his heyday’ (H.D. [Hilda lay people, The Child, the Family, and with a vast army of different professional Doolittle], 1945, p. 79). better known.’ the Outside World (1964), published by groups ranging from cognitive- Penguin Books, which became one of behavioural therapists, to life coaches, to Thus, our long-standing reluctance to Although psychoanalytical practitioners the first best-selling books in the entire massage therapists, to spiritual healers, all work creatively and enthusiastically have become very adept at keeping field of psychology. In spite of these offering treatment for people in distress. with the media and with the public at our patients’ confessions private, we achievements, however, Winnicott had to We know that members of the public still large may stem, at least in part, from our often apply that very same sense of endure quite a lot of resistance from some struggle to understand the differences historical allegiance to Freud’s sometimes protectiveness and silence to all aspects of conservative colleagues for having dared between psychologists and psychiatrists quite justified hesitations and suspicions. our working lives, and consequently, we speak about psychoanalysis in such large and, also, between psychotherapists fail to speak with the general public as public arenas. and counsellors, let alone whether one But over the decades, a tiny band of fully as we might, often to our detriment. should consult a Freudian psychoanalyst colleagues had risked collaboration with Not only have we demonstrated But in spite of these bold forays, very or a Jungian analytical psychologist, or filmmakers, most notably Karl Abraham considerable reluctance to engage with few members of our community have an object relations psychotherapist, or and Hanns Sachs. These early Berlin- the public but, also, we have missed collaborated with the press, and those an attachment-based psychotherapist. many opportunities to collaborate with based Freudians consulted to the famous journalists, authors, radio and television Austrian filmmaker Georg Wilhelm Pabst, producers, and with other media experts who directed a serious, feature-length who might assist us in making our work movie about the new Freudian psychology, better known to a wider audience. entitled Geheimnisse einer Seele – known in English as Secrets of a Soul – which Owing to the fact that most Britons still cannot differentiate between a psychotherapist and a psychiatrist, and that many still believe that we lack any evidence at all for the efficacy of the talking therapies, the education of the public remains of vital importance to the growth and survival of the psychoanalytical community.

Since the inception of psychoanalysis, clinical practitioners have struggled with the question of whether one should collaborate with the media at all. Indeed, Sigmund Freud harboured grave reservations about the merits of granting interviews to newspaper reporters for fear of being misquoted or misrepresented, and often with good reason. For instance,

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Amid the confusion generated by these and good will of these colleagues in the split and splintered groupings, it would promotion of our profession. To cite Letters be naïve to assume that our position but one example, Susie Orbach recently within the growing marketplace remains received many highly favourable reviews safe and secure, in spite of having in the press for her five-part radio series flourished for more than a century. As In Therapy, broadcast on BBC Radio 4. Dear New Associations, Europe’s Enlightenment-rooted values. It an ageing profession which specialises in These programmes feature Dr Orbach is onto such realities that projected fears offering slow, steady, open-ended depth in simulated, unscripted psychotherapy Lene Auestad’s article ‘The social and phantasies are hung – and the Jews psychological work in an increasingly sessions with professional actors, which unconscious and the herd’ (New of France, suffering from a surge in anti- manic, technologised society, registrants of provide the public with a rich sense of Associations, Issue 20, Spring 2016), Semitism largely issuing from France’s the British Psychoanalytic Council cannot the thoughtful and moving way in which based on the idea of a social unconscious Muslim population, know these realities rest on our laurels; and we all know of a clinician can listen and understand and operating in right-wing populist well enough to have begun leaving the prospective patients who have chosen to speak. The series proved so popular with movements, seems hampered by its own continent en masse. have monthly sessions with a life coach audiences that the BBC has commissioned disavowal, idealisation and projection – rather than weekly, let alone daily, Dr Orbach to provide ten more episodes, as it half predicts it would be by stating These facts are currently taboo in the sessions with one of our practitioners. which will be broadcast in late 2016. ‘psychoanalytically informed theorists… West’s academies – the Gramscian are not necessarily in a better position than element of which has long indulged the Several years ago, the Council of the The details of our proposals will be anyone else to spot dehumanising practices utopian and ultimately self-destructive BPC created a Future Strategy Working circulated in more detail in due course, of which they are part.’ I am concerned fantasy of bringing down the West. Group (FSWG), currently chaired by and will serve as a complement to the that the article’s apparent cultural This erosion of Western culture is not, Susanna Abse, which meets monthly. already important and impressive work relativism ultimately fails to promote however, ushering in a socialist paradise Gary Fereday, the Chief Executive of the undertaken by BPC staff members. In tolerance by being too accommodating for the marginalised, it is catalysing the BPC, attends regularly, along with seven the meantime, with the blessing of of the intolerance found in minority aggressive dominance of Islamism and registrants from a variety of BPC member Helen Morgan, our Chair, and Gary communities. Auestad seems to stand other fascistic ideologies. As evidenced institutions. In recent months, the FSWG Fereday, our Chief Executive, we wish to for the confused, seemingly unlimited by Auestad’s article, psychoanalysis has focused intensely on brainstorming alert members to the BPC’s increasing tolerance of left-wing multiculturalism; has affiliations with this misguided about the possibilities of enhancing the interest in, and concern for, liaising with the internal contradictions of which are tendency in our academies, but being in BPC’s media and public relations strategy the general public and with the media now more sharply defined than ever by the business of exploring what is taboo by creating plans for a variety of exciting, so that our work in this arena will soon the migration crisis and Europe’s rapidly and aware of the dangers of disavowal, outward-facing projects, including the reach the same high standards of impact changing demographics. Much of the it might be mindful of Karl Popper’s development of a pool of experts from as our work in the fields of professional rise of right-wing populism is rooted paradox of tolerance: within the membership body who would registration, public policy, regulation of in precisely this disavowal of very real be willing to speak to journalists, radio training standards, and maintenance of concerns about Islam in particular – Unlimited tolerance must lead to the and television producers, and filmmakers, ethical codes. concerns which may be permeated with disappearance of tolerance. If we offering timely responses to immediate, unconscious fears and phantasies, as all extend unlimited tolerance even to newsworthy queries as well as consultation Unless we prioritise public engagement mental life is, but are real nonetheless. those who are intolerant, if we are not to longer-term projects. The BPC also more fully than ever before, we run Specifically, much as Auestad casts the prepared to defend a tolerant society plans to launch a publications programme the risk of being occluded by newer ‘other’ of Islam as benign, and reductively against the onslaught of the intolerant, as well as a series of events targeted professional organisations which have psychologises to dismiss as ‘dark’ and of then the tolerant will be destroyed, specifically for members of the general already embraced technology, social the ‘herd’ any concerns regarding it, such and tolerance with them. (Popper, public to advertise some of the most media, and publicity very enthusiastically, concerns are not without substance and 1945, The Open Society and its impressive, outward-reaching clinical unencumbered by the inhibitions of are not at odds with classical liberalism. Enemies) services initiated and facilitated by our their professional ancestors. Without registrants. responsible, but also potent and effective, The multiculturalist failure to take such Psychoanalytically informed voice public relations strategies, we will become real concerns seriously has been capitalised needs to be given to the uncomfortable, We recognise that working with the media both marginalised and vulnerable and we on by the unsavoury right, and much inconvenient truth of ascendant, radical demands tremendous thoughtfulness, will lose not only potential trainees for our could be retrieved for the rational political Islam’s scripturally sanctioned theocratic supreme diplomacy and, at all times, an institutions but, also, any clinical referrals middle-ground by looking squarely violence and intolerance; augmenting adherence to our vital ethical principles for our own practices. at what the left will not. The reality critiques by moderate, reformist Muslims (e.g., Dinwiddie, 2015). For instance, many beyond the populist right’s undoubted such as Maajid Nawaz and Raheel Raza, colleagues might harbour a reluctance The need to engage vigorously must projections onto the approximately 1.5 in addition to those offered by the likes to become involved in media-related no longer be regarded as an option but, million tragically displaced or migrating of Douglas Murray, Sam Harris and activities for fear that their patients rather, as an obligation people entering Europe in 2015 is that, Melanie Phillips. If psychoanalysis limits would be distressed at seeing their according to EU Vice President Frans its engagement on this issue to entirely psychotherapist or psychoanalyst on a Signed: Susanna Abse, Nigel Burch, Timmermans, approximately 60% were appropriate empathic identification with public platform. Should this prove to Brett Kahr, Harvey Taylor, Daniel Weir, not Syrians fleeing their civil war. For displaced people and the ‘othering’ they the case, practitioners would have the Serena Willmott the Syrians among them, neighbouring suffer, while disavowing anything which opportunity to work with patients in On behalf of the countries such as Turkey were places of challenges the dogmatic multiculturalism sessions about the thoughts and fantasies Future Strategy Working Group. safety where asylum could have been typically attached to such good will, that might emerge. Our experience of claimed had the economic opportunities then, paraphrasing Auden’s September 1, speaking to experienced contributors to and generous welfare provision of 1939, the clever hopes of such political the field of media psychology suggests References northern Europe not beckoned from across correctness will expire as the unspoken, that patients often derive great comfort dangerous waters. Furthermore, there is uncomfortable truths here outlined are Chodorkoff, Bernard, and Baxter, Seymour (1974). the not inconsiderable issue of opinions given uglier voice by others from knowing that their therapist or ‘Secrets of a Soul': An Early Psychoanalytic Film analyst has the capacity to speak clearly, Venture. American Imago, 31, 319-334. in the Muslim world (e.g. Pew Research compassionately, and sanely, in spite of Dinwiddie, Stephen H. (2015). Communication Centre’s The World’s Muslims: Religion, Yours sincerely, with Mass Media. In John Z. Sadler, Werdie (C.W.) Politics and Society, 2013): terrorists have Adrian Smith being under pressure of making a live van Staden, and Kenneth W.M. Fulford (Eds.). The radio or television broadcast. Oxford Handbook of Psychiatric Ethics: Volume II, the sympathy of a significant minority pp. 826-838. Oxford: Oxford University Press. numbering millions and attitudes towards H.D. [Hilda Doolittle] (1945). Writing on the Wall. Adrian Smith is a PhD student in And yet, in spite of the challenge of [Part I]. Life and Letters To-Day, 45, 67-98. fundamental liberties, separation of state communicating about our work to a Hale, Nathan G., Jr. (1995). The Rise and Crisis of and religion, gender equality and sexual Psychoanalytic Studies at University Psychoanalysis in the United States: Freud and the minorities are predominantly contrary to College London. larger audience, and the anxiety that Americans, 1917-1985. New York: Oxford University this often engenders, we already have a Press. number of registrants within the BPC Ries, Paul (1995). Popularise and / or Be Damned: Psychoanalysis and Film at the Crossroads in 1925. who have undertaken such work quite International Journal of Psycho-Analysis, 76, 759- successfully over a long period of time; 791. hence, it would be a waste of our resources Winnicott, Donald W. (1964). The Child, the Family, and the Outside World. Harmondsworth, Middlesex: if we failed to enlist the cooperation Penguin Books

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Culture

Tension at the border, emotional freedom and the creative process

By Tomasz Fortuna

I found that I could say things with color and shapes that I couldn’t say any other way – things I had no words for.’ Georgia O’Keeffe (1926)

OW DOES ONE portray in ourselves in regard to the external world words an emotional and our internal landscape. It is a version experience, a sense of of the Copernican revolution and its freedom, or the creative psychological consequences, where the process,H which by their very nature are unconscious mind becomes the centre of non-verbal? gravity (Laplanche 1999).

Georgia O’Keeffe’s quote immediately Berger adds that the way we see our confronts us with the difficult and at surroundings is influenced by our made by a particular perception and the witness is then a kind of fulfilment of times the impossible task of finding knowledge and our beliefs. Thus this conflicts that are activated. this internal scenario. Might he not only words, verbalising, and symbolising our relationship, as we know, works the have hated but also loved and admired emotional experience. Yet, in our minds, other way too. Not only does what we The intrigue portrayed in Antonioni’s an older man in his own life? One can there is a range of representations of see determine our thinking, but our film Blow-up (1966) can be interpreted imagine the resulting sense of terror and different degrees of concreteness or unconscious beliefs and phantasies in the as a metaphor for discovering something guilt. Although all these events occur in experiences which are only stored, such world of our internal objects colour the unexpected or even something that we reality and concern strangers, for the as beta agglomerations, which still are in way we perceive. do not want to know about. A young photographer, his internal drama is search for their meaning. photographer suspects that, in the painful and palpable, because the internal Although Berger largely focuses on the surreptitiously taken photographs of a reality is no less significant than the The question of creativity is closely cognitive as well as historical and cultural couple encountered in the park, he has external one. On the one hand, this is an related to the understanding of human aspects of seeing, he also touches on the uncovered evidence of an attempted Oedipal scenario, and on the other, we psychic life, its richness, complexity and emotional sphere when commenting on murder. The photographer finds the are dealing with much more primitive mystery. As practising clinicians know falling in love. One can see the experience discovery simultaneously shocking and experiences and phantasies. The sense well, analysis without creativity would not of perfection and completeness as exciting; convinced that his presence must of helplessness and danger seems to be do; in turn, psychoanalytic understanding emerging from the point of contact have saved somebody’s life, he shares constantly present in the background. sheds light on the nature of art itself. between our actual experience with the the news with his agent. Perhaps the beloved person, our previous relationships photographer is attempting to protect The ways of dealing with this kind of Richard Wollheim (1998) reminds us and attachments, and relevant himself from the disturbing recognition experience raise another question. For about the importance of applying the unconscious phantasies and expectations. that the murderer has succeeded. Only the film’s main character, the blurring best knowledge of the human mind and In the analytic encounter the totality later does he consciously notice on the of the image and the evidence, as well as the human psychology we have, and he of transference, with the projective and prints the presence of a man’s body. the emergence of doubts that serve the considered psychoanalysis a key tool. introjective processes, colours the way The reality of the murder has been need to forget and disavow his knowledge Not without humour, he remarked that we relate, and the way members of the confirmed; however, the negatives are of the murder, become the solution. The ‘many art historians, in their scholarly analytic couple experience themselves and stolen during a break-in into his studio final scene of the film seems to confirm work, make do with a psychology that, if each other. and the body disappears from the park. this: the photographer encounters a they tried to live their lives by it, would Only one blurry and grainy print remains, group of mime artists and joins them in leave them at the end of an ordinary day The complexity of seeing is reflected in as if a faded reminder that something did a pretend tennis match. In this scene, the without lovers, friends, or any insight into the ambiguity of our language. To see, to happen and that something was seen to awareness and sense of reality seem to how this came about.’ His sharp comment perceive, also means to understand and to have happened, and that it is he who has fade away. It is no longer clear whether makes the link between artistic creativity have a particular attitude towards people, the knowledge of what has happened. what seemed to have happened did occur and the complexity of our psychic life situations, places and ideas. One of the in reality, or whether it had been a game very palpable. dimensions of emotional freedom is the The emotional dimension of the of make-believe. In addition, the woman extent to which we can bear, tolerate and predicament can be illustrated by disappears, which allows the photographer As art critic John Berger writes: ‘Each engage with what we see. Despite the hypothesising about the photographer’s to forget about his desires towards her. evening we see the sun set. We know fact that the filtering of what we observe unconscious phantasies and desires that that the earth is turning away from occurs on different levels, the role of played a central role in his experience. Bion (1957) confronts us with the it. Yet the knowledge, the explanation, emotional experience is especially curious. What if he had had murderous wishes to difficulty in tolerating knowledge and never quite fits the sight’ (Berger 1972). The way in which we recognise and accept eliminate from his life an older, powerful insight in his paper, where Oedipus’ This dissonance has its reflection in our some elements as well as reject, forget and man and to seduce a mature woman? arrogance turned out to be catastrophic, inner life, through the way we position repress others depends on the impression The reality of which he has become a as he pursues the uncovering of the truth

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regardless of the costs and consequences. in part an aspect of Wollheim’s (1993) impulse. Shots repeated later, although escape from Cuba, her mysterious death Oedipus pays for his actions with model of correspondence, where the link perhaps technically better, do not tend to and the character of her art do not blindness and exile, which symbolise between the emotional experience and have the same mood and aesthetic depth, lend themselves to simple classification. departure from knowledge. The blindness the artistic creativity is established. He as if they had no soul. To my mind, the Blocker says that she found herself ‘in and the exile provide him with a shelter, emphasises the importance of the artist’s described moment is the point of contact the contradictory position of wanting to a peculiar kind of oasis born out of intentions in this process and, I would with the unconscious; it has the quality of save her [Mendieta] both through history a version of events, which lifted the add, the artist’s unconscious motivations. dreaming and a reverie. It is the moment and from history.’ To pin Mendieta’s weight of responsibility opening the way It represents the wish to communicate an of truth. work down and allocate her ‘place’ would to psychic retreat (Steiner 1990). The experience and give it a form, as well as already be an enactment in relation falsehood of this version of events is due a wish to repair one’s own internal world In his recommendations for analysts at to the artist’s personal history, which to the obliteration of the complexity of and an attempt at psychic growth. work, Wilfred Bion felt that repetitive would dismiss her continuous search for this situation with its actual implications. elements such as routine associations, expressions and meaning. And further I think in similar terms about the memories of previous sessions or the (Blocker 1999): ‘I was reminded of this Writing about how we come to terms with dynamic movement and interaction desire to cure the patient in analysis do dilemma when I first saw, at Galerie the fact that we are both the observers and between the paranoid-schizoid and not really help; instead, they become Lelong in New York, one of the drawings the observed, Berger (1972) underlines depressive positions, as well as Thomas obstacles and lead to the creation of that Mendieta did directly on leaves. … an important issue that has been a subject H. Ogden’s autistic-contiguous position a distance from the actual emotional The leaf, brown and dried, was inscribed of psychoanalytic examination. Ronald (1989). The complexity of experience in experience shared with the patient in a with an abstract drawing of a female Britton explains (1999): ‘If the link each of these positions or states of mind consulting room. Bion calls the negative figure whose curving spine was formed by between the parents perceived in love and not only enriches the created art object capability a state in which we are able the leaf’s central vein. … Holding the box hate can be tolerated in a child’s mind, but also opens up a possibility for the to allow an experience and tolerate it, in my hands, I was struck by the thought it provides the child with a prototype development of new original attributes even though we may not know how to that I could quite easily crush the leaf to for an object relationship of a third and forms. The autistic-contiguous mode interpret it; or else, we find it surprising dust, an act that I could never perform kind in which he or she is a witness and of experience, with its sensory dominated or frightening, and we are as yet not able but the thought of which haunted me. not a participant. A third position then nature, adds yet another dimension to the to describe it in words. It is the capacity to To destroy the leaf seemed to me an act comes into existence from which object experience of the other, a rudimentary carry on without the assumption that it is of inconceivable brutality, as though it relationships can be observed. Given this, sense of boundedness that leads to the our task to have to find urgently some way meant physically harming another person.’ we can also envisage being observed. This more complex experience of otherness of describing what is going on. provides us with a capacity for seeing in conjunction with the transmission This is a description of a powerful, ourselves in interaction with others and between the child’s and the adult’s emotionally moving experience that for entertaining another point of view unconscious minds. ‘The spectator almost demands to be acted on. And while retaining our own – for observing recognises there, this is an example of the capacity ourselves while being ourselves.’ Hanna Segal (Quinodoz 2007) draws our to receive those powerful emotions. The attention to the existence of a kind of echoes of a sense of lightness, fragility and beauty Looking at this issue from a different conflict between positions which leads communication is confronted by a brutal, destructive angle, Jean Laplanche (1997) developed to creative tension. According to Segal, force and a wish to annihilate. It is not in his work the question of the origins the artist creates a specifically intimate received in an unusual reaction to Mendieta’s art. I of the unconscious mind, as initiated world which reflects internal experiences chidhood.’ found the recent retrospective exhibition by the enigmatic messages representing and negotiates conflicts, expressing them of her works moving in a very similar the adult sexual unconscious which symbolically through a concrete form Thus, there is a freedom from something, way. She draws the spectator in and one becomes a recipient of in early life. of art. Segal adds that it is the form of for example from anxiety, and freedom unsettles his inner calm. It is, however, Following Laplanche, I think that it is the artistic expression that depends on the to grow, create and associate in a free worthwhile resisting the temptation continuous movement between different elements relevant to experience in the way, which allows us to discover new of overhasty classification in return for axes, between Ptolemaic and Copernican paranoid-schizoid position. meanings and dive into new experiences, an unsettling and creative, thought- points of view. By its very nature, our as yet unintelligible, instead of juggling provoking experience. At the end of my mind is egocentric but at the same time The moment of all of these elements the old ones with which we are already visit to the exhibition, however, it struck decentred through experience of the coming together – for example when familiar. A question arises whether one me that, although I knew very few facts unconscious, in terms of an internal the photographer decides to release the can watch and experience art without about Mendieta’s life, various pieces were otherness of the unconscious mind as shutter – is fascinating. What is it that has prior expectations or preconceptions, as starting to come together. I felt a sense well as the otherness and strangeness of motivated the artist and provoked him for instance in the case of the Cuban- of intimacy with this forever-exploring another person. According to Laplanche, into action? And what is it that has given American artist Ana Mendieta, restraining adolescent’s feeling at a loss as well as there not only takes place a phantasy him the certainty that this is the moment, oneself from the compulsive rush to with the incredible strength of one who about the existence of another person angle, and frame? allocate her a place. Jane Blocker (1999) had to leave her homeland on her own, contrasted with the objective presence of writes: ‘Ana Mendieta’s ashes are buried at the same time trying to face up to the another, but also a communication coming In one of his early photo books entitled A in my hometown. Such is my relationship culture she had grown up with and to her from this other person that provides one Hunter, the Japanese photographer Daido to her. She moved there before I did, and, identity as an artist and a woman. with a sense of being different as well Moriyama published a set of photographs, although we lived there at the same time, as with the sense that there does exist some of which had been taken from the she moved away again before I had ever I have attempted to demonstrate my someone or something outside oneself. window of a moving car. His photographs heard of her.’ interpretation of some of the processes have no captions; the book can be seen present during both the creation of art I am interested in two aspects of this as a record of the author’s experience. It Despite this, her art had made a and during its reception. I have also situation: the continuous movement is an extreme example of an intimate significant impact on Blocker, who wrote considered elements that seem essential in between the egocentric, Ptolemaic, and relationship with the moment and the a book contemplating Mendieta’s work. a free creative act. These are, for example, the Copernican points of view (the latter place of the photograph being taken. His The author states that the period when aspects of psychological functioning with centres of gravity outside the self) blurry, high contrast, black-and-white performance art was blossoming led many such as fluidity in communication with experience of this movement, and street photographs, with the raindrops art critics and merchants to despair. Here, with the unconscious and a capacity for the communication, a message that comes and the light trapped in these images, the action of the artist and the response of dreaming and reverie. The art acts as from the other person. Looking from this allow us to see through Moriyama’s eyes, the audience created a unique experience a kind of symbolic container in which perspective one could say that through as if following the photographer around. that was not replicable in exactly the same internal conflicts can be expressed while his or her work, the artist unconsciously The creative intimacy of his photographs way and which was certainly impossible the creative process can be used as a sends a message. In this way, the artist results from the artist’s experience of to sell. reparative process in our inner world. The lures their audience, while the spectator the particular moment in the context creative act can provide the potential recognises echoes of a communication of his internal world. It is not only his Mendieta’s art comprises sculptures, for emotional development through received in his or her childhood from relationship to the place but also to the photographs and recordings of the artist’s engagement with the external world, someone historically significant. The people appearing in the frame as if by performances; the essence of it is, however, with individuals in this world and with process of locating, projecting, own ‘chance’, and to the entire ambiance of that her art is this kind of emotional experiences and expectations onto the the surroundings. The photograph is a experience. The history of Mendieta’s object of art seems crucial and it became creation of the moment, driven by an Continues on page 27

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and we cannot reasonably blame which lead to specific policies and to Opinion politicians both for refusing to listen to which they adhere whatever the evidence what others have to say and (the other to the contrary. In fact, political ideologies persistent charge against them) pandering play a small part in British politics. No to the electorate to win the next election. one could seriously contend, I think, that either fascism or Marxism has played any Although we all like to personalise significant role in British politics. All three Engagement, not politics, the truth about policymaking main parties in the UK often struggle is much less exciting. Even the poll tax, to define what their underlying beliefs arguably the most egregious domestic actually are, especially the Conservatives, estrangement policymaking disaster of the past thirty who for quite long periods of their history years, wasn’t, in my view, the result of have been clear what they have been a personal ideological crusade on the against, but have been less clear what they By David Fanthorpe part of Mrs Thatcher (though she was actually stand for. Labour used of course eager to replace the rating system). It to be a socialist party, but formally ditched didn’t fail because the prime minister it as its ideology with Tony Blair’s ‘Clause refused to listen to dissentient voices (and IV moment’. Although briefly back in there were some powerful ones, even vogue, no one seriously imagines that it in government, including Chancellor will fight the next election on some kind S A STRONG supporter of this rings true. I think we all recognise Lawson). In fact, one of the worst aspects of explicitly socialist manifesto. the psychoanalytic and this phenomenon; I have certainly seen of the implementation of the poll tax, psychotherapeutic it in action. It is a danger for all leaders, the decision to abandon the initial policy In fact, the UK’s (still essentially) profession, on the one and the more powerful they are, the of phasing in the new tax in favour of two-party politics, underpinned by hand,A and as someone who has spent a lot greater the danger. Whether we are a ‘one fell swoop’ approach, was owed the electoral system, has not led to of his life with or around politicians, talking about Mrs Thatcher’s increasing – unbelievably – to a vote to that effect two ideologically-based traditions but many of them on the political right, on isolation in Number Ten by the end of in the Conservative party conference. instead to the emergence of two ‘internal the other, reading recent editions of New her premiership, or Mr Blair’s preference Unsurprisingly, this was the first and coalitions’, one of the left and one of the Associations has been at times a rather for ‘sofa government’, powerful leaders last time that a conference decision was right. Changes of government usually painful experience. ‘Modern politics,’ increasingly surround themselves with allowed to affect government policy. come about because of voters’ judgment 1 writes Philip Stokoe, ‘is distorted by a sycophants. All that is true. But we do on the competence, or otherwise, of the shared unconscious belief’; politicians, he politicians a disservice if we go on from So, I would argue that a policy disaster incumbent, and only very rarely express continues, ‘become overwhelmed with that to imagine that, even within the tent, usually associated personally with a any strong yearning for a particular persecutory anxiety and… preoccupied there is no room for debate, dissent or political leader and ascribed to her style or ethos of government (1945 is with defending against this assault, e.g. second thoughts. ‘stubbornness’ and ‘refusal to face facts’, is perhaps the obvious exception). So I blocking freedom of information, human actually a case study of something rather think we should be instinctively wary of rights etc., and becoming more dictatorial ‘Each different – accident, cock-up, misguided in their departments.’ Politicians on the intentions, perhaps skewed right of the spectrum are especially taken government political priorities, but not to task: ‘Since Thatcher,’ says Graham department has evidence of pathological Music, ‘this [belief we are born selfish] inability to hear an has become a dominant strand in its own dynamic.’ opposing point of view neoliberal ideology.’ Stokoe delivers the or to change course in coup de grace: ‘The electorate voted to There are two main reasons for this, the face of disaster (even remove from the coalition the single both to do with the workings of when, as in this case, presence that made thinking in British government. First, there is the the disaster befell the government a possibility: the Lib Dems.’ departmental system of government. Each government itself).2 department has its own dynamic, its own It’s not my purpose in this article to try interests and institutional memory. Some I agree with Stokoe that to put the political record straight, still departments are decidedly more equal we get the leaders we less to seek to persuade readers of New than others, and the Treasury is the most deserve, but unlike him, Associations that they should learn to love equal of all, but even the Treasury does I think, I believe that we the Conservative party. But I do want to not always get its own way. Government is largely create our leaders stand up for politicians in government, an exercise in holding together competing in our imaginations. We and I also want to suggest to the interests. then judge all their actions profession that if it wants to achieve the through the prism of the objective of becoming socially engaged, The second is the existence of an kind of leader we have an aspiration set out by the Chair in impartial civil service. Many government decided they should be; another recent article for this publication, policies start out life as a departmental and we ascribe pretty then it should also strive to be perhaps a options paper; some may have been much all the actions of little more sympathetic towards those in gathering dust in a drawer for years before their government to them government, and above all to understand their time arrives. But at least at some personally. Above all, we what motivates them and the constraints stage each will have been subject to a credit all politicians with under which they work. rational analysis. Now of course officials far more power than they become adept at divining their political actually have. I suspect Now, I am necessarily arguing from a masters’ wishes, but the point is that we do this because it lay perspective. I’m in no position to most policies have been through a pretty makes life simpler for us; tackle the psychoanalytic insights of rigorous vetting process before they get perhaps it’s the only thing the contributors to this journal. What I anywhere near parliamentary scrutiny. that makes it bearable at will try to do, in the context of some of Then they go through it all again. times – the belief that the critiques advanced in these pages, the omnipotent ‘they’ are is to offer a lay view on the pressures, It is, admittedly, a weakness of our system responsible when things go motivations and mindsets of our political that governments, especially those with wrong. leaders. a healthy majority in the Commons, can do pretty much what they like, within Part of our belief about I think a good place to start is Stokoe’s the law; our constitution lacks the built- the mindsets of politicians analysis of the dynamics within groups in checks and balances of its American is that they are excessively surrounding leaders, and between the offspring. But we do need to remember ‘ideological’, that is, driven group and the external world. Much of that we live in an ‘elective dictatorship’, by a set of first principles

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explanations (or critiques) of government I do believe that there is a glimmer policy which are founded on an of an opening for psychotherapy and Tension at the border ideological analysis. More often than not psychoanalysis as part of the overall continued from page 25 the ascription of ideology to an opponent healthcare armoury of the 21st century. tells us more about the ascriber than the If even a Conservative prime minister can ascribed. espouse a ‘happiness index’ and – more the techniques and materials that the something characteristic and close to seriously – MPs of all parties can share artist chooses. Not without significance its deepest nature and the nature of the In fact, the two main parties in British their own experiences of mental ill- here is the capacity for the ‘third position’, relationship in analysis. I think a similar politics have had long periods since 1945 health, we might just be at the beginning referred to earlier, and for self-observation. process is reflected in works of art and when they have occupied strikingly of an exciting development in genuinely What also matters is the potential for takes active form in our reception of art similar policy territory, and the obvious holistic healthcare. movement, or in other words, for not and its creative power ‘turning-points’ of electoral history – remaining permanently in one place. 1964, and especially 1979 and 1997 – have The profession has choices: to engage in In my view, it is precisely this dynamic often masked the fact that there was debate, or to shout from the sidelines; movement that is pivotal for freedom Dr Tomasz Fortuna is a member of the little change in the overall direction of to deal with the world as it is, or as you while creativity involves the capacity to British Psychoanalytical Society and works government policy (especially economic want it to be. I hope for the sake of the express the tension between the described at the Portman Clinic. policy). For example, the UK embarked profession, and for society – and yes, there states, which through work and emotional on essentially monetarist, deflationary is such a thing as society4 – that the choice engagement lead to the creation of an policies in 1976, at the behest of the is engagement, not estrangement art object. Referring to movement, I References IMF, not in 19793. The reason why the do not mean an escape from emotional Conservatives struggled after 1997 was Blocker, J. (1999) Where is Ana Mendieta?: Identity, experiences, but rather a creative Performativity, and Exile. Durham, NC: Duke that New Labour was camped on their David Fanthorpe is a former civil servant, dialectical interplay between various University Press. territory, and they made the mistake of deputy director of research for the states of mind; a continuous shifting of Laplanche, J. (1997) The Theory Of Seduction searching for ‘clear blue water’ to put And The Problem Of The Other. Int. J. Psycho-Anal., Conservative party, councillor, constituency the centre of gravity of our experience. 78:653-666. between them and the government. chair and parliamentary candidate. He is The developmental aspect of art O’Keefee, G. (1926) In the 'Foreword' of the now a freelance public affairs consultant. involves emotional development and the catalogue for the show at the Anderson Galleries in David is also a member of the BPC’s negotiation of internal conflicts through New York, 1926. ‘The profession Ogden, T.H. (1989). On the Concept of an Autistic- Independent Scrutiny and Advisory establishing their representations as well Contiguous Position. Int. J. Psycho-Anal., 70:127-140. has choices: to Committee and was for six years a member as finding new forms of expression, whilst Ogden, T.H. (2016) Reclaiming Unlived Life: of the BPC’s Screening Committee. simultaneously engaging the viewer in Experiences in Psychoanalysis. New Library of engage in debate, Psychoanalysis. this process. There however is the threat Quinodoz, J-M. (2007) Listening to Hanna Segal: or to shout from of a tyrannical phantasy that one is Her Contribution to Psychoanalysis. New Library of required to always be in touch with one’s Psychoanalysis Teaching Series. the sidelines.’ Steiner, J. (1990). The Retreat from Truth to Notes feelings, which is yet another version of Omnipotence in Sophocles' Oedipus at Colonus. Int. foreclosure and obliteration of meaning, a R. Psycho-Anal., 17:227-237. Many readers of New Associations will no 1. For a good discussion of group-think in British version of non-dreaming. Wollheim, R. (1993) The Mind and its Depths. doubt not accept this analysis. But there government, see King & Crewe, The Blunders of our Harvard University Press. Governments, chapter 17 (Oneworld, 2013). is one final reason why I believe BPC Wollheim, R. (1998) Preface in Painting as an Art, 2. For an excellent in-depth study of the genesis of When Ogden (2016) writes about the London 1998, p. 9. registrants should strive even harder to the poll tax, see Failure in British Government: the unique language and rhythm which find it in themselves if not to like, at least Politics of the Poll Tax (Butler, Adonis & Travers), OUP, 1994 develop in every analysis, he recognises An earlier shorter version of this text was published not to feel so antagonistic towards, and to in Art and Freedom. Psychoanalytic reflection on the 3. Or possibly, according to Denis Healey, who should some native aspect to the personality, understand, our political leaders generally have known, 1975. See Beckett, When the Lights meaning of creativity, ed. Sala, E., Mocak: Kraków Went Out: Britain in the Seventies, p.322-3 (Faber & 2014. and the current government in particular. Faber, 2009) And that’s because by understanding 4. As the full quote, in context, demonstrates. ‘There them better, and – if I may say so – less is no such thing as society. There is [a] living tapestry of men and women and people and the beauty of judgmentally, you are far more likely to that tapestry and the quality of our lives will depend have a successful dialogue with them. upon how much each of us is prepared to take responsibility for ourselves and each of us prepared to turn round and help by our own efforts those who I know that the BPC executive team are unfortunate.’ (Transcript of an interview with Woman’s Own in 1987, extracted from http://www. understands this, which is why they are margaretthatcher.org/document/106689.) effective representatives of the profession. But if the profession more widely could adopt this attitude, it might just help to get its views across. Of course, if you really do feel that the government is hell-bent on destroying the NHS for ideological purposes of its own (though I’m not quite sure what those could be), then it might be difficult to sit down to have a constructive discussion.

If you want genuinely to engage with government, whoever you are, you have to be able to put yourselves in their position; and it helps, on the whole, to treat them as if they are people who are actually trying to do their best, to act rationally and to do a very difficult job. If you completely reject them and everything they stand for, you can hardly complain if you don’t get much of a hearing. It will be even more challenging if you dismiss right-of-centre policymakers who do support the value of psychotherapy, or other talking therapies, as seeking only to bolster ‘neoliberal individualism’.

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Home is where we start from

By Angela Joyce

ONALD WINNICOTT from London during World War Two, are beneficial impact on the world than many any other figure in psychoanalysis. Largely needs little introduction in now being confirmed by neuroscientific of the more bombastic and theory-driven unacknowledged by the general public, psychoanalytic circles. research and are practically taken manifestos for social change characterising although his name would be familiar to However, in this special for granted when it comes to social the 20th century. many, his perspectives have permeated editionD of New Associations, focusing as it policy: without good-enough parenting, the culture, appearing, for instance, in is on the interface between psychoanalysis becoming a well-adjusted member of Winnicott has been accused of being a reference to artist Grayson Perry’s teddy and society, the broader implications of society is an uphill struggle indeed. This conservative by those for whom the term bear, Alan Measles, who helped him his work are salient. After all, it is perhaps task of adjustment is all the more pressing is practically derogatory: his emphasis on through a lonely and troubled childhood Winnicott, second only to Freud, who in our internet era, when young people the mother-infant relationship seen as (see article written by Grayson’s wife, stands as the most influential analyst in especially are bombarded with false normative and a post-war push to get the Philippa Perry, The Independent, Monday the culture at large beyond our institutes promises of instant gratification and lured traditional family firmly back in place. 29 September 2014). and consulting rooms. This claim could into virtual worlds of fantasy, with the If putting children at the centre of the easily be contended: what about the resulting potential for real-time anti-social agenda about family life is conservative, It is for greater acknowledgement influence of Jacques Lacan on literary behaviour. Parents, carers and children then he would rightly be regarded as of Winnicott that the Institute of theory, or Erich Fromm and the certainly have their work cut out for such; but his conservatism is not one of Psychoanalysis and the Winnicott Trust Frankfurt School? Winnicott’s influence them nowadays and no doubt Winnicott, fear, pessimism or original sin: it is a will shortly be presenting English was not on the academy and was not were he still with us, would have been a humane, Burkean conservatism which Heritage with a bid for a Blue Plaque for primarily intellectual; and it is the aim of measured, sagely voice facilitating passage sees society as a family, an organic unity Winnicott’s 87 Chester Square residence. this article to make the case that it is through such dangerous waters. which it would therefore be misplaced to As Chair of the Winnicott Trust I have precisely for these reasons that he comes artificially engineer with an aggressive been working on the central bid; and in second only to Freud. ‘Parents, carers ideological programme. This stripe of British Psychoanalytical Society President conservatism has permeated British Nick Temple, ex-President Michael Winnicott was on the cusp of the first and children society so extensively that it even Brearley, Christopher Bollas and IPA and second generation of British analysts, encompassed the political reforms of President Stefano Bolognini will be and his unique contributions range far have their work the 19th century and the Trade Union submitting supporting statements in beyond psychoanalysis to the care of cut out for them movement of the 20th – it is perhaps, the hope that what many consider to be children in medicine, social services, therefore, less ‘conservatism’ and more Britain’s greatest psychoanalyst will be residential care and ordinary home life, nowadays.’ the essence of the British political more widely appreciated as well as to British cultural life more tradition. Until very recently, change broadly. In addition to being a pioneering Winnicott worked with an enormous has come to British society step by step, range of people and organisations psychoanalyst (and the first male child a piece at a time without any utopian Angela Joyce is a psychoanalyst (BPAS) within and outside the mainstream psychoanalyst to be qualified in Britain), dreams in mind. This might be seen to and Chair of the Winnicott Trust. Winnicott was also a child psychiatrist psychoanalytic community. He was echo Winnicott’s observation that the and paediatrician (he was awarded the involved with giving talks to and teaching infant is best served by being gradually James Spence Gold Medal for Paediatrics teachers, social workers, doctors and let down by their good-enough mother – in 1968). These aspects of his professional residential workers amongst others; he the ‘world in small doses’ – so reality can life mutually informed his unique and taught generations of social workers slowly be encountered and revolutionary approach to understanding and teachers at the London School of played with, rather than the psychological troubles affecting Economics and the Institute of Education; controlled by the demands people of all ages. and he contributed to the government of infantile omnipotent investigations into state provision for fantasy, its pathology One of Winnicott’s major contributions children (The Curtis Committee, 1946). an outcome of having was to highlight the lifelong task of really been let down. It managing the relationship between Perhaps most famously though, he worked takes only a brief look at the inner world and external reality – to promote more humane childcare in the political history to see that with obvious social ramifications. He post-war years through his numerous BBC utopian dreams have hard appreciated that the coherence of the radio talks (from 1943-62 he gave over 50 landings, just as fantasising inner world of fantasy and external broadcasts): the series The child, the family can have those overly reality depended upon the quality of and the outside world and The ordinary prone to it come crashing the real relationships the baby has with devoted mother and her baby were also down. his or her caregivers at the beginning of published and remain in print selling life, particularly with the mother. These large numbers even today, 70 years later. The strength of caregivers (all being ‘good-enough’) Along with Benjamin Spock and John Winnicott’s ideas thus lie gradually adapt their responses to the Bowlby, Winnicott ushered in our society’s in their grounded quality baby so that the fantasy expectations – more liberal, child-centred parenting. As and in their relevance to a the ‘illusion/creations’ – of the infant expressed in the title of his best selling life worth living, a life of encounter and find external reality collection of essays, Home is where we creativity and feeling real. and become, over time, capable of start from, Winnicott saw our early family They make sense as much managing that unpredictable and at life as the generative root not only of adult to a psychoanalyst as they times frustrating reality. Such insights, personality, but of the nature of society do to an ordinary devoted largely originating in his extensive as a whole. His work to promote a more mother. In this way, after clinical experiences and his work with empathic style of parenting, in the modest Freud, Winnicott has children displaced during the evacuation way which characterised this impressive touched more lives than man, has thus had a more sustained and

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make the psychodynamic community more sure of is that her story is a valuable Review pause and consider its thinking about part of a growing canon of work including OCD. Esman (2001) traces the way in authors such as Matt Haigh and Stephen which contributions from biological Grosz, whose books on mental health psychiatry and behavioural psychology are reaching a wide audience. In July Bryony Gordon, Mad Girl: A through our fingers. This raises questions have marginalised psychodynamic 2016, Mad Girl became a top ten selling Happy Life With a Mixed-Up Mind about the merits of self-disclosure and thinking in relation to the treatment of book in the UK. We are all, patients and (Headline 2016) the appeal of apparent ‘madness’ to those OCD. Gabbard (2001) too points to the therapists alike, engaged in a process of Review by James du Cann looking on. The title and the cartoonish increasing tendency within psychiatry battling stigma, and Gordon’s courageous cover of the book, showing the author to consider the biologically based contribution to this is most welcome. Aficionados of television comedy may facing outwards with an open mouth aetiology of OCD. The latest research These kinds of publications assuredly recall a sketch from the BBC’s A Bit of and startled face, beckons us into her published by the Lancet in June 2016 make it easier for sufferers to discuss their Fry and Laurie in which Stephen Fry, internal world through the very mouth suggests that a range of interventions illnesses, bringing them to our doors to dressed up as a lady of a certain age, that will address us directly throughout is effective in the management of OCD seek the help they need addresses the camera as if replying to the book. The fact that there are no symptoms, specifically a combination an unseen pavement interviewer. Fry other photographs in the book to act of psychotherapeutic (mostly exposure interrupts his own sentence with the as a juxtaposition to the portrayal of and response prevention techniques) and James du Cann is a Psychodynamic words: ‘Oh Christ, I’ve left the iron the author as ‘mad’ leaves no room for psychopharmalogical methodology. Where Psychotherapist in private practice at on!’, before scuttling off screen to a confusion. We are supposed to believe our does this leave psychodynamic thinking? Southbank Counselling soundtrack of canned laughter. Just such subject is ‘mad’ and therefore interesting. (www.southbankcounselling.co.uk). a preoccupation led the journalist and After all, she tells us that she comes [email protected] columnist Bryony Gordon to take her own from a family of journalists ‘where all ‘The candour of iron to work in a handbag, preferable as personal humiliation can be used for the this book is this was to spending hours checking that it greater good and mined for a few hundred was switched off. words,’ and inhabits a world in which its forte.’ References self-destructive behaviour is rewarded Mad Girl is Gordon’s story of her with a column, while her editor calls her Leib (2001) contends that a purely https://www.youtube.com/watch?v=dUM6MxqaMDA psychodynamic approach has serious (A Bit of Fry and Laurie) struggles with mental illness from stress-related alopecia ‘a story’ and so it Skapinakis, P., et al. (2016) Pharmacological and childhood to motherhood, set against her naturally follows that it must be written limitations in this area but that it can add psychotherapeutic interventions for management rise up the Fleet Street career ladder. Her much to a combination of modalities, of obsessive-compulsive disorder in adults: a about. It is no surprise when the author systematic review and network meta-analysis. Obsessive Compulsive Disorder revealed tells us at the end of the book that in including more standard techniques The Lancet http://dx.doi.org/10.1016/S2215- itself in a remarkable way. At the age of spite of her wholehearted dance around such as the aforementioned exposure and 0366(16)30069-4 twelve, she woke from a dream in which the confessional pole, it was a difficult response prevention. My own experience Esman, A.H. (2001) Obsessive-Compulsive Disorder: in the field supports this. Like others, I Current Views. Psychoanalytic Inquiry 21: 145-156 she had a terminal disease and thereafter experience to write the book and her OCD Gabbard, G.O. (2001) Psychoanalytically Informed became convinced she was dying of symptoms reappeared. Little wonder she have introduced a longer session time to Approaches to the Treatment of Obsessive- facilitate this approach and it has been Compulsive Disorder. Psychoanalytic Inquiry 21: AIDS. So began a pattern of breakdowns, can come across as an unwilling contestant 208-221 a seamless process, not impinging at depression, anxiety, addiction, panic caught up in a larger journalistic game Leib, P.T. (2001) Integrating Behaviour Modification attacks and eating disorders lasting until that does not have her best interests at all on the depth of the psychodynamic and Pharmacotherapy with the Psychoanalytic work. If we accept that OCD symptoms Treatment of Obsessive-Compulsive Disorder: A Case her mid-thirties. As she calls it, an ‘endless heart. Study. Psychoanalytic Inquiry, 21: 222-241 cycle of self-loathing and despair.’ are rich in unconscious meaning, an Meares, R. (2001) A Specific Developmental Deficit There are two other areas in which the understanding of this fact can be most in Obsessive-Compulsive Disorder: The Example of the Wolf Man. Psychoanalytic Inquiry, 21: 289-319 The candour of this thought provoking book serves as a useful, if not edifying, helpful to a patient in the implementation book is its forte – the word ‘honest’ commentary. Firstly, Gordon comes into of behavioural therapeutic interventions. appears four times in its first six lines contact with medical professionals and Furthermore, as OCD fluctuates, an – the degree of self-disclosure utterly therapists from time to time. Almost all understanding of its unconscious unsparing. Meares (2001) refers to this in of these meetings prove uncomfortable triggers can assist in the management relation to OCD as an impediment ‘of the reading as they show very poor practice, of symptoms. One last point is to stress boundary between inner and outer worlds.’ leaving the patient confused and the importance of the assessment process Sadness and humour walk arm in arm in humiliated. Although Gordon admits that before embarking on psychodynamic work the story, not always to the greatest effect, she wishes she had stuck to a particular as a part of a combined modality approach as it is when the two separate that the course of therapy, the tragedy is that she with an OCD patient. As ever, it is the prose is at its most powerful. One wonders felt obliged to suffer in silence for so long assessment task to establish whether a whether the author felt the need to cradle and that silence was not helped by the working alliance can be established with this sadness in a humorous tone to make poor care she received. Clearly, twenty the particular patient in the light of what herself more palatable to her unknown years is far too long to find the appropriate might be cripplingly severe symptoms. readers. Stylistically, this can grate care for a disorder such as OCD. Secondly, After all, what use might a florid somewhat. Throwaway words like ‘nutso’ Gordon reveals that she is frequently interpretation into unconscious processes and ‘bonkers’ sit uncomfortably next to subject to sexist comments about her be to a patient whose only thought is that more considered phrases such as ‘linguistic appearance after her articles appear in they might be about to crash our table parsimony’. Nevertheless, Gordon can be print. Although she bats this away with lamp into our skull? terribly funny. She tells us about arriving typical humour, it reflects critically on the in China with Joan Rivers who started way in which female journalists are in the Gordon’s own experience is free from looking for its ‘Great Mall’. She casts firing line of mostly male comment from exposure to psychodynamic practice so we herself as a permanent fish out of water behind the anonymous computer screen. can only speculate as to how that might which gives her a detached observer’s have assisted her, if at all. What we can be eye to events, never more insightful than As a psychodynamic psychotherapist, when she finds the disappointments of it is hard to read the book without own body easier to accept while witnessing looking for ‘clues’ as to the aetiology of the amount of synthetic body components Gordon’s OCD. In this way, the book is on show at a Hollywood party. She can also a psychodynamic detective’s treasure break the reader’s heart, telling us that as trove, but it is perhaps best left to every a child she longed to hold her mother’s reader to find their own way into this hand but feared she would infect it with a material, from the endless self-deprecation poisonous touch. to a maternal figure who looms large, invested with the power of moral Gordon invites us to be ringside at every arbiter, whose words to her daughter are part of her life to the extent that we laden with meaning far beyond their become voyeur participants, peeking apparent simplicity. The book might also

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character of my training was coming with website. In making marketing decisions Training me; my clinical work would deepen into like our internet presence we are also new territory. advertising and modelling our therapy modality. But the truth is I want to earn Nina Coltart wrote about what it feels like a living and getting patients is important. at the beginning of a therapist’s working I pay rent, I have other costs so I need life and I have read and re-read parts clients (note the terminology change from ‘A prolonged of How To Survive as a Psychotherapist patients). Commercial considerations in many times this year. It feels like the the early stages are inextricably linked closest thing to a self-help manual for to therapeutic ones. In the early years newly qualified psychotherapists that I of my training we were expected to period of have found. She captures the emotion and make initial contact with our patients the experience with common sense and solely via the postal service – imagine! compassion for patients and therapists. Now psychotherapy competes alongside She reminded me that, ‘whatever the a wealth of ‘feel better fast’ services, uncertainty’ content of a period of severe anxiety, or sometimes on the same website. The point complete bafflement, or feeling hopelessly is a professional identity has many facets. inadequate in the face of another person’s By Rebecca Davies massive unhappiness, we do know that The practical considerations of being we have chosen to be where we are.’ I felt a working psychotherapist were thus this comment was helpful at lifting me endless and felt momentous. If I do not out of too much narcissistic preoccupation charge for consultations does that mean ATURDAY 25th JUNE, 2016. intellectual. Outside the institution the with colour charts. (Enjoyable though it I cheapen the work? If I always charge 48 hours since the EU landscape looked very different. Where was.) Her chapter on ‘Apparent Trivia’ for missed sessions am I too punitive? referendum and I hear on once I might have whined about being gave me solace as I made decisions about If I reply to initial patient enquiries on the radio an economic allocated a therapy room with dodgy air the set up and location of my consulting the same day do I come across as too forecastS for the UK in the wake of the conditioning, now I had no room at all. room, fees and invoicing, the use of a anxious? Do I call myself a counsellor country’s vote to leave the EU. ‘A Clients had been assessed and allocated to contract, communicating with patients as well as a psychotherapist because prolonged period of uncertainty for the me, senior clinicians and supervisors were outside the session, time given over to I think I will get more enquiries? UK, with negative implications.’ assigned to me and access to PEP web was consultations, offering counselling and And a tricky question to answer was free. One of my tutors once described the psychotherapy or just psychotherapy. the one enquiring, ‘What exactly is I could now write at length about the institution as like a ‘brick mother’ so the I consulted with my peers and more psychodynamic psychotherapy then?’ psychological significance of an ‘Out’ vote loss of her was going to have its ups and experienced colleagues as well as friends All these questions were symptomatic of and the impact of Brexit on our patients downs. who were self-employed and ran their a much more fundamental set of ideas and our profession, but I won’t. What I own businesses. A big point of debate about my clinical work – what is my heard in that economic forecast put me ‘Life as a working was what kind of online presence should identity as a psychotherapist? What are in mind of the period of uncertainty I have? Some psychotherapists post on my values? My theoretical underpinning? in my first ten months in private psychotherapist Twitter while some balk at having a How do I work with patients? This is still practice. I qualified as a psychodynamic psychotherapist in September 2015. at present is full The implication in the quotation is of unknowns.’ that uncertainty in our environment breeds or feeds our negativity and that It feels important to say that the end of only certainty can make us feel better. training was not all melancholy and un- Well, yes and no. It has been a time worked through loss; a very large part of uncertainty since I set up in private of me bristled with excitement about practice in central London but it has also the freedom and autonomy to come. I been a time when something else – I set out, literally, with a map of central struggle to know what if I’m honest – has London to consider, where next? No emerged and is emerging still. longer infantilised by the training, I remembered I was a grown-up with two After graduation I held my certificate careers behind me. Surely I just work with thinking, ‘Yes, I am a qualified what I know? Oh, the irony. Setting up in psychotherapist, it says so here!’ but, private practice (the name of a course I to quote Shakespeare, ‘We know what went on and can highly recommend) had we are but not what we may be.’ I have layers to it, very like Freud’s topography come to think over the past ten months of the mind. The conscious considerations that all I know for sure is that life as were the concrete business decisions. a working psychotherapist at present Registering with professional bodies, is full of unknowns. This is not a new having professional indemnity insurance, idea yet it holds some certainty for me. building a website, managing finances I had a rigorous four-year training at and making marketing decisions filled my WPF Therapy for which I am extremely time and mind for the first two to three grateful. The Post Graduate Diploma months. However, when I found myself had strict requirements and assessment awake and anxious at 4.00am about font procedures for all academic and clinical styles for the website I knew something work. Personal therapy, experiential else was probably going on beneath the groups, supervision, lectures, role-plays surface. Emotions were stirring and my and presentations all contributed to the defences were being mobilised. Crucially rigour necessary to maintain professional I had clients transferring with me from and ethical standards in the profession. the training institute; I had to find a home These elements of the training became for them, for the therapeutic relationship. entrenched in me over the years of The analytic frame and setting was to training and provided both an internal be disrupted and I had to work with and external structure for my thinking. this clinically. I felt guilt, a huge sense As many of us experienced, pleasures of responsibility, but I was relieved too and pains were personal, clinical and to be honest. Some of the structure and

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very much a work in progress; I haven’t that environment can shape our psychic found clear answers to all these questions functioning and that the compulsion to but in all the uncertainty something repeat is pervasive. I am flexible with true(r) is emerging. Symington writes, some patients but with others I am ‘psychoanalysis is not a thing; it is a inclined not to offer replacement sessions complex reality,’ and just like therapy when they ‘can’t make it’. Each of my itself, ‘a new entity is forged: a new reality patients needs a different psychotherapist emerges.’ from the next and the quandary is that I am all these psychotherapists. The In my training I learnt about and from sheer weight of their miseries and the the psychoanalytic greats – Freud, Klein, projection at work can push and pull Bion, Winnicott, Fairbairn – applying me in my seat. Ogden wrote about the theory to practice and evaluating my dangers of ‘stir(ring) up the depths of clinical work in light of clinical examples the unconscious mind.’ He wrote that was part of the learning process. But therapists in the early days misrecognise what did it mean now, in practice, to be, their anxiety about patients leaving, ‘in say, a ‘Kleinian’? An ‘Independent’? And fact the therapist is afraid that the patient how important was it? I always used will stay.’ How unsettlingly true. to feel quite torn when I read papers for seminars. They contained so much So I’ve reflected on the uncertainties a impressive insight and clinical experience great deal, and where am I now? How and the articulation of the therapeutic can I reconcile the fragile, embryonic encounter in theory and practice was sense of a professional identity? In the absorbing. Yet as a student the hierarchy ‘space’ Coltart wrote of, confidence is of there being ‘one who knows’ and ‘one growing and I can say with certainty that who doesn’t’ is firmly in place in training I really like this job. The trajectory of the and I think I am still the ‘one who doesn’t learning curve can sometimes feel brutal know’ to a large extent. My supervisor but I like its direction. Coltart wrote about said to me in the early weeks of private ‘survival with enjoyment’ in the work practice, ‘We’re colleagues now’, but and that says it for me. The ‘push and I’m still bringing him verbatims from pull’ is dynamic and ultimately human. I time to time and hoping to get it ‘right’. believe psychotherapy and psychoanalysis ‘You’ll start to feel a bit more certain can effect change for people. ‘With a about things in about five years’ time,’ an mental life that has been restored to experienced colleague said to me recently. health, you will be better armed against Cold comfort indeed. that unhappiness’ (Freud). Returning to the EU referendum, many people feel But patients have come and my practice unhappy and the future looks decidedly is growing. There are fluctuations but uncertain, but this is our ‘complex the work is there. And in this lies the reality’ answer I think, doing the job and gaining the experience. Coltart wrote, ‘try to keep space in your mind free from the Rebecca Davies is a psychodynamic very prevalent “beginner’s anxiety”. It psychotherapist in private practice and does gradually fade.’ The idea of space also an Honorary Psychotherapist for is significant, I think, for what I have Assessments at WPF Therapy. tried to establish in many ways since I graduated. When we work with our patients we create the space for symbolic thought and something new to emerge, References we set that up and see what our patients Coltart, N. (1993) How To Survive as a do with it. In private practice I have found Psychotherapist. Sheldon Press, London that quite lonely and overwhelming at Joseph, B. Transference: the total situation. The times, due simply to the fact of having International Journal of Psychoanalysis, Vol 66(4), 1985, 447-454. more patients than ever. In a way I’ve Moody’s Investor Service. www.moodys.com. 24th forgotten a lot of what I learnt in the June 2016 training but I’ve retained a kind of mental Ogden, T.H. (1989) The Primitive Edge of Experience. toolkit of psychoanalytic headlines. I Karnac, London listen closely to my countertransference Shakespeare, W. Hamlet Act IV scene v. Symington, N. (1986) The Analytic Experience. Free and I have come to believe Betty Joseph’s Association Press, London idea of transference as the ‘total situation’. I hear in all my patients’ narratives

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more on self survival and extremes of love situations, it is necessary to be explored Society and hate than the more object-related, in this destabilised state. One way we flexible, depressive state of mind. manage this destabilisation is to shore ourselves up through our own use of Countertransference is useful in projective identification. The fear of the becoming aware of certain restricted other. states of psychic experience and certain Migration uncontained psychological processes Yasmin Alibai-Brown says: ‘There is that are created by projective dynamics. now a caste system in this country, the However, these particular projective wealthiest – the Brahmins – zoned off identification mechanisms also provided from everyone else, the upper classes with and loss a very rudimentary or primitive psychic their millions, the middle classes anxious shelter for the patient, from which but relatively secure, the working poor, they could function without completely then the workless poor who are beginning By David Morgan collapsing into internal disintegration or to resent the next group, immigrants and paranoid defeat. This psychic shelter is other indigents, then finally, the homeless experienced as the last refuge of inner or illegal immigrants who are treated security before severe despair, unstoppable worse than animals.’ The Caterpillar and Alice looked at each other for some time in silence: at last the fragmentation, unbearable loss, and Caterpillar took the hookah out of its mouth, and addressed her in a languid, sleepy emotional chaos. The latter two as outsider castes can voice. be scapegoated conveniently to divert My first experience of working with a attention from other facts: ‘Capital out of ‘Who are you?’ said the Caterpillar. former refugee analytically included in control needs a scapegoat.’ In an era of session after session, the repeated enquiry, footloose capitalism, stark inequality is This was not an encouraging opening for a conversation. Alice replied, rather shyly, or sometime cry: ‘Who are you?’ and consequent. ‘I – I hardly know, sir, just at present – at least I know who I WAS when I got up this ‘What do you do?’ ‘Where do you live?.’ morning, but I think I must have been changed several times since then.’ My training warned me to be opaque but my gut wanted to answer and justify. ‘In the face of the Lewis Carroll, Alice’s Adventures in Wonderland migrant in our After all, the question that displaced HO WE ARE depends suggesting that the patient is anxious that people ask of the other: ‘Who are you?’ midst, we are upon the conflicts of the analyst’s standard of living makes is a reasonable question for a patient all driven to be love and hate shaped it hard for them to feel that the analyst to ask of one, the analyst, who at least by feelings of could possibly understand what they are appears to have a place, to be settled, to silent.’ knowingW or not knowing the primary experiencing, might be called for! have a home, the comfort of a place to We analysts know this model well; other and of feeling unknown or be, a job, food – and an analytic silence, the use of projective identification to negatively known by the other. Wanting to Individuals, including or especially which might denote apparent ingratitude evacuate knowingly or unknowingly into learn more about one’s self or others, analysts, with a stable emotional anchor for this paradise, difference or a sense of the other all we do not want to know in epistemological knowledge is driven by and a sense of self, can find it difficult to entitlement, is possibly provocative and ourselves, including our knowledge of feelings of love and hate towards the self view others as separate and different, and certainly not enough as an answer. our own state’s economic exploitation, our and other. recognise their own prejudice (Morgan 2012). Globally, in the face of the migrant in our complacency, and relative ignorance of the many other countries these people come Just as learning and change are impacted midst, we are all driven to be silent; we from. Unfortunately our culture has an by issues of love and hate, what we know A person who has no sense of personal are confused, we want to help, but we also ignoble history, and we ourselves in our or find out about the self and other value, inner stability, or lasting internal feel a deep sense of threat when seeing consulting rooms meeting the other are can generate greater degrees of love or identity, desperately searches for these the pictures of people trying to get onto redolent with that history. hate. Thus, projective cycles of healthy elements in others. lorries and trucks. They threaten our own learning, loving, and growth emerge. Or, feelings of security. John Berger in A Seventh Man states: ‘The in many cases of psychological disorder, The analyst can put their own sometimes Western world, whether we like it or not, a confining cycle of persecution, loss, and limited vision into the mix. (See Onel We are warned these people are interested looks to migrants to perform the most censored thought solidifies (Waska 2008). Brooks, New Associations 12, Summer in social security entitlements, but they 2013.) As I have said to my patients, at come low on the list of priorities; for menial tasks, our cleaners, the surgeon driving a mini cab, but their valiancy To risk a change in how one lives life times they are anxious that my theories, ‘The survivors I have seen, such as a man enables acceptance of this humiliating and how one relates to self and other is my sense of my own certainties and values, tortured in Kurdistan who leaves his situation.’ often balanced upon how loyal one is to are more important to me than they are. village on horseback, raises the cost of the current familiar ways of living and a passage to sanctuary, buys a place on a Berger shows the catastrophic changes whatever internal emotional bargains are This quest for an open mind is in part boat to Albania and, three months later, which the migrant faces, but also that in place. based in a belief that others might is invited to step out of a lorry on the A3 serve as collateral to find the antidote to and make his way to a police station in they are not really so much on the margins of modern life, but are absolutely For analytic treatment to be successful, fundamental anxiety and mental distress, Guildford…’ (Berger) central to it, presenting a mode of living the therapist must be constantly working and projective identification becomes that pervades the countries of the West to understand this and interpret this in the singular vehicle in a desperate Belonging and not belonging is very and yet is catastrophically excluded from terms of both defence and underlying and aggressive hunt for reassurance of powerful; the analyst/therapist in his much of its culture. anxiety. I would add that the analyst’s meaning and existence. consulting room or in his suit, or analyst own sense of self and security in their or consultant role, is felt to belong. Freud, in Civilisation and its Discontents, own certainties at these times, or in In such a chaotic and perilous state of says: Men are bound together in groups these times, is faced with moral, political mind, it can be impossible to view others The question ‘Who are you?’ destabilises through the affectionate ties to each other and social uncertainty that must also be as separate and unique. In these projective and communicates questions of identity, and to the leader, and the suppression of explored. identification-based experiences of self searches the mind of the analyst through inside the object, others become mere projective identification as to whether their natural aggression. However, the suppressed aggression will always seek Psychoanalysts are still predominantly extensions of self, without personal he has the equipment, unlike the an outlet. ‘It is always possible to bind white middle class and live not far from meaning. They are sources of needed patient, to manage a sense of insecurity a number of people in love as long as Hampstead. I have been amused when love that are always out of reach or are and homelessness – the destabilising there are others left over to receive the colleagues living and working from purposely denying their much needed experience of what Bion describes as manifestations of their aggressiveness’ houses worth several million pounds supplies. These psychological experiences ‘catastrophic change’ – or a failure of what – the outsider may be different in only evince surprise at the intense envy of are characteristic of the paranoid-schizoid Winnicott called ‘continuity of being’. minor ways, but this will suffice. their patients, when an interpretation part-object world in which the focus is When working with people from these

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I think I have A challenge to continuity is the conflict seemed thoughtful about my apparent been better able around unfamiliar surroundings, climate, willingness to be thought about as such an to appreciate how food, landscapes and cultural difference. unattractive figure. difficult it is for These catastrophic changes lead people to those managing decide to hold on to concrete objects from She stayed in analytic therapy with me. It in foreign their original cultures that are imbued transpired that there was a great deal that environments to with personal symbolic meaning that I did not understand. feel safe enough to will help them keep a sense of sameness. do analytic work. This is why it doesn’t work when we Unlike nuclear families, tribes allow I might not have try to encourage too much assimilation, diversification of investment, no any insight into through the banning of religious foreclosure, more power balance, less how frightening dress. For the immigrant it’s a way of competitiveness among siblings. Similar it is to be in a retaining contact with the old regime. to an extended family, precisely what foreign culture as So this disruption in continuity leads to industrialisation has destroyed, and some I am relatively at a sense of confusion and purposeless; a psychopathology is a by-product of that. home here. The sense of worthlessness for being unable importance with to contribute to the environment; the The confusion. I have understood patients from other blocking of memories and feelings to this struggle as akin to the power of Crucial here are those social processes cultures is appreciating what it feels like avoid experiencing loss, uncertainty, nationalism in that when we are under that support denial of our nature and the to be in their shoes. As I have learned, it fear and confusion; projection on to the threat, we often look for flags that we can splitting off of uncomfortable aspects of is only this appreciation that can begin to new culture, of states of mind which stand under to protect our identity from ourselves and locating them in others. allow patients from different backgrounds the immigrant cannot tolerate; conflicts fragmentation. Psychoanalytic theory can to feel that they could be listened to by over remaining loyal to the original also be used this way when patients bring The migrant threatens us where it hurts, someone who may have the ability to culture versus embracing new customs; ‘foreign’ experiences into the consulting in the fear that there is not enough to go stand aside, however much prejudice a feeling of helplessness and inability to room – it functions as a form of protection round, so global inequality lies at the heart intervenes, from their own experience, use internal and external resources which to the analyst whose own normative of the anxiety that the other creates. The and be put in touch with something new could facilitate the adjustment; a sense of experiences are put to the test. I think this need to get others to carry this sense of and unfamiliar. isolation, embarrassment and alienation has happened around sexuality and race. superfluousness in a social Schadenfreude caused by language barriers; lack of social It is enormously important for the analyst is then paramount. The psychological impact of migration, support or negative reactions on the part to be discovered as someone who might leaving or entering a country and the of the host country who may perceive the be able to think about their own restricted Asylum seekers serve as a perfect internal experience, involves massive newcomer as an invader or rival; a fear experience without using psychoanalytic projective object, and we dispose of our psychological struggles and catastrophic of being annihilated by the new culture, theory defensively as a psychic retreat. unwanted anxieties into them. Lumped change. These tap into the deepest expressed by a desire to adjust but also to together in a manner that combines psychotic anxieties. remain the same; and a loss of familiar This defensive retreat can include the superfluousness with racism. They roles, accompanied by a feeling of ‘not reduction of ethnic beliefs to psychotic become the barbarian at the gate. This is People emigrate because they have a belonging’ or ‘fitting in’. mechanisms, the issue of sexual difference heightened and manipulated by ISIL and realistic appreciation of the difficulties to failures in oedipal development, or their avowed management of savagery of where they are and an idealisation In order to bear in mind this sort of other forms of reductionism. However, at (Reardon 2015). or longing for that which is foreign, emotional experience, we can understand the same time as bearing all this in mind, different, not familiar, and offers hope. the defensive modes of organising it is also extremely important that the In a first consultation to a hostel for and dealing with the temporary analyst, as well as having the ability to be homeless migrants (I have now done Leaving one’s origins results in psychopathology of migration as follows. open-minded, is not so open-minded that several over the years), there is no room for psychological turbulence which can Denying the emotional experiences of his brains fall out. my large group with interpreters to meet. be so traumatic that it will trigger any migration and entertaining idealised, This has happened for several weeks. latent psychopathology, but I also think defensive fantasies of one day returning This is the difficult task, but maybe the the experiences I have heard would to one’s homeland (the fantasy of only experience some of our patients have The most difficult aspect of this work cause serious disturbance to any of us. return). Idealising the original culture ever had of diverse thinking. A vital part is a countertransference involving my (Even moving house brings up psychotic and tenaciously clinging to it through of this process seems to be awareness own smug middle class feeling of ‘being anxieties in many of us.) recreating one’s lost environment, of the initial impulses in the counter- at home’ that has led me to sometimes nostalgically clinging to memories of transference to repudiate alien experiences feel that what I offer is a bare support, to Akhtar (2011) examines external and the original culture, or association with as pathologies. This helps maintain our process identity loss, ‘merely’ involving internal features of the experience of compatriots only. Quickly engaging in sense of equilibrium rather than giving my capacity to bear my advantages, in the immigration and the challenges that an a manic, pseudo-adjustment to the new the patient the experience of someone face of their disadvantage, including my immigrant must deal with. The trauma of country, taking up likings and habits that whose theories are more important than role guilt and debt in the exploitation of separating from a familiar geographical characterise the host culture. Degrading they are others so I can enjoy the life I live. location; loss of personal possessions; the the original culture or keeping secrets encounter with unfamiliar ways of living; about one’s origin; and unrealistically The people I see are almost always often and inability to find legal or gainful devaluing the new culture. David Morgan is a consultant excluded from mainstream therapy due employment in the host country. psychotherapist and psychoanalyst, BPAS, to money, insecurity, language, fear of A patient criticised me for being a white BPA, BPF, and AmBPS. repatriation, and they often present All of these involve learning to adjust male. The fact, she said, that I was having been driven to madness or some and getting accustomed to the rules that evidently Welsh did not in any way mean form of enactment, often in-patients, true govern external life in the new land. that I did not represent a section of British References asylum seekers, in an asylum. colonialist attitudes that had enslaved Akhtar, S. (2011). Immigration and acculturation: Winnicott (1966) states that, in order her country of origin. How could I, she Mourning, adaptation, and the next generation. I saw someone in prison to provide a court to have an integrated sense of self, we said, hope to understand her experience Lanham, MD: Jason Aroson report who had been committed for not need to have an experience of continuity when our experiences, both racial and Berger J. (2008) Hold Everything Dear. Dispatches gender-based, were so opposite. I said that on Survival and Resistance. Verso Press. allowing the residents in his block of of being. This term refers to a sense of Grinberg, L. & Grinberg, R. (2004). Psychoanalytic flats into the lift. It seemed obvious, at consistency and internal security that we I thought she was right to explore with perspectives on migration. In Bell, D. (Ed.), least to me, that this man was driven to partially achieve through ‘environmental me what sort of analyst I was and whether Psychoanalysis and culture: A Kleinian perspective I had any equipment that could be used (154-169). Great Britain: Karnac Books distraction by his own precarious existence validation’ which is provided by the Morgan, D. H. (2013) ‘Is it Coz I'm White? ‘ In and was driven to communicate this continuous interaction between the to understand her. It was possible that I Thinking Space: Promoting Thinking About Race, did not – indeed she doubted any white Culture and Diversity in Psychotherapy and Beyond feeling through powerful projection of spatial, temporal, and social dimensions (The Tavistock Clinic Series). Frank Lowe.(2013). man’s capacity to truly understand. I said homelessness into others. It was the other of life (Winnicott 1956). This means that, Waska. R. (2008) Psychoanalytic Psychotherapy. A who was temporarily unhoused. ‘Who are when what is reflected to us is unfamiliar, it remained to be seen whether she should Modern Kleinian Approach. Electronic Publishing. you?’ And ‘Where do you come from?’ we lose a sense of ourselves. continue her analysis or end it, because Winnicott, D. (1966). The location of cultural experience. The International Journal of I might be a bigoted racist analyst. She Psychoanalysis, 48(3), 368-372

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14 September 2016 1 October 2016 26 October 2016 Diary Whose Depression is it Anyway? We need to talk about Kevin Political Indifference: a Response Liz Hamlin, Kate Thompson Don Butler of Resistance or Denial? SEPTEMBER Tavistock Relationships, 70 Warren AGIP, 1 Fairbridge Rd, London N19 Stephen Frosh Street, London W1 http://agip.org.uk/activities/cpd-events/ University of Essex, Colchester CO4 Until 25 September 2016 www.tavistockrelationships.ac.uk/ cpd-event/9-we-need-to-talk-about-kevin- https://www.eventbrite.co.uk/e/political- Mark Wallinger: Self Reflection forthcoming-events/985-depression- continuing-our-theme-of-trauma indifference-a-response-of-resistance-or- Freud Museum, 20 Maresfield Gardens, projective-system denial-professor-stephen-frosh-birkbeck- London NW3 8 October 2016 tickets-25542961686 https://freud.org.uk/exhibitions/76519/ 16 September 2016 Life and Death in Group Analysis, self-reflection/ Face to Face with Psychoanalysis: Bion and Beyond 28 October 2016 Sex, Death and the Unconscious Michael Bell, Arturo Ezquerro, Working with Dangerous Minds and 1 September 2016 BPF, 37 Mapesbury Road, London NW2 Bob Hinshelwood, Morris Nitsun Vulnerable Bodies The Abused Child www.britishpsychotherapyfoundation.org. Tavistock, 120 Belsize Lane, London NW3 Stanley Ruszczynski, Marcus Evans Hotel Villa Pagoda, Via Capolungo, 15, uk/Events/A-Weekend-with-Psychoanalysis www.groupanalysis.org/ Tavistock, 120 Belsize Lane, London NW3 16167 Genova, Italy WorkshopsandEvents/LIFEandDEATH https://tavistockandportman.nhs.uk/ https://www.ipa.world/IPA/en/ 17 September 2016 inGROUPANALYSIS,BIONandBEYOND. training/conferences-events/working- news_and_events/Event_Display. Europe in Dark Times: Some aspx dangerous-minds-and-vulnerable-bodies/ aspx?EventKey=EV31 Psychodynamics of Hate and Prejudice 8 October 2016 NOVEMBER 3 September 2016 Jonathan Sklar The Stranger in our Midst PROJECTIONS: David Lynch’s The Pavillion Room, St Antony’s College, Renos K. Papadopoulos, Fakhry Davids 1 November 2016 Blurred Identity Trilogy 62 Woodstock Rd, Oxford OX2 Clayton Hotel, Cardiff Neuroscience & Freud Museum, 20 Maresfield Gardens, www.britishpsychotherapyfoundation.org. www.welshpsychoanalyticassociation.co.uk Neuropsychoanalysis London NW3 uk/Events/Wessex-Sklar Mark Solms https://www.freud.org.uk/events/76373/ 8 October 2016 Institute of Psychoanalysis, 112A Shirland 17 September 2016 projections-david-lynchs-blurred-identity- Psychic Reality: Road, London W9 trilogy/ Identifying, Understanding and Where beliefs become facts https://www.bpc.org.uk/events-cale Working with Personality Disorder Ilse Seglow Memorial Lecture Philip Stokoe Ron Britton 9 September 2016 Drake House, 44 St George's Rd, 11 November 2016 St Thomas’s Hospital, London SE1 Fomenting Political Violence: Wimbledon, London SW19 Sociology and Psychoanalysis: Phantasy, Language, Media, Action www.britishpsychotherapyfoundation.org. The Unfilled Promise https://www.eventbrite.co.uk/e/ Steffen Krueger, Karl Figlio, Barry uk/Events/Ilse-seglow Jessica Benjamin identifying-understanding-and-working- Richards Institute of Education, 20 Bedford Way, with-personality-disorder-tickets- Essex Business School, University of London WC1H 19885644498 8 October 2016 Essex, Colchester Campus Working with Couples https://psychoanalysis.org.uk/civicrm/ http://www.essex.ac.uk/events/event. Haya Oakley event/info?id=446&reset=1 23 September 2016 aspx?e_id=10086 October Gallery, 24 Old Gloucester Street, Freud Today/Freud Tomorrow London WC1 19 November 2016 Freud Museum, 20 Maresfield Gardens, 9 September 2016 www.the-site.org.uk/events/workshop- Between Mind and Culture: London NW3 The Impersonal Group: An working-with-couples/ Ordinary Differences Introduction to Contemplative https://www.freud.org.uk/events/76529/ Salman Akhtar freud-todayfreud-tomorrow/ Group Dynamics 15 October 2016 Lift, 45 White Lion Street, London N1 IGA, 1 Daleham Gardens, London NW3 English Speaking Weekend: https://www.bpc.org.uk/events- 24 September 2016 www.groupanalysis.org/ Metapsychology in the Consulting calendar/#event|between-mind-and- WorkshopsandEvents/TheImpersonal Jungian Dream Workshops Room culture-ordinary-differences|1 GroupContemplativeGroupDynamics. BPF, 37 Mapesbury Road, London NW2 Royal Society of Medicine, 1 Wimpole www.britishpsychotherapyfoundation.org. aspx Street, London W1 20 November 2016 uk/Events/Jungian-Dream-Workshops- https://psychoanalysis.org.uk/civicrm/ Meditation and Psychotherapy 10 September 2016 20152016 event/info?id=381 Deirdre Dowling, Monica Lanyado, In memory of Harold Searles: Rachel Melville Thomas, Helen Morgan Facing Climate 24 September 2016 21 October 2016 BPF, 37 Mapesbury Rd, London NW2 Institute of Psychoanalysis, 112A Shirland Maturation and Ageing: An Research: the Current Debates www.britishpsychotherapyfoundation.org. Road, London W9 exploration of Developmental Ann Scott, Jessica Yakeley uk/Events/BPF-MPD www.climatepsychologyalliance.org/ Processes in later Life Institute of Psychoanalysis, 112A Shirland events/our-upcoming-events/169-searles- Chair: Sandra Evans Road, London W9 25 November 2016 event St Pancras Hospital, 4 St Pancras Way, https://www.bpc.org.uk/events- Nietzsche, Psychoanalysis and Kings Cross, London NW1 calendar/#event|introduction-to-the- http://squiggle-foundation.org/events/6/ Feminism 11 September 2016 series-and-to-research-in-the-field|2 Kingston University, KT1 Jung & Film 2016: Black Cat, White Cat maturation-ageing-an-exploration-of- developmental-processes-in-later-life/ www.kingston.ac.uk/events/ Jewish Community Centre London, 22 October 2016 item/2126/25-nov-2016-nietzsche- 351B Finchley Road, London NW3 Shutting Down, Shutting Out: 24 September 2016 psychoanalysis-and-feminism/ www.confederation-an-psych.uk/event/ Interplay of Attachment and Virtual Prisoners: The Impact black-cat-white-cat/ Sexuality of Internet Pornography on Gulya Diyarova 25 November 2016 Relationships WPF Therapy, 23 Magdalen Street, Psychoanalysis, Therapy and 12 September 2016 John Woods London SE1 Psychosis Susie Orbach in conversation with WPF Therapy, 23 Magdalen St, London http://wpf.org.uk/want-to-train/ Brian Martindale filmmakers Carol Mavor, Susie SE1 Orbach, Megan Powell workshops-and-events-types/workshops/ Institute of Psychoanalysis, 112A Shirland http://wpf.org.uk/want-to-train/ Freud Museum, 20 Maresfield Gardens, Road, London W9 workshops-and-events-types/workshops/ London NW3 22 October 2016 https://www.bpc.org.uk/events- Money Matters calendar/#event|psychoanalytic- https://www.freud.org.uk/events/76531/ OCTOBER full-screening-and-discussion/ Anca Carrington psychotherapy-and-psychosis|12 WPF Therapy, 23 Magdalen Street, 1 October 2016 London SE1 The Work of Bion and his Clinical Relevance http://wpf.org.uk/want-to-train/ www.britishpsychotherapyfoundation.org. workshops-and-events-types/ uk/Events/The-Work-of-Winnicott-and- workshops/?goto=3295 Bion

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I have to believe it: ‘Einstein predicted curious and intrigued: I remain unsettled. Culture that time passes more quickly hight up The cello seems to represent something than below, nearer to the Earth. This alien, as if it should not be there. In was measured and turned out to be the the mid-seventeenth century, the cello case. If a man who has lived at sea level was taken as a symbol of harmony in a meets up with a twin who has lived couple, specifically marital harmony but in the mountains, he will find that his also sexual harmony. So, who is the man Psychoanalysis sibling is slightly older than him’ (p. 8). next to the woman? An innocent music This is but a glimpse of reality – similar teacher, as we initially thought? Is he a and comparable to the psychic reality as lover? Or her husband? Or, much more is here to stay revealed by psychoanalysis. Our dreams interestingly, is he a music teacher (the are made on this same stuff, and so are our ‘familiar') who is also her lover ('the alien’, aesthetic experiences. ‘the intruder')? Have we found the reason By Gregorio Kohon why the identity of the woman has to be A patient tells me, ‘My father was in my hidden? Here there is the ‘in between': dream last night; it was my father, and, on the one hand, the cool and chaste yet, I’m quite certain that it could have beauty of the picture; on the other, the also been my friend Rob: he had his long, discomfort felt by the observer. This area curly hair, the same North London Jewish of the in between becomes the playground N THE TEMPEST, anticipating eventually crumble and ‘dissolve'; time accent… I always thought of Rob as a where an imaginary passionate story of a his daughter’s wedding to the will inexorably pass, leaving not even a very sadistic kind of a guy…’ This is the clandestine love affair can be constructed Prince of Naples, Prospero has ‘rack’ behind. The performance is a play stuff that dreams are made on: an illusion and developed by the observer. staged a short entertainment, within Shakespeare’s play; both are an of a similarity that exists only through Iwith spirits taking the parts of Roman illusion imbued in temporality, as is the the differences between one person (the For a long time, the poet,Elizabeth Bishop gods. At a certain point, he declares, world itself. People, we are told, are the father) and another (the friend). This wished that someone would compare Our revels now are ended. These our ‘stuff’ dreams are ‘made on’. Prospero’s is a ‘negative form of forgetting’ (Hillis her poems to the paintings of Vermeer, actors, ‘stuff’ refers to the creation of an uncanny Mills, 1982), which becomes meaningful something finally done by the poet and As I foretold you, were all spirits, and illusion, not to the object of our desires. through a process of après-coup: the critic, Randall Jarrell. In telling this story Are melted into air, into thin air: The ‘great globe itself’ which is where we memory of the friend throws potential in his accomplished book on Bishop, Colm And like the baseless fabric of this exist, work and love, is not ours to possess: light on the forgetting of the father (see Tóibín describes the Dutch paintings as vision, in this scenario, the most familiar becomes Perelberg, 2007; 2008). This is in between a ‘…something made that is both real and The cloud-capp’d tow’rs, the gorgeous utterly alien. remembering and a forgetting, something filled with detail, but, in the play of light palaces, which defines the uncanny character of and shadow, in the placing of people and The solemn temples, the great globe Works of literature and art open the our dreams, the surreal sense of existence things, in the making of figures, it is also itself, possibility of experiencing multiple in which all human beings live. totally suggestive, without any of the Yea, all which it inherit, shall dissolve, temporalities, both contradictory and suggestions being easy or obvious’ (2015, And, like this insubstantial pageant uncanny – like the figures of a dream. The uncanny is not a feature of p.23). Equally, the power of Bishop’s faded, Artistic creations, as indeed literary contemporary art alone (the main poems come from somewhere in between Leave not a rack behind. We are such creations, are strange things, illusions, but focus in my book: Reflections on the ‘what is said and what lies beneath…’ stuff so is science. Einstein’s equation describing Aesthetic Experience – The Uncanny and (2015, p.23). Something real, and yet As dreams are made on; and our little the curvature of time proved that indeed Psychoanalysis (2016)); a similar use of ‘only’ suggestive. life space curves. That’s it: a ‘simple’ equation. space and time is present and experienced Is rounded with a sleep. But, as Carlo Rovellis explains to us in all forms of art and literature. For This is the world of poetry, a poetic world The Tempest Act 4, scene 1, 148–158. laymen: ‘…here the magical richness of example, looking at Vermeer’s Lady at not created just by words but also by the theory opens up into a phantasmagorical the Virginals with a Gentleman, we notice silences, the emptiness and voids that exist The performance, Prospero claims, succession of predictions that resemble a number of unfamiliar things in the within, and in between. A psychoanalytic is simply an illusion; ‘all spirits’ are the delirious ravings of a madman, but familiarity of the scene which inevitably world bound, sooner or later, to melt into which have all turned out to be true’ (p. produces a feeling of estrangement. ‘thin air’. The play is a metaphor for 7). Delirious, but true. Space is not the There is a woman, her back turned to us, (Fragment from ‘Some thoughts on the the world outside the theatre, equally only thing that curves. We are told that ostensibly having a lesson with her music negative in the work of Eduardo Chillida’, fleeting; everything in that world will time curves too. I do not understand it but teacher – all rather normal and mundane in The Greening of Psychoanalysis, eds. – and this is the usual interpretation of Rosine Perelberg and Gregorio Kohon, to the painting. Everything seems chaste be published by Karnac.) and understated. And yet, after the first few minutes of contemplating the Gregorio Kohon is a psychoanalyst – and picture, we cannot completely relax into after many years, still trying to learn how this normalised version of the painting; to dance the tango. unwittingly, we resist this ‘normality’. What makes us feel uncomfortable? Why is the identity of the lady, for example, Bibliography hidden? Who is she? There is more here than meets the eye; doubts about our Freud, S. (1919). The ‘Uncanny’. SE17: 217-252. initial perception start creeping in. Hillis Miller, J. (1982). Fiction and Repetition – Seven English Novels. Oxford: Basil Blackwell Publishers. The painter used semi-precious stone, Kohon, G. (2016). Reflections on the Aesthetic lapis lazuli, for colour; Vermeer had Experience – Psychoanalysis and the Uncanny. London and New York: Routledge. also painted an undercoat to achieve Perelberg, R. (Ed.) (2007). Time and Memory. certain effects, a complete extravagance London: Karnac. for the times! The simple beauty that —————— (2008). Time, Space and Phantasy. we observe in the painting begins London: Routledge. Rovelli, C. (2014). Seven Brief Lessons on Physics, to convey something enigmatic and trans. by Simon Carnell and Erica Segre. London: unsettling. There is a cello on the floor, Allen Lane, 2015. in rather a strange position behind the Tóibín. C. (2015). On Elizabeth Bishop. Princeton and Oxford: Princeton University Press. woman. It is a music lesson, so why should there not be a cello on the floor? It makes sense. But the more I look, the less convinced I am; the effect is to make me

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