the Fall/Winter 2012 AMERICAN Volume 46, No . 4 PSYCHOANALYST Quarterly Magazine of The American Psychoanalytic Association

INSIDE TAP…

COPE National Meeting Highlights...... 7–9 Continuing Challenge of Leaving a Landmark. . 13 Rehabilitating Boundary Violators Special Section on Marvin Margolis New Voices. . . 14–20 In 2007, the Committee on Psychoana- After six years, we still feel that we are a lytic Education (COPE) established a Study long way from the conclusion of our work. Autonomy for Group on Boundary Violations and Reha- The following is a brief interim overview. Analysts? ...... 24 bilitation to consider the rehabilitation of Most of our institutes, societies, and centers unethical colleagues. The members of our do not as yet have rehabilitation programs. APsaA’s Fabulous study group are indebted to the many cou- We have been studying the efforts of the Fellows...... 26 rageous colleagues and patients who have minority who do have such programs. They shared their experiences of boundary viola- have initially been established to help deal tions and rehabilitation with us. We are also with colleagues who have been sanctioned deeply appreciative of the representatives of for major sexual boundary violations, but institutes and societies who have joined our they are structured to deal with a wider meetings to describe their creative efforts to range of boundary violations. These psycho- establish innovative structures to deal with analytic communities wish to devise pro- these issues. grams to provide a path back to full membership, if at all possible, since many of these colleagues have the potential to deal Marvin Margolis, M.D., Ph.D., is chair of successfully with their ethical problems. the Study Group on Boundary Violations and Rehabilitation. ANALYTIC COMMUNITY’S RESPONSE: All recognize our responsibility to help these Study group members are Sydney Arkowitz, SANCTIONS AND REHABILITATION patients find a new analyst and continue our Ph.D., Rita W. Clark, M.D., Suzanne Sexual boundary violations have been par- support as long as it is needed. M. Gassner, Ph.D., John M. Hall, M.D., ticularly shocking to the entire analytic commu- Understandably, colleagues’ shock soon Rion Hart, Ph.D., Ellen Helman, M.S.W., nity, especially when committed by prominent turns to anger. While this is not the appro- Elizabeth Hersh, M.D., Peter Kotcher, analysts in leadership positions. Their unethi- priate time for a decision about permanent M.D., Frederic Levine, Ph.D., Howard B. cal behavior has been a betrayal of our ana- membership status, there is an immediate Levine, M.D., Gayle E. Marshall, M.S.S.W., lytic ideals, an undermining of our effectiveness need to discipline the colleague usually by Lynne Moritz, M.D., Dushyant Trivedi, in the community, and, first and foremost, restriction of privileges and often by a sus- M.D., Vaia Tsolas, Ph.D., and Peggy very damaging to patients who had turned pension of membership. Warren, M.D. to our colleagues for help but were betrayed. Continued on page 23

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 1 CONTENTS: Fall/Winter 2012 THE AMERICAN PSYCHOANALYTIC ASSOCIATION President: Robert L. Pyles 3 Unfree Associations Bob Pyles President-Elect: Mark Smaller Secretary: Beth J. Seelig Treasurer: William A. Myerson 5 Fault Lines: What Kind of Organization Does APsaA Want to Be? Executive Director: Dean K. Stein Colleen L. Carney, Lee I. Ascherman, and Elizabeth A. Brett

7 2013 APsaA National Meeting Highlights: THE AMERICAN PSYCHOANALYST January 15–20 Christine C. Kieffer Magazine of the American Psychoanalytic Association

“Two Harmless Drudges” Revise Psychoanalytic Terms Editor 10 Janis Chester and Concepts Elizabeth L. Auchincloss and Eslee Samberg Special Section Editor Michael Slevin A Dangerous Method: Notes on a Film about Freud and Jung 11 Editorial Board Lloyd I. Sederer Brenda Bauer, Vera J. Camden, Leslie Cummins, Phillip S. Freeman, Maxine Fenton Gann, Noreen Honeycutt, 12 From Behind the Couch: Greed in Bull Markets John W. Schott Sheri Butler Hunt, Laura Jensen, Navah Kaplan, Nadine Levinson, A. Michele Morgan, Julie Jaffee Nagel, Bittersweet Farewell to a Boston Landmark Alan Pollack 13 Marie Rudden, Hinda Simon, Vaia Tsolas, Dean K. Stein, ex officio SPECIAL SECTION Photographer Mervin Stewart New Voices Manuscript and Production Editors Michael and Helene Wolff, 14 New Voices: Introduction Michael Slevin Technology Management Communications

The American Psychoanalyst is published quar- The Echo of Narcissus Adele Tutter 15 terly. Subscriptions are provided automatically to members of The American Psychoanalytic Asso- ciation. For non-members, domestic and Cana- Phoebe A. Cirio 17 Desire on Chincoteague Island dian subscription rates are $36 for individuals and $80 for institutions. Outside the U.S. and Canada, rates are $56 for individuals and $100 for institu- 18 Silence Melinda Gellman tions. To subscribe to The American Psychoanalyst, visit http://www.apsa.org/TAPSUB, or write TAP Subscriptions, The American Psychoanalytic 19 A Narrative of One’s Own: The New Voice of Alison Bechdel Association, 309 East 49th Street, New York, Vera J. Camden New York 10017; call 212-752-0450 x18 or e-mail [email protected].

Poetry: From the Unconscious Sheri Butler Hunt Copyright © 2012 The American Psychoanalytic 21 Association. All rights reserved. No part of this publication may be reproduced, stored in a Cases from the Frenkel Files: Control of the Suicidal Patient retrieval system, or transmitted in any form or by 22 any means without the written permission of The John C. West American Psychoanalytic Association, 309 East 49th Street, New York, New York 10017. Politics and Public Policy: MOC/MOL and Status of Consent 24 ISSN 1052-7958 in Certification Graham L. Spruiell The American Psychoanalytic Association does not hold itself responsible for statements made in 26 APsaA’s Excellent New Fellows for 2012-2013 The American Psychoanalyst by contributors or advertisers. Unless otherwise stated, material in The American Psychoanalyst does not reflect the endorsement, official attitude, or position of The Correspondence and letters to the editor should be sent to TAP editor, American Psychoanalytic Association or The Janis Chester, at [email protected]. American Psychoanalyst.

2 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 FROM THE PRESIDENT

Up to this Unfree Associations point, the IPA Bob Pyles had always for- mally recog- I have just As many of you know, the PPP (Perlman- nized only a returned from Pyles-Procci) Proposal was introduced in single system of the 29th Con- September of 2011. This has sparked an education, the gress of the ongoing discussion, which culminated in our Eitingon, based Latin American last meeting with the Executive Council pass- on the original Psychoanalytic ing a resolution that the selection of training model of the Group held in analysts should be based on objective criteria. Berlin Institute, Sao Paulo, Brazil. Naturally, this has created a tremendous though others It was a remark- amount of confusion, consternation, and mis- were known able meeting and understanding about the meaning of the to exist “under Bob Pyles I will write more Executive Council’s action and the meaning the radar,” similar to our own situation. about it in my next column. What I would of the PPP Proposal. One of the wonderful achievements that like to focus on here is that the International Although this was simply a proposal put the IPA was able to accomplish was to get Psychoanalytical Association seems to have forward for the purpose of discussion and away from the narrow legalistic way of think- been able to accomplish something that we consideration, it would seem that there is ing, and focus on the larger educational pic- in our Association thus far have been unable something in the very nature of our group ture and the larger issues. Up to that point, to do. That is, to consider and discuss a cen- that prevents us from being able to tolerate the IPA was focused, as we are now, on a tral idea, an idea that is at the core of our actually discussing these ideas without feeling very legalistic way of thinking that was highly philosophy, without reaching for lawyers or a kind of annihilatory anxiety. polarizing and problematic. threatening to split. The title of this column is taken (with per- mission) from a remarkable book of the The most impassioned and damaging of these same name, published in 2010, written by conflicts were animated by perceived inequities Douglas Kirsner, an Australian professor of philosophy and psychoanalytic studies at in the TA system. Deakin University. The book is based on a series of inter- views with faculty members of four institutes, At the heart of this discussion is the ques- My committee hit upon the idea of sur- New York, Boston, Chicago, and Los Angeles, tion of authority: Who has it and what place veying the training practices in all of the soci- and describes in riveting fashion the bitter it has in a psychoanalytic education system. eties around the world and came up with internecine political struggles, marked by The Presidential Plenary at the January 2013 the concept of “models of education.” The intolerance and polarization and often result- National Meeting, which will be given by past- willingness of the committee to collect and ing in splits. This book is a “must read” for any- president, Warren Procci, will focus on one assess objective data was key in breaking the one involved in psychoanalytic administration aspect of this issue in his address, “The Second impasse. Then by moving to the concept of or education. Century for Psychoanalysis and for APsaA: models, we were able to rise above narrow Their Fates May Differ.” Otto T. Kernberg will issues and look at educational systems in CLEAR AND COMPELLING take up the TA system directly in an address, their entirety. For quite some time, the con- CONCLUSIONS “The Twilight of the Training Analyst System.” troversy was focused on the single issue of Kirsner’s conclusions are clear and compel- frequency. As long as each side maintained ling: Each of the institutes he studied was IPA PRECEDENT and hardened its position, the anger and bit- divided by conflicts over power and authority. We might very well look to the example of terness became so pronounced that the IPA The most impassioned and damaging of the IPA a few years ago when they were was in serious danger of splitting. these conflicts were animated by perceived faced with a similar crisis. The flashpoint of By moving the discussion to the higher inequities in the TA system. the issue was that of frequency, three versus plane of educational systems, we were able four-to-five times a week as a minimum train- to consider each element, such as frequency, ing standard. Former IPA president, Daniel training analyst system, and so forth in a Bob Pyles, M.D., is president of the Widlocher, put me in charge of a committee context. American Psychoanalytic Association. to try to resolve the conflict. Continued on page 4

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 3 FROM THE PRESIDENT

Unfree Associations been able to discuss the nature of the TA differences in how an institute should be run Continued from page 3 system and what the cost or benefit of such and its involvement in the community.” a system is. So the conflict points over power and The three models that we were able to Interestingly, two of the three officially rec- authority don’t seem to change very much identify (the Eitingon, the French, and the ognized models do not utilize a training ana- over time. What remains to be seen is Uruguayan) were carefully considered and lyst system. It seems to me that the French whether we have changed enough to come discussed by the IPA Board. Each of these sys- and Uruguayan systems, by focusing on the together for the sake of our patients and tems had been in existence for decades and analysis as a clinical issue rather than an edu- our profession. had a proven track record of producing grad- cational one, are on much more solid ground. Conflicts over the TA system cannot be uates of high quality. By looking at the total resolved by ideological arguments, parliamen- educational system, we were able to evaluate OUR CURRENT IMPASSE tary maneuvers, or narrow debates about the quality and nature of each of them. The However, the main issue is that we cannot procedural details. We cannot transcend IPA Board came to the conclusion that, while seem to be able to discuss these things in these conflicts by fetishistic attachments to each of the three had real differences, all three any sort of civilized or “analytic” manner. It habitual, taken-for-granted assumptions, or depended on the tripartite model (course- was my deep wish when this discussion by concrete thinking that throttles creativity work, personal analysis, and supervised con- began that we could finally come to some by obstructing abstract thought. We need to trol cases), at least in spirit, if not in letter. sort of resolution of our disagreements think more freely, more abstractly, and with a For example, the French system does not over the training analyst system and certifi- wider field of vision. If we do not transcend have the title “training analyst,” and analysis is cation, so that we could move on to do the the narrow confinement of our current habits not mentioned in its description of the things we need to do to promote and save of thought, we will be perpetually locked in requirements for training, because the analy- psychoanalysis. futile and exhausting exercises of power poli- sis is considered to be entirely outside of the Kirsner interviewed me for his book in tics and stale rhetoric. All this and more, and educational process, a completely indepen- 1992, partly because I had been president of all the while our numbers dwindle, our ener- dent function between the candidate and the Candidates’ Council when the Boston gies dissipate, and our profession declines. analyst. However, in general the French have split occurred. He asked if I thought the split We must break this impasse before it a tradition of long analyses. There is consider- could have been averted. I said I thought the breaks us. The three-model solution adopted able evidence to show that length of an anal- split was entirely avoidable, but there was by the IPA is a paradigm for creative problem ysis, rather than the frequency of sessions, is a major failure of leadership and “major solving. in many ways more important in terms of producing growth. Consequently, in the French system, absence of the formal title of training analyst was accepted by the IPA and Contacting the National Office grandfathered as a perfectly acceptable way of treating candidates. There is a similar situation within the Uru- National Office guayan model in which the actual title of Voice Mail Extensions training analyst is not used because of the country’s political history of people suffering Chris Broughton x19 under fascist authoritarian regimes. Conse- Brian Canty x17 quently, the structure of the educational pro- Sherkima Edwards x15 cess is much more democratic, with the candidates’ full participation in their education Tina Faison x23 and in the affairs of the institute right from the Carolyn Gatto x20 start. On this basis, this was also considered to be a variation of the tripartite system. Stephanie Kunzmann x28 What the IPA should be congratulated for Geralyn Lederman x29 is being flexible enough to recognize and Nerissa Steele-Browne x16 accommodate these rather differing systems of education. In our situation the first action Dean K. Stein x30 of BOPS was to create a Reference Commit- Debbie Steinke Wardell x26 tee, which was designed to look at the legal- ity of the PPP Proposal. At no point have we

4 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 FROM THE BOARD ON PROFESSIONAL STANDARDS

Fault Lines What Kind of Organization Does APsaA Want to Be? Colleen L. Carney, Lee I. Ascherman, and Elizabeth A. Brett

Only two years ago, the Board on Profes- NATIONAL STANDARDS VS. eliminate the practice of having those applying sional Standards adopted the most compre- LOCAL AUTONOMY for training and supervising appointment pres- hensive revision to our Standards in Education The specific issue that precipitated the ent clinical material to the local TA/SA Selec- and Training in Psychoanalysis since 1938. compromise of 2010 was the requirement tion Committee or its functional equivalent. This document was thought to be a unifying that certification in psychoanalysis was a pre- Historically, and still today, all training and compromise between two fundamentally dif- requisite for an analyst to be appointed as a supervising analysts have had two processes ferent positions pertaining to both educa- training and supervising analyst. The establish- of formal peer review. The first is during the tional and professional matters. Since that ment of the developmental pathway at first certification process and involves presenting time however, the fault lines between these appeared to solve the problem by integrating clinical material to members of the Certifi- two positions have broadened and deep- the processes of certification and TA/SA cation Examination Committee, who are ened, but they have also become clearer. In evaluation. It appears now that the true fault unknown to the applicant and who are this sense, the recent crisis in governance is a line still remains. To ensure that the credential trained to evaluate the core competencies blessing in disguise because the disagree- of certification in psychoanalysis would have for independent practice in psychoanalysis. ments that have plagued and crippled our a single and uniform meaning, the Standards The second is the TA/SA evaluation process, organization for decades are now so starkly Review Committee delineated the specific part of which is a presentation of clinical clear that we can no longer ignore the critical roles of the national participants and local material to the Selection Committee of the decisions we have managed to avoid, the participants of this integrated evaluation pro- local institute or a neighboring institute. The most fundamental one being what kind of cess. This respects the fact that certification is, evaluation of clinical work is only one part of organization does APsaA want to be? as for all professions, a blind evaluation of the TA appointment procedures, which also The future of APsaA and psychoanalysis core and clinical competencies. include assessment of personal suitability, is too important to be determined by By contrast, an evaluation for TA/SA being five years or more past graduation, reactive solutions and unintended conse- appointment is a local institute’s process of analysis of both genders, and with termina- quences of piecemeal changes. The silver vetting and requesting the appointment of an tion of analysis as well as 3600 hours of clini- lining in our organizational struggles is that analyst who will perform a clinical function. cal immersion in psychoanalysis. APsaA now has a valuable opportunity to Put simply, the compromise of 2010 was not The second fault line concerns the pro- carefully think about and thoughtfully intended to change the meaning of certifica- posal to eliminate the evaluation of clinical decide what it wants to be. In this article, we tion; it created a different but equivalent pro- work of an analyst who will be analyzing and will present our perspective on what these cess through which it could take place. This supervising candidates in training. Some fundamental fault lines are. In the most highlights the first fault line; for some the argue that graduating from an APsaA psycho- general sense, they seem to fall into three preservation of this distinction is essential, analytic institute and minimal post-graduate categories: 1) national standards vs. local while for others it diminishes local autonomy. immersion should suffice. We believe that autonomy, 2) formal peer review of clinical This disagreement raises a critical question: this would be problematic for educational faculty, and 3) separation of membership/ Is this a problem that can be solved, can such and professional reasons. guild issues from professional credentialing different ideas of professional credentialing APsaA institutes as well as IPA institutes and accrediting functions. co-exist in one organization? require candidates in training to be in analysis with a TA while seeing control cases. This is FORMAL PEER REVIEW not suggested or encouraged, it is required. OF CLINICAL FACULTY This means that the institute assumes both Over the past year, the Board on Profes- the responsibility and the liability not only sional Standards has been under increasing for the candidate but also for the control Colleen L. Carney, Ph.D., is chair of BOPS. pressure, first by individual members and most cases that they treat under the auspices of Lee I. Ascherman, M.D., is secretary and recently by the Executive Council itself, to the training program. TA/SA appointment is chair-elect of BOPS. change or eliminate some of the criteria that a clinical appointment comparable to an Elizabeth A. Brett, Ph.D., is co-chair of the qualify individual analysts to be appointed as attending in a residency program or clinical Committee on Institutes and secretary-elect training analysts. The proposals have had many faculty in an internship program or fellowship. of BOPS. iterations, but the most recent version is to Continued on page 6

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 5 FROM THE BOARD ON PROFESSIONAL STANDARDS

Fault Lines the Training and Supervising Analyst Devel- reasons why other professional organizations Continued from page 5 opment Project. This study is one part of the separate these completely, each having its larger Psychoanalytic Development Project, own board of directors, there are also pro- In other health care professions clinical pre- initiated in 2010 and is a series of studies fessional reasons for doing so. Standard prac- ceptors are routinely, if not exclusively, board intended to develop benchmarks for psy- tice is that membership concerns are kept certified in their specialty and vetted by the choanalytic competence at a number of key separate from credentialing and accrediting program for which they will perform a par- points in any analytic career: admissions, functions, and certification and accreditation ticular function. Graduation from their own progressions, graduation, certification, and are still further separated from each other. residency program or doctoral internship is a TA/SA appointment. It is a wonder that APsaA has survived this necessary but not sufficient criterion for clini- long given the precarious cauldron it tries to cal appointments. Eliminating formal peer SEPARATING MEMBERSHIP FROM contain. Our recent vote to externalize certi- review processes would not only render PROFESSIONAL CREDENTIALING fication is a step in the right direction as is institutes more vulnerable, it also distances ACCREDITING FUNCTIONS our support of institutes applying for accredi- our psychoanalytic institutes from main- The third fault line has to do with the mul- tation from the ACPEinc. stream standard practice in allied health care tiple functions APsaA as an organization However, the recent crisis in governance training programs. embodies. It is a membership/guild organiza- betrays the true fault line. When our bylaws In addition, each institute has the obligation tion, but it also sets training standards for were written, the authors separated the to ensure the integrity of its own training institutes, certifies/credentials individual ana- membership, professional credentialing, and program. Because the training analysis is lysts, and approves training facilities. Other accreditation functions. How and if we can required, it is incumbent upon the institute to health care professions would see that we reconcile these internal tensions will deter- provide TAs whose own clinical work is con- have the missions and work of three separate mine the nature of our organization as well sistent with the educational philosophy of its organizations in one. There are not only legal as the integrity of our profession. educational program. Most of the integration of psychoanalytic learning happens in the candidate’s own analysis and supervisory relationships. How would an education com- mittee know if an analyst is prepared to per- form these functions without some formal evaluation of the analyst’s own clinical work? We know that psychoanalytic competence is not something that ends at graduation; this is the valuable point of the developmental model championed by both the San Fran- cisco and Chicago Institutes. At the same time, psychoanalytic competence does not automatically happen because of graduation and it does not develop in a vacuum; it evolves through continued clinical psychoan- alytic experiences. This suggests that those analysts with more immersion in psychoanal- ysis are probably more prepared to perform these clinical functions than those with less. While our standards require 3600 hours of analytic immersion for training and super- vising analysts, the Committee on Institutes reviews this criterion on an ongoing basis. The question of the quantity and quality of clinical experience that is optimal for TA/SA appointments as well as other criteria for these appointments is an ongoing question under constant review by the Committee on Institutes. It is also being studied as a part of

6 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 National Meeting January 2013 2013 APsaA National Meeting Highlights January 15–20 Christine C. Kieffer

It’s time for that yearly re­ union for psy- choanalysts—the APsaA National Meeting to be held once again in everyone’s hometown (for the week), New Christine C. Kieffer York City. Each year, nearly 2000 people attend the National Meeting, which dependably provides numer- ous opportunities for learning about cutting- edge trends in our field and earning Two-Day Clinical Workshop #1: Child and Adolescent Two-Day continuing education credits, in addition to Workshop Series in Analytic Process Clinical Workshop: Workshop Series opportunities to deepen our knowledge and Technique in Analytic Process and Technique about clinical theory and practice. Partici- Chair: Irene Cairo Chair: Christine C. Kieffer pants can share work experiences and fur- Presenter: Judith Felton Presenter: Monisha Akhtar ther hone clinical skills at the many large Discussant: Jorge Canestri Discussant: Alessandra Lemma panels, symposia, and the more intimate Two-Day Clinical Workshop #2: clinical workshops and discussion groups, as LARGE PANELS Workshop Series in Analytic Process well as reconnect with old friends and make The large panels that examine current and Technique new ones. controversies and offer a variety of thought- Chair: Nancy J. Chodorow provoking clinical perspectives have been an Presenter: Abby Wolfson CLINICAL WORKSHOPS enduring feature of the APsaA meetings. Discussant: Adrienne Harris. The Two-Day Clinical Workshops are one This January, we are proud to feature five of the meeting’s most popular and well-sub- Two-Day Clinical Workshop #3: large panels: scribed features. Given that, in the past, some Workshop Series in Analytic Process Panel I: Silence, Now participants had to be turned away from and Technique Chair: Melinda Gellman registration for these events due to their Chair: Sharon Zalusky Blum Presenters: Ronald Britton popularity, the Program Committee has Discussant: Antonino Ferro Jody Davies added several new sections. This year there Two-Day Clinical Workshop #4: Salman Akhtar will be six clinical workshops. We are espe- Psychotherapy Technique and Process Virginia Ungar cially pleased to have featured discussants, Chair: Larry Sandberg Chair Melinda Gellman will explore ideas Jorge Canestri from Rome and Alessandra Presenters: Larry Sandberg about silence in the context of evolving and Lemma from London, who will comment on Beatrice Beebe diverse theories that shape contemporary presenters’ work. Suzi Tortora psychoanalytic practice. Panelists will offer position papers and clinical vignettes that Christine C. Kieffer, Ph.D., serves on Two-Day Clinical Workshop #5: reflect upon silence in the patient and silence the faculty of the Chicago Institute for Workshop Series in Analytic Process in the analyst. We welcome Ronald Britton Psychoanalysis and Rush University Medical and Technique from London and Virginia Ungar from Buenos School, where she teaches and supervises. Chair: Richard B. Zimmer Aires, who are joining the other presenters She is a member of the APsaA Program Presenter: Henry Schwartz on this panel. Committee and the editorial board of JAPA. Discussant: Lawrence Brown Continued on page 8

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 7 National Meeting January 2013 Meeting Highlights Panel V: Child and Adolescent Panel: traumatizing “otherness” and its dissociated Continued from page 7 Transference in Child and Adult Analysis: dread of attachment rupture, Bromberg Current Views argues. Melinda Gellman will chair this pro- Panel II: Safety for the Analysand, Chair: Thomas F. Barrett gram and I will provide a commentary. Safety for the Analyst, Safety for the Dyad Presenters: Anita G. Schmukler The January University Forum, chaired by Chair: Joseph Lichtenberg Stephen Seligman Stanley Coen, will examine Shakespeare’s Presenters: James Hansell Charles E. Parks Othello, with perspectives by Shakespearean Evelyne Schwaber Discussant: Ruth K. Karush scholars, Robert Brustein and Michael Wood, Estelle Shane This year, the Child/Adolescent Panel will with a discussion by Paul Schwaber, a literary Arietta Slate focus upon current views of “Transference in scholar and analyst. Reporter: Roger Segalla Child and Adult Analysis.” (N.B.: an earlier One of the many symposia offered at the This panel, proposed by the chair, Joseph online announcement of conference high- January meeting, will be “Embodiment and Lichtenberg, will attempt to delineate the lights had inadvertently omitted this panel, Subjectivity,” chaired by Andrea Celenza, role of safety in psychoanalysis, particularly and had erroneously substituted information who will present with John Foehl. Jessica whether safety as an affect may function as about the C/A workshop instead.) This panel Benjamin will be discussant. This symposium the counterpart to anxiety in each session. with presentations by leading child analysts will examine the role of the body in phe- The panelists will engage in a spontaneous will pose the question: Is the development of nomenological experiencing, i.e., embodi- discussion with the chair, one another, and transference and a transference neurosis still ment. The presenters will explore the with the audience. a part of current thinking about psychoanaly- complentarity of clinically useful dialectics, sis? The presenters’ papers, along with Ruth such as self/other, inside/outside, and female/ Panel III: Learning from Ourselves Karush’s discussion, will consider whether male in order to achieve mutual reciprocity Chair: Theodore Jacobs and how the development of transference and subjectivity. Presenters: Richard Almond in children may be contrasted with adult In a plenary address, Warren Procci, imme- Judy Kantrowitz patients, and will also explore the usefulness diate past-president, will discuss the strengths Shelley Orgel of interpretation of the transference in and challenges for psychoanalysis as the field Discussant: Warren Poland patients of all ages. enters its second century. He will examine Reporter: Lori Pellegrino the role of APsaA as a determining factor for “Learning from Ourselves,” originally pro- SYMPOSIA, MEET-THE-AUTHOR, the future of the field. He sees psychoanalysis posed by the chair, will explore a relatively PLENARIES as represented in its institutes, societies, cen- neglected area in psychoanalysis: the follow-up We will be privileged to hear a talk by ters, and especially within APsaA, our major of completed analyses. The three presenters, Otto Kernberg, “The Twilight of the Training professional organization, to be in a serious who are experienced analysts, will report on Analyst System,” chaired by APsaA’s presi- decline. An inability of the major competing their post-analytic experiences with patients dent, Robert Pyles. In his presentation, components of our organization to work who have returned for either consultation or Kernberg will contrast authoritarian versus towards meaningful compromise is, in the further treatment. Warren Poland and Lori functional educational institutions and also speaker’s view, a major factor. Some thoughts Pellegrino will discuss the clinical material, will delineate a means of constructing concerning what must be done, and quickly, highlighting the ways in which analysts may objective, reliable, and transparent instru- will be offered. learn about the impact of treatment. ments for the evaluation of psychoanalytic Rosemary Balsam will give a plenary Panel IV: Mourning, Identity, Creativity competence. address that will examine the role of the Chair: Adele Tutter This year, the featured author in our body in development, particularly the impact Presenters: Otto F. Kernberg Meet-the-Author section will be Philip of procreativity and the major accomplish- Anna Ornstein Bromberg, who will talk about his latest ment of the female body: childbirth. The title Leon Wurmser book, The Shadow of the Tsunami. In this ses- of Balsam’s paper, “(Re)-Membering the Discussant: Jeanine M. Vivona sion, Bromberg will present his view of ther- Female Body in Psychoanalysis,” reflects her Reporter: Tehela Nimroody apeutic action, applying a framework for hope that we will recognize how absent is Examining the lifelong process of mourning expanding the analytic relationship as a dia- the female body in our current analyses and as an inaugurator of personal growth and lectic between dissociation and the increas- theories. She will discuss the importance of creativity, this panel will bring together panel- ing ability to safely experience internal procreative awareness in gender studies and ists who have been leading contributors to conflict without dread of affective dysregu- in gathering analytic data, to inform new this topic. Jeanine Vivona will formally com- lation. By being attentive to the dissociated individual gender theories that included ment on the exchange, with opportunities impact of his own enacted participation, the sexed bodies. for further exploration with the audience. analyst helps decrease the patient’s trust of Continued on page 9

8 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 National Meeting January 2013

We are pleased to feature Mark Solms at DISCUSSION GROUPS Michael Krass will be chairing “Children this meeting, who will discuss his latest work And then, there will be 111 discussion groups and Adults with Asperger’s Syndrome.” in neuro-psychoanalysis in a symposium and from which to choose, including six new ones: which will focus upon analytic work in also will present an additional, innovative pre- “The Critics of Psychoanalysis,” a series this area. sentation, “Psychoanalysis by Surprise.” In the of discussions in which Jonathan Lear Montana Katz and Giuseppe Civitarese latter presentation, Solms will describe his and Alfred Margulies will examine a sig- will co-chair a group devoted to the experience in returning to his home in South nificant critic of psychoanalysis at each study of field theory. Africa, and will reflect upon how applied psy- meeting. They will lead a discussion of choanalysis may have an impact on even the the work of Jean-Paul Sartre. At future ADDITIONAL INFORMATION hardest and most damaged of psychosocial discussion groups, Lear and Margulies The National Meeting includes much more contexts, particularly in its injunction to con- will include Foucault, Heidegger, Kristeva, than these highlights and we urge you to front unwelcome truths. Levi-Strauss, and Wittgenstein. examine the entire meeting brochure, which Glen Gabbard and noted writer Daphne “Mind and Literature: the Talking Cure in is available online through the APsaA web- Merkin will engage in a dialogue about the Chekhov’s Short Story Trilogy,” led by site. If this will be your first time at an APsaA problems that analysts often encounter when Silvia Bell and Jean McGarry. meeting, we strongly recommend that you they attempt to educate the public about visit the following webpage: their profession, using examples from film Susan Finkelstein and Nasir Ilahi will and literature, in a special symposium, “Jargon inaugurate the discussion group, “Schiz- and its Discontents.” They will highlight the oid Modes in Narcissistic and Border- role that jargon plays in the development of line States.” http://apsa.org/ an analytic identity and how this may then “Philosophy and Psychoanalysis,” co- Meetings/Making_the_ create difficulties of translation in addressing chaired by Donna Orange and John Most_of_Scientific_Meetings_aspx. popular media. Foehl. The presenter will be Roger Frie.

says Sandra Walker, chair of the APF We Have Funding… Committee and faculty member of the Linda Benson Seattle Psychoanalytic Institute and Society. The American Psychoanalytic Founda- Recent APF grants show the diversity of One such program Walker points to is tion (APF) is in an enviable position this psychoanalytic ideas and the creative a partnership between Jubilee Jump- year. The foundation has a full bank ways they can influence the most impor- Start, a child care and development account—almost $30,000 in available tant cultural issues of the 21st century. center for low-income families, and the grant money—and is seeking some wor- Combining psychoanalytic principles Washington Center for Psychoanalysis. thy projects to underwrite. with the technological reach of the virtual The two organizations have expanded So, what exactly is a worthy project? world is one example. The committee a collaboration to develop the center’s The APF Committee looks for projects awarded a grant to THRIVE Infant-Family home visiting program. “We urge our that promote a better understanding of Program, established in Los Angeles and colleagues and fellow travelers to jump psychoanalysis and encourage effective sponsored in part by the New Center for in and test the waters—contact our and innovative dissemination of psycho- Psychoanalysis, to create a virtual com- committee members, check out our analytic ideas and services to the public. munity. Its purpose was to implement an website, and submit proposals. We are online emotional neonatal intensive care open for business,” says Walker. Any (ENIC) site to provide parents and care- APsaA member interested in exploring Linda Benson, M.A., an APF Committee givers with support, community resources, the possibility of submitting a proposal member, is a freelance writer on health and education through eBooks, podcasts, to the foundation should feel free to and medicine for national publications and blogging space. contact Dean Stein at the National and websites. She lives in Ann Arbor and “Some projects we have supported Office. He will be happy to put you in is a lecturer on composition and writing show psychoanalysis’s capacity to meet touch with one of the foundation com- at Wayne State University in Detroit. the needs of underserved communities,” mittee members.

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 9 PSYCHOANALYTIC TERMS AND CONCEPTS

operationalize terms and concepts for the “Two Harmless Drudges” Revise purpose of research are also noted. Areas of overlap between psychoanalytic terms and Psychoanalytic Terms and Concepts concepts and those of neighboring disciplines Elizabeth L. Auchincloss and Eslee Samberg are explored. We feel that this kind of con- textualization provides a bridge between the It is a great plea- human mind and its interaction with other glossary format and a “mini-encyclopedia” sure to inform our human minds in everyday life, development, that leads the reader from a study of language membership that psychopathology, and the clinical setting. into the full richness of psychoanalytic thought. a new and revised Our goal has been to provide an accessi- Psychoanalytic Terms ble yet sophisticated reference book for use BALANCING POINT OF VIEW and Concepts was both within and outside our field. We hope Most intriguing is the problem of how to published in Octo- this book will promote communication capture the rich diversity of contemporary ber conjointly by among psychoanalysts who use different psychoanalytic discourse while maintaining an the American Psy- terms and concepts, as well as between integrated point of view. While Psychoanalytic choanalytic Associa- those in psychoanalysis and others in neigh- Terms and Concepts is authored by over 150 tion and Yale University Press. This book is boring disciplines who use the same terms contributors and worked on by an editorial the fourth edition of the book by the same and concepts in overlapping ways. However, board of some 30 psychoanalysts chosen to title edited by Burness Moore and Bernard our chief imagined audience consists of stu- represent a diversity of voices, interests, and Fine, published in 1990. Their book was the dents of psychoanalysis, struggling to read theoretical expertise, there is no escaping the third edition of the original Glossary of Psy- our literature and to make sense of our the- fact that this book expresses a point of choanalytic Terms and Concepts, first published ories and practice. Our hope is that by using view—the point of view of the co-editors-in- in 1967 and revised in 1968. this book as a guide, students at all levels of chief. Indeed, the most complex challenge we Psychoanalytic Terms and Concepts repre- training, including candidates, psychiatry resi- have confronted has been the problem of sents our best efforts as co-editors-in-chief dents, psychology graduate students, social how to recognize, properly apply, limit, and to bring together and explicate psychoana- work and medical students, and undergradu- acknowledge our own point of view. We rec- lytic terms and concepts used in the dis- ates will better understand what psychoana- ognize that every aspect of this project has course of contemporary, North American, lysts are saying about the mind. demanded that choices be made, choices English-speaking clinical psychoanalysis. It is that raise the issue of authorship, even the presented in the format of a lexicon with CONVERGENCE, DIVERGENCE, dreaded specter of “authority,” or, at the very terms and concepts arranged alphabetically. AND CONTEXTUALIZATION least, this problem of point of view. In 2011, It is a hybrid of dictionary, encyclopedia, Since the last edition of Psychoanalytic we discussed our views of this problem at annotated bibliography, textbook, and intel- Terms and Concepts was published in 1990, greater length in an article in the Journal of the lectual history. The overriding mission of this the task of defining terms and concepts has American Psychoanalytic Association entitled, book is to help those interested in psycho- become ever more challenging. Increased “Psychoanalytic Lexicography: Note from analysis achieve a better understanding of the theoretical pluralism, advances in psychoan- ‘Two Harmless Drudges.’” We look forward terms and concepts we use to describe the alytic research, and the explosion of new to discussing this question further in a Sym- knowledge from allied disciplines have all posium planned during the APsaA National contributed to a rapidly expanding psycho- Meeting on “The Politics of Psychoanalytic Elizabeth L. Auchincloss, M.D., is senior analytic discourse. Psychoanalytic Terms and Lexicography.” Meanwhile, we thank every- associate director and training and supervising Concepts reflects current theory, technique, one who has supported this project since its psychoanalyst of the Columbia Center for and research. It also includes entries describ- inception, and the many who have worked Psychoanalytic Training and Research, and ing the work of psychoanalysts who have hard to bring it to publication. vice-chair of Graduate Medical Education made significant contributions to the field. and professor of Clinical Psychiatry at Weill Finally, it includes an expanded bibliography Editor’s Note: “The Politics of Psychoana- Cornell Medical College. of important papers that have created and/ lytic Lexicography: Psychoanalytic Terms Eslee Samberg, M.D., is the former president or elucidated important terms and concepts. and Concepts” is scheduled to take place and training and supervising psychoanalyst Each term/concept is reviewed in terms of at noon on Saturday, January 19, during of the New York Psychoanalytic Society and its origins and the developmental history of its APsaA’s 2013 National Meeting in New Institute and clinical professor of Psychiatry usage. Points of convergence and divergence York City. The book is available at yalepress. in the Department of Psychiatry at the Weill in the current usage of psychoanalytic terms/ yale.edu or amazon.com. Cornell Medical College. concepts are discussed. Existing efforts to

10 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 A DANGEROUS METHOD

A Dangerous Method: Notes on a Film about Freud and Jung Lloyd I. Sederer

I am no apol- Spielrein is a perfect patient for the talking ogist for either cure—to distinguish this approach from the Sigmund Freud purgatives and emetics, bloodletting, cold or Carl Jung, but baths, and restraints that constituted too this film, A Dan- much of 19th-century hospital psychiatric gerous Method, treatment. She was intelligent, highly edu- was a petty, if not cated, and suffered from the condition then perverse, rendi- known as hysteria. She was not psychotic, nor tion of a pro- did she have depression or bipolar disorder. While this indeed did happen, the dominance found moment She had fits, like the infamous hysterics it has in the film is unfortunate—especially Lloyd I. Sederer in the intellectual treated by the great doctors of 19th-century since what may be most disturbingly memo- and social history of the Western World. French psychiatry (especially Charcot and rable from the film are the sadomasochistic What makes the film’s treatment (no pun Janet). Bouts of hysteria are wildly expressive sex scenes so graphically performed. intended) of this era so troubling is that not behaviors and Knightley embellishes them The relationship between Freud and Jung many know the actual story about the origins to a fare-thee-well. Sabina, like the grand hys- has intrigued many an author. A Dangerous of psychoanalysis and psychotherapy, nor of terics of her era, was trying to communicate Method dwells on the father-son aspects and its twin human pillars—Freud and Jung. through her body and her symptoms what caricatures both men. Freud is the rigid, doc- It is 1904, and a horse-drawn carriage is she could not say in words because of shame, trinaire Jew, aspiring to a place in society, who transporting a writhing and screaming young repression, and the oppression that was the spent most of his adult life trying to earn woman to the Burgholzli Clinic in Switzerland. fate of being a woman in Victorian times. enough to support his large Viennese family. Her Russian-Jewish, bourgeois family has sent Jung is the wealthy, aristocratic Swiss Protes- her to this renowned treatment center where A PYGMALION AMBITION tant who is getting special messages from the she will be cared for by the gifted Dr. Carl Freud (played cautiously by the usually universe that became instrumental in his later Jung (Michael Fassbender). The Burgholzli uninhibited Viggo Mortensen) claimed that theories about archetypes. Freud saw human director, Herr Doctor Eugen Bleuler, had his treatment could turn neurotic misery into nature as driven by unconscious forces of sex gained fame for naming “schizophrenia.” ordinary unhappiness. Jung’s ambition for and aggression where Jung saw a “collective Bleuler described this disorder in a more Sabina was far greater, it was Pygmalion: He unconscious,” the repository of human expe- hopeful manner than had Emil Kraepelin who would help her become a doctor. Jung, mar- rience from time immemorial. Where Freud had earlier called it dementia praecox, signal- ried to a devoted and very rich wife who saw fate perhaps it could be said that Jung ing an early and hopeless course. Jung, too, bore him five children, soon invites his patient saw opportunity. was an innovator, like his mentor, and had read to assist in his research. From bench to bed- Freud’s accounts of the “talking cure.” Jung side, but not in the traditional sense of how CONFLICT AND LEGACY would try it on his new patient, Sabina Spiel- science goes from the laboratory bench to Sabina serves as a link and a source of rein (Keira Knightley). Almost instantaneously, its use in hospitals for patients. Instead, we conflict between the two men. Freud was she recalls humiliating thrashings by her father, see him do the ethically unspeakable, namely, appalled by Jung’s taking his patient as a dating back to when she was four. Very soon have a torrid sexual affair with his patient. lover. He was also threatened by Jung’s ideas thereafter, she adds she relished the abuse. and the impact they could have on the That’s short-term therapy if I ever saw it. fledgling field of analysis. Jung was enraged by Freud’s determination to rule psycho- Lloyd I. Sederer, M.D., is medical director, analysis, dominate Jung, and dismiss his ideas. NYS Office of Mental Health; adjunct Continued on page 29 professor, Mailman/Columbia School of Public Health; Huffington Post medical editor for mental health. His book, The Family Guide An earlier version of this review was to Mental Health Care, will be published published in the Huffington Post. in 2013. www.askdrlloyd.com

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 11

from behind THE COUCH Greed in Bull Markets John W. Schott

Managing From early childhood, we are told by our greed in bull mar- parents that greed is bad. This becomes kets is the second quickly incorporated into our super-egos, i.e., most important our conscience. It is then quite usual to ratio- 8. You stop thinking about having a diver- psychological nalize any greedy thoughts or behaviors as sified portfolio and instead concentrate task in investing. they occur. In the realm of investing, this on whatever are the hot areas of the Only coping with sometimes takes the form of saying, “ABC moment, such as Internet gaming fear in a bear Corporation has gone up consistently. Buying companies. market is more more is obviously sensible.” 9. You know for certain that “It’s different important. this time.” John W. Schott At this mo- NINE SIGNS OF GREED ment, fear still predominates among inves- The neuropsychological correlate to this is TRAUMATIZED INVESTORS tors, but there are increasing signs of growing that our frontal lobes release more serotonin When I discussed this article with a col- greed in the investment community. Some with such thoughts, making us feel even bet- league, his response was, “Boy, I wish I had to of the telltale signs are statements such as, ter. If you feel this way when making profits, cope with greed again. I am sick of this side- “I know the economy is going in the tank, but remind yourself that this is a potential danger ways market.” I understand his point. Even I know I have plenty of time to get out.” Or, signal. In this regard, here are nine of the most though the market is near its all-time high, a statement is heard like, “There are no wor- common warning signs: no one is feeling rich. Everyone still feels ries because the market is not overpriced.” 1. Experiencing wonderful feelings of traumatized by the 2008-09 collapse. We It is well to think about greed because control. will not know until time elapses whether or greed becomes infectious in a bull market as 2. Growing expectations of unrealistic not my warning is premature, but, with that people begin to think of large gains and the returns. in mind, I offer you the following market sig- accompanying growing greed as normal 3. Speculative investments no longer seem nals to watch that may alert you to greed occurrences. As greed grows, the psychology speculative. again becoming rampant: of the crowd tends to sweep away the ordi- nary investor, creating a subtle hypomania alluded to in the Wall Street aphorism, Managing greed in bull markets is the second most “Never confuse a bull market with genius.” Crowd mentality seduces its members important psychological task in investing. into feeling safe. To avoid crowd thinking dur- ing episodes of greed, the goal is to think independently. To achieve this, especially 4. Your stock choices favor overpriced 1. A sharp increase in initial public offer- when it comes to greed, you need to know stocks. (You can measure this with sim- ings (IPOs). Although not yet at levels that our unconscious works to conceal ple math by applying valuation ratios associated with dangerously heated greedy behavior from us. This is what makes such as performance/earning (P/E) markets, there has been an increase in greed so powerful as a mental force. ratios, price/book value (P/B) ratios, per- recent months. formance earning/growth (PEG) ratios, 2. Ratios of prices to companies’ earnings, price (P)/free cash flow ratios. sales, and book values approach record John W. Schott, M.D., is a member of the 5. When you hear cocktail conversation heights. Boston Psychoanalytic Society. He is director about new stock ideas, you feel left out 3. Dividend yields are low, perhaps at and portfolio manager at Steinberg Global unless you buy, too. record lows. (Currently these yields are Asset Management. He also publishes a 6. Stock tips excite you. quite low.) monthly newsletter on investment psychology, 7. Investing becomes a competitive activity The Schott Letter. for you. Continued on page 25

12 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 BOSTON LANDMARK

Bittersweet Farewell to a Boston Landmark Alan Pollack

The Boston Psychoanalytic Society and Palmer took on Institute (BPSI) sold its beautiful Back Bay the task of cap- mansion at 15 Commonwealth Avenue in turing the spirit the spring of 2012. It was a difficult decision. and architectural So identified were we with our building that detail of our its image has been our logo, representing us building in a visually on our website, diplomas, stationery, series of photo- mouse pad, folders, and wherever else we graphs that have put our stamp. The question of whether to been compiled as sell was initially so divisive that it threatened a memorial vol- Alan Pollack to split the society. But wise leadership, seem- ume and tribute. ingly summoned up by our need, led us The book is titled, simply, 15. through a long process of self-reflection and Fifteen Commonwealth Avenue was built renewal to redefine our mission and to face as a grand residence in 1867 with money some challenging realities, including fiscal reaped from the China and India sea trade. In BPSI’s former home, 15 Commonwealth Avenue ones. When we voted once more, after this 1898 it was sold to the Ames family, whose process, the decision was unanimous. wealth had been extracted from the bogs of pages of Palmer’s book of images, we tour Our unanimity was a triumph. We secured New England in the form of bog iron. They the interior of the building in two phases, lovely new quarters, which fit our needs promptly hired Ogden Codman to com- divided in the center of the volume by a brief better than did 15 Commonwealth Avenue. pletely redecorate their home. Codman, return outside to glory in the magnificent We escaped the looming financial threat architect to the Vanderbilts and Rockefellers, pink magnolia trees that frame the front door posed by maintaining an old building. We had just published with Edith Wharton their and line the entire block. even pocketed a respectable sum for our classic treatise on Beaux-Arts interior design, endowment. And we were a rejuvenated The Decoration of Houses. In Ogden’s hands, PARALLEL PROCESS and united society. 15 Commonwealth Avenue became an opu- The interior photos interpose close-ups of lent home, replete with richly detailed wood opulent architectural decoration with photos SADNESS AND SUBLIMATION carvings, molded plaster, elaborate wrought of the workspaces, library, meeting rooms, But even triumphs can have their sadness. iron, and the like. Much of that elaborate and classrooms of BPSI. This intermixture is Amidst our celebration, we now turned ornamentation survives to grace the building fitting, documenting the way a living organiza- together to the business of loss, the mourning today—and to be lovingly captured in Allen tion inhabited and honored this space built for our beloved home of 60 years. How to Palmer’s photographs. for another time and a very different purpose. memorialize it? Once again, need summoned Palmer’s book invites us into the building, Continued on page 29 up the appropriate response, this time in the starting with close-up person of Allen Palmer. Chair of the Commit- photographs of the front tee of Training Analysts during our period of door and context shots self-examination, Palmer well understood the of the remarkable street meaning of the building to BPSI. And he hap- in which the building is pens to be a gifted photographer, whose situated. In the middle sensitive and penetrating portraits of senior of the first block of analysts graced the walls of our classrooms. Commonwealth Avenue, adjacent to the Boston Public Garden, Number Alan Pollack, M.D., is a member of the 15 is set in an extraordi- faculty of the Boston Psychoanalytic Society nary and graceful stretch and Institute, where he served as director of historic Back Bay of Psychotherapy Training for 24 years. architecture. Turning the A room of gracious elegance

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 13 SPECIAL SECTION: NEW VOICES

Ne w Vo i c e s Introduction essay drawing, as does Tutter, on concerns of narcissism, Michael Slevin this time when one is faced The American Psychoanalytic Association is rife with the natural world. with new voices. “New” has many permutations, and She is an advanced candidate I have been eclectic in my interpretation. I have leaned in adult psychoanalysis and heavily on the arts, but other special sections could a candidate in child and Michael Slevin easily emphasize research or engagement with the adolescent psychoanalysis. political or social worlds. Melinda Gellman, whose panel on “Silence” The intellectual fecundity of our membership will be produced this January, discusses, like Tutter, touches all regions of our country. Two of the authors psychoanalysis and the visual arts, Gellman turning are from New York, one from Cleveland and one over the facets of negative space and silence in our from St. Louis. busy world. The analytic encounter is her subject. To start off, Adele Tutter, a remarkably prolific Gellman serves creatively and thoughtfully as a author, is emerging as a mainstay of psychoanalytic non-APsaA member of the Program Committee. journals. She has been published in the Journal of the Finally, Vera Camden, a former Committee on American Psychoanalytic Association, the International Research and Special Training (CORST) candidate and Journal of Psychoanalysis, and the Psychoanalytic now training and supervising analyst, is a John Bunyan Quarterly. She has an especial affinity for the interplay scholar at Kent State University and co-editor of of psychoanalysis and the arts. Her article on Poussin’s American Imago. She is likely new to many in the Narcissus reminds us that interdisciplinary work is a American Psychoanalytic Association. She writes two-way street: Psychoanalysis can learn from the arts. about new voices herself, those of an emerging genre Our second and third authors have conceptualized of domestic life, the graphic narrative. Not novel. rich panel discussions for our meetings. Phoebe Cirio, For each of these voices of APsaA, there is a score writing in the first person on desire, offers us a lovely more to discover and to celebrate.

Michael Slevin, M.A., M.S.W., a former TAP editor, graduated as academic associate from the Baltimore Washington Institute for Psychoanalysis, where he completed as a clinician the Adult Psychotherapy Training Program. He works at Sheppard Pratt and has a private practice.

14 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 SPECIAL SECTION: NEW VOICES

The Echo of Narcissus Adele Tutter

Certain works of art do more than just illustrate the classical myths: Rather, they illu- minate the uni- versal dynamics exemplified by these immortal Adele Tutter stories. Nicolas Poussin’s 1631 masterpiece, the Dresden Realm of Flora (Fig. 1), supports a radical

interpretation of the Narcissus myth when used with permission. Image ©Lessing/Art Resource, contexualized by a close reading of Ovid’s Figure 1. Realm of Flora, Nicolas Poussin, 1631. Staatliche Gemäldegalerie, Dresden. Metamorphoses. In the canvas, the goddess Flora dances amidst the mythical figures I have loved him… without obtaining his Poussin specifies Echo’s special connection that, in the Metamorphoses, she turns into beloved.’ Nemesis answered his prayer.” Cap- to Narcissus by joining them around the urn flowers: Ajax, Clytie, Hyacinthus, Adonis, tivated by his image, Narcissus wastes away that bears his reflection. Matthias Winner, Crocus, Smilax, and finally Narcissus, accom- and returns as the narcissus flower that, in classicist and art historian, identifies this ves- panied by Echo. Echo loves Narcissus, but, Realm of Flora, already blooms around him. sel as an echeia—a resonating vase used to as Poussin shows us, he is smitten with his Typically read as a punishment for his vain amplify sound in the ancient Greek theater, own reflection, mirrored in a vessel of water. self-love (the traditional symbol of vanity derived from the same root as “echo” (hch, Many had been turned away before her. being the mirror), Ovid’s text specifies that eche; “sound”). The brimming echeia is in turn “echoed” by the overflowing fountain above it. But Ovid relates that Narcissus dis- Normally a meticulous and faithful interpreter of covers his reflection in a natural pool, not the poet, when Poussin departs from the text, a man-made vessel. Normally a meticulous and faithful interpreter of the poet, when he does so for a reason. Poussin departs from the text, he does so for a reason.

Largely credited with structuring the nar- Narcissus’s demise is more accurately under- MIRROR OF SLEEPING WATER rative of the linked myths of Narcissus and stood as a result of his failure at mature love. Unexpectedly, Realm of Flora alludes to Echo, Ovid explains that one of Narcissus’s The echo is the auditory analogue of the an anomalous metamorphic myth—one not rejected would-be suitors retaliated in fury, mirror. In the Metamorphoses, the “mirroring” involving flowers, but stone: the story of appealing to Nemesis to curse the object of Narcissus and Echo is symbolically elab- Niobe. The art historian Sheila Barker has of his frustrated desire, making him “ ‘love as orated on multiple linguistic levels: Their discerned Niobe’s iconographic posture in comingled stories are “mirrored” by shared the bas-relief on the sarcophagus at the left Adele Tutter, M.D., Ph.D., is faculty of themes of impossible love and violent acts of the picture. In this myth, the prideful queen the Columbia and New York Psychoanalytic of retribution; and their text is chiastically Niobe angered the goddess Leto by insist- Institutes, and member of the editorial structured, e.g., like a mirror, and pervaded ing that it was she, not Leto, who should be boards of JAPA, International Journal by myriad semantic and syntactic doublings. worshipped for her riches and fecundity, hav- of Psychoanalysis, and American Imago. The noted art historian Doris Panofsky ing borne seven daughters and seven sons, She has been awarded the Menninger and observed that Poussin was the first painter the Niobids, as opposed to Leto’s scant two. Affiliate Council Scientific Prizes. to restore Echo to her full “Ovidian status.” Continued on page 16

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 15 SPECIAL SECTION: NEW VOICES

The Echo of Narcissus Continued from page 15

She should have known better than to blas- pheme the goddess with her hubris, as those two children were Apollo and Artemis, who swiftly defended their mother’s honor by slaughtering Niobe’s prized offspring with their bows and arrows. For her offense, Niobe was turned to stone, “rigid in her grief,” and condemned to lament forever. The rocky cliff-side in Realm of Flora con- tains another covert reference to this myth: It follows the profile of the “Weeping Rock,” a stone formation atop Mount Sipylus in Turkey, Figure 2. Left, detail, Realm of Flora; right, “the Weeping Rock,” Mount Sipylus, Turkey. fancied by the ancients to represent Niobe’s petrified incarnation (Fig. 2). When wet, its a mirror,” relating the formation of his identity an image.” Poussin adds additional sensate porous limestone weeps, as if to “bathe the to this “primitive self-observation, the earliest dimensions to the seductive specular mir- marble with her flowing tears.” In the canvas, mirror of self.” And even earlier, in the 1940s, roring of the echeia via its proximity to the this rocky embodiment is situated above the Harry Stack Sullivan spoke of mirroring as a smiling Echo, whose postural mirroring of fountain, illusionistically filling it, and thence the reciprocal, interpersonal interaction between Narcissus complements her intrinsic auditory echeia, with Niobe’s tears. Her pride in her mother and infant. From the perspective of mirroring. And, by positioning the echeia fated offspring is paralleled by that of another myth, Marie Bonaparte has elegantly demon- between her legs, Poussin intimates that the mother—Liriope, who consulted the oracle strated how the eerie silence of still water site of Narcissus’s death is the site of his birth. out of worry for the life of her aggrandized traditionally evokes “the death-aspect of the Linking the gaze to oral incorporative pro- child, Narcissus. Poussin alluded to this very mother-deities”: “the unforgettable smile of cesses, Otto Fenichel argued that at their connection in an earlier painting of Narcissus, the mother,” who “seems, under the mirror inception, object representations are visual, in which his figure is adapted from a classical of the sleeping water, to call the children who their internalization into the forming self statue of a slain Niobid. The plot thickens have remained under her fascination.” effected through mutual eye contact, “the when we realize that Ovid identifies Liriope Knitting together some of these threads, magical property of a look.” In the Metamor- as a water nymph and Narcissus’s father as Leonard Shengold posits that water in the phoses, Ovid specifies that Narcissus is drink- Cephisus, a river god. Given this aquatic ances- Narcissus myth “symbolizes birth and the ing the water that bears his reflection when try, Poussin’s conjuring of Narcissus’s image in mother; its surface is a mirror and its depths he is “overcome by the beauty of the image Niobe’s tears suggests that the painter inter- are the medium for symbiotic entrapment.” that he sees,” a most poetic evocation of the prets his reflection as signifying the mirroring Yet the role of Echo, the mirror, and the nursing infant riveted by his mother’s eyes. gaze of mother—in this case, a mother who mother had long before been meaningfully Indeed, “Narcissus at 16 seemed to be both cannot but mourn her idealized child. interpreted within the legend—not by an boy and man.” Ovid further suggests a In 1967, Winnicott wrote, “the precursor analyst, but by an artist. devouring, incorporative quality by referring of the mirror is the mother’s face,” and to Narcissus’s “insatiate stare” and by having offered that the mother’s mirroring gaze AMPLIFICATION OF him exclaim, “touching is forbidden / but gives “back to the baby the baby’s own self.” DYADIC MIRRORING looking isn’t: then let me look at you / and feed Heinz Lichtenstein also held that the mother Over 300 years ago, Poussin couched in my wretched frenzy on your image.” “reflects back to the child a configuration of aesthetic terms what psychoanalysts have Within the set of propositions outlined its own presence,” stressing in 1964 that the adumbrated, but not explicitly specified: that here, the transformative symbolization of “magnification and reduplication (echo)” of the overlooked presence of Echo in the myth Liriope’s mirroring gaze into Narcissus’s mir- her “narcissistic libidinous mirroring” imbues of Narcissus evokes an essential dynamic— rored reflection in water preserves a meta- this reflection with “the mother’s uncon- the echoing amplification of dyadic mirroring. phorical trace of his watery origin. This textual scious needs with regard to the child.” A The Realm of Flora’s suggestion that Nar- transformation recursively, brilliantly mirrors decade before, while Jacques Lacan was for- cissus’s admiring mirror image is a revenant and represents the developmental transforma- mulating the “mirror stage” of development, of his mother’s admiring mirroring helps to tion of the mother’s mirroring gaze into the M. Royden Astley made the comment that explain Ovid’s curious description of the forming identity reflected back to the infant. “the young child can use his mother’s eyes as visage reflected in the water as “an image of Continued on page 20

16 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 SPECIAL SECTION: NEW VOICES

developing infant, and provides a platform for Desire on Chincoteague Island the emergence of a mind. Phoebe A. Cirio FILLING THE VOID I sit on the Desire, too, pulls us out of narcissism. The hungry gulls are, and are not, me. I deck of my As infants we are hungry, we cry to be fed, understand hunger and the need for a meal, friend’s beach but feeding never comes as quickly as we but I can also understand the suffering of the house on Chin- want. We have to wait. While waiting for a creature who gives up his life to feed me. All coteague Island feed from the breast, the infant halluci- voids beckon to our narcissism to fill them, in Virginia. I hear nates the satisfaction that can be provided and nature is such a void, because humanity the laughing by the breast. is missing. There are, of course, things we can gulls. Earlier, we Marilia Aisenstein described how the see in nature that are like us. I understand had been on capacity for desire arises in this time of wait- hunger, and so do the gulls. But when looking the beach of ing for the breast to arrive. Primary masoch- into nature the human mind is absent. Phoebe A. Cirio the adjoining ism facilitates desire, when the infant learns Donald Moss, in his paper for the desire Assateague Island, a federal wildlife refuge, to find the pleasure in waiting. In her paper, panel, described a patient who would not and host to a herd of wild Chincoteague for the panel at the January 2012 APsaA allow himself to feel desire. Moss’s counter- ponies. The beach borders the Atlantic and meeting “On Desire and Desiring,” she transference experience of being with this has bracingly cool water even in July. All describes the mother around these islands are eagles, hawks, cardi- soothing her baby and nals, turkey vultures, terns, pelicans, and abun- helping it to wait. The dant gulls. There seems to be nothing more baby, supported by the demanding to do today than watch the gulls mother’s cooing and gen- fish for oysters and crab. They hover over the tle strokes, becomes able wooden pier with the shellfish in their beaks, to wait, and eventually to and then drop them, cracking their shells, find pleasure in the pain allowing access to the tender meat within. of delay. From this toler- One of the gulls dropped a crab on the ance for waiting emerges pier so that it became lodged, pincer end the capacity for desire. down, between two planks. So confined, the In the empty space, the hapless crab was devoured. My sympathy lies with the crab; but the gulls have to eat, and the crab provided a meal. This is the sort patient was to feel “entombed.” Such a of place that allows me to forget patient forsakes desire, the wishing for about myself. Attending to the something that is not yet here, to have ponies and birds draws me out the seeming safety of the eternal now. of myself and my mundane con- With such a patient there is no future, cerns. This is the appeal of trips no place other than the present. There into nature. It does not reflect is no other, no not-me to seek or long back to me my worries and pre- for. Such a patient seeks a merger in occupations, and it therefore the present, to erase time, space, and makes me feel enlarged. separation, and so erases the possibil- ity of real engagement with another person. Desire introduces risk, and it Phoebe A. Cirio, M.S.W., L.C.S.W., is an void, between hunger and satiety, something allows for growth. We have to let go of what advanced candidate in adult psychoanalysis takes place. Desire fills the space, and desire we have now to take a chance on the next at the St. Louis Psychoanalytic Institute. leads to thinking. Thinking of what is to come thing. But it might not work out. By suppress- She is also a candidate in child psychoanalysis makes it possible to wait. Finding pleasure in ing desire, this patient does not take that risk, at the New Orleans/Birmingham Institute. the void makes it tolerable. And when the and so does not form connections. She maintains a private practice in St. Louis. void can be tolerated, it is made use of by the Continued on page 20

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and plane, he played with the ambiguity of Silence figure and ground. Is that a narrow band of Melinda Gellman red painted on to a white background, or is the red background peeking out between The silence of the patient and the analyst Interiority larger squares and rectangles? Similar ambi- held a defining place in the history of psycho- seems to be at guities concerned Matisse over his lifetime. analysis and its technique. Once thought sim- risk at the very ply to indicate abstinence or resistance to same time that free association, silence is an element that psychoanalysts often drops out of contemporary case pre- privilege the sentations in favor of more dramatic and use of counter- active tales of therapeutic action. The assimi- transference to lation of intersubjective and relational per- guide our work. spectives and the widening scope of patients Crowded ses- Melinda Gellman we treat, as well as pressures from economic sions at lesser and time constraints, have shifted our goals frequency can push contemplative experi- His early work exploded with color that towards more fully engaging patients of dif- ence outside of psychoanalysis and towards deliberately blurred the distinction between ferent stripes within the dyad. What we share meditation, yoga, and other traditions that foreground and background, and between tends to emphasize the positive and interac- promote self-knowledge and healing. inside and outside. Later in life, the success tive elements of our work: what we say and I was a child who naturally loved going to of his cutout series was based instead upon what we do. art museums. My experience of looking at careful articulation and placement of shapes My interest in silence is partly responsive paintings deepened when I was later intro- and colors of both figure and negative to the noisy world I inhabit—an urban hub, duced to the discipline of looking at visual art space. shared with construction sites and growling and grasped concepts of formal composition Robert Rauschenberg challenged the very garbage trucks, where finding a quiet office and subjective meaning, as well as the rele- existence of empty negative space in his rev- can be a challenge, and the retail establish- vance of historical context. Negative space olutionary White Paintings series. He applied ments I enter have been acoustically designed was one concept that helped to build my ordinary white house paint to canvas using to maximize sales and profits. The volume visual muscle and changed the way I observe. an ordinary painter’s roller, indicating neither inside my professional head can grow quite Negative space in art is created when the subject matter nor even brushstrokes, yet loud in a different way. Thinking more inclu- positive form, or subject matter, is articulated intended that there still be something to see. sively than was permissible when our field against a background to create figure and was born, psychoanalysts today seek per- ground. The artist’s lines and brushstrokes spectives from neighboring institutes, multiple that define the subject at the same time cre- journals, and from abroad, and unexpected ate the shapes, colors, and textures of nega- disciplines influence new clinical models. The tive space where the eye can rest from direct abundance to integrate heightens aware- confrontation with the foreground. These ness that wherever we are looking in our often overlooked spaces between and work, there is much content and texture not around the subject are not just empty, but attended to. So what has become of silence locations with their own distinct visual form in the process of our evolution? Are our and meaning while supporting the identity of minds so busy with multiple ways to make the figure. meaning that it is too daunting to also track the shifting nature of the quiet spaces in CONTEMPORANEOUS ART Perhaps best expressed by his friend and between? Do contemporary psychoanalytic Reflecting on the works of several artists collaborator John Cage, (in his book On trends press us too readily to bridge silences? of the modern era, the same in which psy- Robert Rauschenberg, Artist and His Work) choanalysis developed, illuminates the Rauschenberg’s white paintings were not Melinda Gellman, Ph.D., a graduate of the importance of paying attention to the rich meaningless blank canvases but airports for New York University Postdoctoral Program content to be found in what would other- the lights, shadows, and particles and sug- in Psychoanalysis and Psychotherapy, wise be dismissed as negative space. Piet gested that they be examined in microscopic is currently serving on the APsaA Program Mondrian was one of the first artists to detail, for the white paintings caught what- Committee and is in private practice move into pure abstraction. In distilling ever fell on them. in New York City. painting down to its essence of color, line, Continued on page 31

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A Narrative of One’s Own: The New Voice of Alison Bechdel Vera J. Camden

Alison Since then the graphic novel has been recog- Bechdel is one nized as a serious form of both fictional and of the most non-fictional narrative. With its imbrication of dynamic figures the visual into bold staccato scripts of mem- in contemporary ory and dialogue, its variegated shapes and literature and folds on the page invite the reader into an popular culture alternative reading experience that is affec- Photo: Elena Seibert today. Her Fun tively arresting. At once jarring and stirring, it is Alison Bechdel Home (2006) a form given to memorializing history through and Are You My the telling of one’s life story. Its authors typi- These life narratives, taken together, consti- Vera J. Camden Mother? (2012), cally chronicle a search for an “authentic self.” tute the new voices that grapple with domes- offer two new voices from the cutting edge Hillary Chute’s critical study of this form tic dissent within the literary scene today. literary genre of “the graphic narrative.” Are entitled Graphic Women: Life Narrative and Because of Bechdel’s commemoration of her You My Mother? (the title derives from the Contemporary Comics (2010) notes that this personal psychoanalytic treatment and vir- eponymous children’s book of the same form is particularly given to the depiction of tual memorializing of the place of psycho- name by P. D. Eastman) was reviewed in the family trauma in the context of cultural his- analysis in modern history, it is her testimony April 23rd issue of The New Yorker. And Fun tory. Quoting Cathy Caruth’s assertion that that, I believe, emerges as the strongest strain Home opened in October at New York’s “to be traumatized is precisely to be pos- in the chorus of these new creators. Public Theater as a new musical, directed by sessed by an image or an event,” Chute Sam Gold. Bechdel earned her reputation as a explains how the graphic life narrative “pushes FINDING PSYCHOANALYSIS “comic” book writer in an underground series on conceptions of the unrepresentable that Whereas Bechdel calls Fun Home a “Family called “Dykes to Watch Out For.” In what have become commonplace in the wake of Tragicomic,” she calls her new narrative, Are must be music to the ears of many American deconstruction, especially in contemporary You My Mother?, a ”Comic Drama.” Her frank psychoanalysts, her recent narratives not only discourse about trauma. Against a valorization sense of generic experimentation and radical credit her psychoanalytic treatments for much of absence and aporia, graphic narrative innovation takes hold in this recent narrative. of her personal growth and creative capacity, asserts the value of presence, however com- If in Fun Home she depicts her mother as a but also dramatize in inviting ways the history plex and contingent.” woman whose thwarted creativity and and theories of psychoanalysis itself. As a psychoanalyst and literary historian, I depressed resignation to the secret of her have been intrigued by the ways that this lit- husband’s closeted homosexuality ends up COMPELLING CONTENDER erary form testifies to personal and histori- embalming the whole family in a suppressed ON THE LITERARY SCENE cal trauma within its pages. This summer I secret, here Bechdel links her own “mother” As a literary form, the graphic narrative is taught a course, “From Trauma to Testimony: hunger as a daughter to the transferences relatively new to the literary scene. Most the Emergence of the Contemporary she is able to experience within two power- readers of The American Psychoanalyst will be Graphic Narrative,” to an undergraduate fully transformative psychoanalytic therapies. familiar with Art Speigelman’s Pulitzer Prize class at Kent State University in which we Indeed, she frames her graphic narrative winning, Maus: My Father Bleeds History looked at the intriguing evolution of this new around psychoanalytic dream interpretations (1986). Told in comic book form, Speigelman’s literary phenomena. Starting with the urtext that directly correspond to the major essays daring, brilliant narrative of the Holocaust of Art Speigelman’s account of the Shoah, of D.W. Winnicott, whose voice thus becomes captured the attention of the reading public. we moved on to Persepolis, Marjane Satrapi’s embedded as a kind of Virgil to her Dante record of growing up during the Iranian Rev- on this journey into the underworld of the Vera J. Camden Ph.D., is professor of olution, to Gene Yang’s satirical rendering of unconscious. Thus her chapters are entitled English at Kent State University, training his boyhood as an American Born Chinese, to “The Ordinary Devoted Mother,” “Transi- and supervising analyst at the Cleveland Lynda Barry’s creation of a family archive in tional Objects,” “True and False Self,” and the Psychoanalytic Center, a member of CORST, One Hundred Demons, finally to the “lies, like, each preceded by a graphically depicted the Committee on Psychoanalysis and the secrets, and silences” rendered in Bechdel’s dream sequence. Arts, and Psychoanalysis and the Academy. Fun Home and Are You My Mother? Continued on page 30

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Figure 3. Realm The Echo of Narcissus of Flora, details. Continued from page 16 Arrows indicate the vertical axis of By extension, the figure of Narcissus may two distinct faces reflected in the epitomize how problems with loving often echeia: Narcissus’s results from disturbances in identity, e.g., by reflection (solid arrow), better the tendency to feel colonized, fragmented, seen when the or fused in intimate relationships. Certainly image is rotated mothers like Liriope and Niobe can over- to the left; and the reflection whelm and imprison their children with their of an unseen seductivity, projected anxiety, and grandiose presence, (broken arrow), better mandates, fostering a regressive, dependent seen when image attachment that interferes with the separation is inverted. and identity development of the adolescent and young adult. And if a child can devour his mother through his eyes, then the mother can also devour her child. The replacement of the mother’s mirroring gaze by the symbolic mirror image in the Narcissus myth evokes how, in Stephen Frosh’s words, “the extent to which what is other dominates our exis- tence is too painful, too terrifying, to be of a mother’s eyes are the matrix in which his elusive reflection, which carries the per- maintained” by some individuals without Narcissus’s image, his identity, is thus con- petual echo of the original unattainable love, regular escape to an omnipotent “fantasy of structed. A far more interpersonal and object- the other that lingers “under the mirror of completeness, of narcissistic selfhood.” Such related figure than is usually construed, the sleeping water”—the enduring, alluring a periodic retreat is in fact enacted in the Poussin’s Narcissus is forever spellbound by avatar of mother. text, wherein the bewildered Narcissus alternates between seeing his reflection as himself and seeing it as another. Poussin inventively visualizes this dynamic flux in Desire In some way, these poles define the experi- Realm of Flora by rendering the ghostly Continued from page 17 ence of being human. I am, and am not, a part image floating in the echeia ambiguous, leg- of nature. I can reflect on life. The gulls, eagles, ible as a face in not one, but two distinct Nature, for Lacan, is the big-O Other. It is terns, and herons do not think, and so are not spatial orientations: One accounts for the not-me. When I look at the wild ponies on like me. I know I will age and die. They don’t. expected reflection of Narcissus, but the Assateague Island, I know that in two weeks I want things I do not have. They don’t have a other is summoned by an invisible presence there is going to be a round up of the moth- sense of the future. (Fig. 3). Thus does the painter represent the ers and their foals. Because the island can Desire is born of wanting what we do not blurred relationship between the inchoate only accommodate about 160 ponies, they now have. This experience of wanting is embryonic self and the ever-remembered have to cull the herd. This is accomplished by deepened, and made tolerable, when we can gaze of the other, which can organize, separating some of the foals and selling them. find pleasure in it. Desire draws us out of our cohere, and feed but can also dominate, I can empathize with the mothers, who will own narcissism. It pulls us into connection consume, and drown. shortly lose their yearlings. And with the foals, with others, and deepens our experience. Aesthetic transformation negotiates and who as herd animals, will lose the only family But desire is also dangerous. If we take the manages these tensions, and more. Poussin’s they have ever known. risk of wanting what is not here now, we risk aesthetic interpretations open doors to Their experience is similar but not the same the disappointment of not getting it. Moss’s meanings embedded in a timeless text— as mine. Nature is Other. It is the not-me that patient is frozen in time and space, and fittingly enough, one in which vision is both reminds me of my limitations. My experience defensively compromises his humanity by metaphor and vehicle of knowledge. In Realm of my humanity is one where I am finite, lim- avoiding the risk of desire. Nature is unreflec- of Flora, Echo’s echeia is a synthesthetic meta- ited. I have arthritis in my thumbs. But, it is tive; it just is. There is no tension about what phor for the complex, resonating, multi-sen- also part of my human experience that I long is to come. In traversing the void, we have to sory experience of mirroring, and the tears for omnipotence. Why can’t I go on forever? chance loss to find meaning in life.

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From the Unconscious Silent Unfolding Sheri Butler Hunt poetry Mm, Ma, mama, mother Monisha Akhtar obtained her Ph.D. in clinical psychology Sounds that follow one after the other from Wayne State University in 1985. She pursued analytic Effervescent, ebullient, the cascading waterfall training at the Michigan Psychoanalytic Institute completing Seeks refuge, blending in the pool below her adult training in 2005 and child/adolescent training in 2008. Labyrinth of labor and love She was in private practice in Southfield, Michigan, for over Mother and child 20 years before relocating to Ardmore, Pennsylvania, in 2007. Transforming sound and structure Currently practicing adult and child/adolescent psychoanalysis Sweet melody of ebb and flow Life and music in perfect harmony and psychotherapy, she is a faculty member of the Psychoanalytic Silent rapture unfolds Center of Philadelphia and an adjunct faculty member at Gurgles of delight, a kaleidoscopic world Immaculata University in Malvern, Pennsylvania. Her interests are issues of trauma and attachment. She is But lie quietly and you just might hear involved in a research project examining how trauma and Grass growing attachment impact adjustment in orphans. This work is being A single droplet hung in midair Quiver of a sycamore tree carried out in New Delhi. Keenly interested in providing Bent in the autumn wind psychotherapy training to mental health professionals in India, Sound of an earthworm she founded the India Institute of Psychotherapy Training Burrowing stealthily deep into the ground in 2012 in New Delhi. Banyan trees bursting in the early spring air She has been writing poetry for some time and is Marigold blossoms writhing in ecstasy contemplating putting together her first book of poetry. Myriad of rainbow colors In the sky below

Sounds of silence are loud and clear Open your mind and you will hear Painstakingly woven into the fabric of our lives Medley of color, sound and sight Rich tapestry now unfolds The miracle of life does show Mother and child in unspoken sync Gesture, thought, a look askance Silent meanings where love grows Sheri Butler Hunt, M.D., is an adult training and consulting analyst In a flawless and synchronized world and a certified analyst in the child division at the Seattle Psychoanalytic Society and Institute. A published poet and member of TAP’s editorial —Monisha Akhtar board, she welcomes readers’ comments, suggestions, and poetry submissions at [email protected].

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CASES from the commit a patient if she is a danger to herself or others. Frenkel Files Accordingly, the Court of Appeals held that there was a genuine issue of material fact regarding the appropriateness of Peterson’s Control of the Suicidal Patient care for Reeves and affirmed the denial of John C. West the motion. The management of the potentially sui- Beginning in early August 2005, Monisa Reeves cidal patient is a perennial issue in mental Reeves experienced a number of psychiatric brought suit for health. In this case the issue is not whether symptoms. She was seen at a mental health medical negli- Peterson had control over Reeves’s actions, facility on August 5 or 6, 2005, for psychotic gence against a but whether he should have had control symptoms, but she was not hospitalized. The number of de- over her actions by involuntarily admitting next day she attempted to jump off a balcony fendants, includ- her to a psychiatric facility. That is often the into an empty swimming pool. The police ing Peterson. crux of the issue and it is not a decision to were called and took her to a hospital emer- Peterson moved be made lightly. gency department. On that occasion, Reeves for summary A patient who is felt to be at risk of sui- was involuntarily admitted to a mental health judgment, which cide (and someone with severe depression John C. West facility. However, three days later her status was denied. He probably qualifies as an at-risk person) was changed from involuntary to voluntary moved for reconsideration, which was also should be reassessed periodically for suicide and she was discharged. denied. This appeal to the Court of Appeals risk, and should have a suicide risk assess- When Reeves was discharged from the of Georgia ensued. ment done at every juncture in care. The psychiatric facility, she was transferred to suicide risk assessments should be contin- Horizons Crisis Group Home, a voluntary VOLUNTARY TREATMENT STATUS ued until the person is no longer considered mental health facility. She stayed at Horizons The issue was whether Peterson could be to be at risk of self-harm. These cases often from August 15 until August 17, when she held liable for Reeves’s injuries when she was turn on whether the practitioner was duly was discharged at her request. on a voluntary therapy regimen and Peterson diligent in assessing the patient. Was the ini- On August 23, she was taken to a hospital had no control over her actions. tial assessment appropriate? Were ongoing emergency department and was again The Georgia Court of Appeals reviewed assessments made at junctures in care appro- admitted to Horizons. She was seen at the evidence to date and affirmed the priate? Were appropriate interventions put Horizons by a psychiatrist, Mark Peterson, denial of the motion for summary judgment. into place? Was the discharge assessment who diagnosed her with severe major depressive disorder with psychosis and bipolar disorder with psychosis. He pre- These cases often turn on whether the practitioner scribed medication for her. Reeves was was duly diligent in assessing the patient. again discharged from Horizons on August 29. Expert testimony later indicated that she had not been subjected to either a suicide The court acknowledged that Peterson did appropriate? Were potential threats identi- risk or a self-harm assessment. not have control over Reeves’s actions, but fied and addressed? Was the patient and/or On August 31, Reeves poured gasoline on noted that the subject of control is not pres- family appropriately instructed in after- herself and set herself on fire. She did not die ent in the statute on a physician’s duty to discharge care? Was care taken at every turn in the attempt. his/her patient. (See Off. Code Ga. Annot. to ensure, to the extent possible, that the §37-3-4.) Rather, the court noted that the patient would be kept safe? statute would hold a physician liable “for fail- The practitioner’s control over the patient John C. West, J.D., M.H.A., is a senior ing to meet the applicable standard of care is always going to be limited, to some extent. health care consultant with Global Loss in the provision of treatment to a patient.” The question will always be: Were all appro- Prevention, Inc., a Chartis company. Reeves presented the affidavit of an expert priate steps taken to provide care for the This column constitutes general advice that indicated that Peterson’s care was not patient in a safe and effective manner? If the not legal advice. Readers should consult within the standard of care for a treating psy- answer is no, liability may ensue. with legal counsel for legal concerns. chiatrist under the same or similar circum- For questions or comments contact stances. The court noted that the standard of Peterson v. Reeves, No. A11A1870 [email protected]. care can encompass the duty to involuntarily (Ct. App. Ga. March 30, 2012).

22 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 COPE

Boundary Violators The cultural climate of the institute may have that we do not protect such colleagues, that Continued from page 1 been too permissive and forgiving of these we welcome their complaints of boundary lapses. De-idealization is a necessary step in all violations so we can take appropriate reme- A rehabilita- analyses, but it is a priority in these situations. dial action. This goes a long way toward tion program is To this end, some suggest that attention be restoring trust. next considered given to the history of unethical behavior, Some analytic communities have estab- if agreeable to both local and national, in candidate educa- lished special study groups to deepen their both the analyst tion to further the process of de-idealization. understanding and find ways to improve the and the institute. Increasingly, colleagues are concluding that ethical climate. Colleagues and candidates A special sub- early detection and correction of minor need to have institutional pathways to safely committee of boundary violations are necessary, since if bring forward their complaints and ethical the Ethics Com- unattended over time, they often balloon concerns. Candidates are often positioned mittee may be into major ethical breaches. It is granted that to be the first to detect an analyst’s growing Marvin Margolis appointed to the major problem lies in the analyst’s grandi- difficulty in maintaining an analytic frame. oversee the rehabilitation program, which osity, seductiveness, and unresolved core Help should also be provided to colleagues primarily consists of a return to analysis and problems that require further treatment. who were not directly involved but may have supervision. These subcommittees must been the analysands of an unethical col- report regularly to the Ethics Committee, COMMUNITIES LACKING league, or classmates of an affected candi- which in turn reports to the elected officers REHABILITATION PROGRAMS date, and have experienced considerable of the institute. If the colleague demonstrates Some psychoanalytic communities do not collateral damage. growth, insight, and a deep sense of remorse, provide rehabilitation programs for sanc- Rehabilitation seems to work best when privileges may be gradually restored; for tioned colleagues. They are expelled for a an ethics breach is self-reported early on in some, full restoration may not happen, i.e., given number of years and can then request its development by an analyst who is in psy- the return to functioning as a training and reinstatement. There are many problems chic distress over the breach, particularly supervising analyst. The support of colleagues with this approach. The colleague usually feels when this is a singular occurrence that is due and family is often critical for the sanctioned abandoned and has to create a do-it-yourself to situational traumatic events such as illness, analyst’s survival, for suicide is not rare among rehabilitation program. Usually, this separa- divorce, or even death of a loved one. Ideally such colleagues. They are often profoundly tion leads to a permanent alienation on both the degree of remorse has already led to humiliated by their unethical behavior. sides. The colleague needs support and efforts at reparation and restitution both to Rehabilitation is broader than prescribing advice. The Ethics Committee can provide the patient and the analytic community. There more treatment and supervision, for this is guidance and monitoring of progress through are always exceptions—even colleagues who not just a clinical and educational matter. a special subcommittee. The oversight and were involved in unethical conduct for many Most would agree that unethical colleagues restrictions provided help the analyst regain months, even years, have made substantial have to make formal amends to both their the confidence of his colleagues. Some psy- recovery. Rehabilitation should be available former patients and to the analytic commu- choanalytic communities export the reha- to all and we should reserve judgment about nity. This often includes an apology to the bilitation to the Ethics Committee of the outcome, which in any case may not be patient, restitution of fees paid for the flawed colleague’s primary professional affiliation, known for several years. treatment, and a deep recognition of the e.g., the local medical society or psychology The pain to our analytic community and harm caused to the patient and the analytic board. These efforts usually lack the rigor and to the individuals more directly involved community and to psychoanalysis itself. analytic focus of our Ethics Committees. Out- has had some beneficial side effects. We Psychoanalytic communities require years side analysts can help if they work very are now more mindful of this ever-present to fully recover from these tragic events. While closely with the governing bodies of the insti- risk in analytic work; we have deepened it must be primarily an internally driven healing tute and/or society since the analyst is living our understanding of our institutional, clini- process, outside consultants may help in shar- and working in that community and is well cal, and theoretical responsibilities. As we ing the experience gained in other communi- known to his colleagues. all know, trauma can lead to enhanced ties who have faced similar problems. Many strength both with individuals and groups. find that they have over-idealized colleagues REHABILITATION IN THE This can only occur if we are open, resilient, in an effort to avoid dealing with early signs WIDER COMMUNITY and scientifically modest before the daunt- of unethical slippage. Perhaps such colleagues Rehabilitation extends to both the analytic ing challenge of rehabilitation. It is in that were beginning analytic sessions late on a con- and wider mental health community. The psy- spirit that we offer these initial observations. sistent basis or disclosing excessive amounts choanalytic community may need to demon- We hope they stimulate others to join in of personal information to their patients. strate to the larger mental health community our conversation.

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POLITICS and to demonstrate skills and knowledge in their areas of practice on an ongoing basis— PUBLIC POLICY throughout their careers.” (See: http://www. fsmb.org/mol.html)

MOC/MOL and Status of Consent SUMMARY OF THE THREE MOL COMPONENTS in Certification 1. Reflective self-evaluation, self-assess- Graham L. Spruiell ment, and practice assessment through continuing medical education. Unlike The American between the Federation of State Medical current CME requirements, educational Medical Associ- Boards (FSMB) and (ABMS). In 2002, these activities will be tailored to meet the ation endorsed separate organizations began a collaboration needs or deficiencies identified by an a resolution in that embraced the goal of “life-long learning,” assessment of skills. 1867 to secure a program promoting “excellence in medical 2. Demonstrate competence in medical legislation that practice” through Maintenance of Certifica- knowledge, patient care, practice-based would require all tion (MOC) and Maintenance of Licensure learning, and interpersonal communica- persons who (MOL). Similar to Continuing Medical Educa- tion skills. wished to prac- tion (CME), the process of certification began 3. Demonstrate accountability for per- tice medicine to as voluntary, but now threatens to become a formance in practice. Demonstrate Graham L. Spruiell be examined by requirement of licensure. application of quality improvement the State Board of Medical methodologies to clinical Examiners in order to practice. Licensees will be become licensed to prac- held accountable for meet- tice medicine. Licensure ing MOL requirements to was a requirement, and renew their licenses. hence mandatory. The American Board of Medical COMPLIANCE ISSUES Specialties (ABMS) was Approximately 80 per- established 60 years later, cent of physicians are cur- representing 24 medical rently certified in at least specialties, including the one medical specialty. American Board of Psychia- ABMS has recommended try and Neurology. ABMS is that state boards accept the largest physician-led certification as proof of, or specialty certification orga- in lieu of, compliance with nization in the United components 2 and 3 of the States. In contrast to licen- new MOL. If state boards sure, certification has been accept that recommenda- voluntary, signifying aca- tion, then certified physi- demic achievement. Certifi- cians will be considered to cation has never been considered a legal FSMB comprises 70 state medical and be substantially in compliance with compo- requirement to practice medicine. osteopathic boards. FSMB’s long-standing nents 2 and 3, without having to perform Psychoanalysts, who are M.D.s and D.O.s, mission has been to protect patients from “demonstrations” called for in those will be particularly affected by the alliance unlawful, unethical, and incompetent doctors. components. Having received recommendations from Even though most physicians are certified, ABMS, FSMB will be implementing a new, there remain approximately 200,000 physi- Graham L. Spruiell, M.D., is co-chair expanded MOL on a trial basis in 12 states cians in the United States who are not board of the Committee on Government Relations over the next decade. According to the MOL certified. For those physicians (including and Insurance and a member of the Program Overview web page, “MOL provides a some renowned psychoanalysts) there may in Psychiatry and the Law, Beth Israel needed alternative to our current system, be difficulties in achieving compliance with Deaconess Medical Center, Boston. offering a framework that requires physicians Continued on page 25

24 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012

components 2 and 3. It is not yet clearly basis, competency under the new MOL is under the new MOC/MOL. If physicians are spelled out, but it appears that state boards redefined in terms of compliance with (and unwilling or unable to defend their own rights will create an alternate route for mainte- submission to) an array of practitioner proto- and ethical principles from being redefined nance of licensure, other than certification, cols prescribed by MOL. Instead of being by third parties, including the government, whereby uncertified physicians can achieve presumed competent, such that the state can we protect our patients’ rights? compliance with components 2 and 3 by boards must demonstrate that a physician is APsaA will be joining forces with other working through state boards. ABMS may be incompetent or has engaged in misconduct, groups and organizations to oppose efforts involved in such activities, but has stated that every physician will be required to demon- by third parties to link certification (which there may be issues about the confidentiality strate evidence of “competency,” continu- should remain voluntary) with licensure of physicians’ test scores, and the costs of ously, by meeting whatever metrics state (which is a requirement); and to resist efforts compliance of an alternate pathway for licen- boards establish for components 2 and 3. that attempt to radically redefine profes- sure are estimated to be greater than costs Instead of “excellence of medical practice” sional ethics, competency, and the agency of associated with MOC. Thus, when MOC/ being a function of the expertise and the health care professionals. MOL is fully implemented, MOC will effec- conscience of the physician in the context of tively become the path of least resistance to the physician-patient relationship, excellence maintain licensure. of medical practice will come to mean com- Greed in Bull Markets Physicians-psychoanalysts who are not pliance with MOC/MOL. Continued from page 12 certified will face a dilemma. They can either ABMS has, from the beginning, assured sign up to get certified and then recertified subscribers that certification would be volun- 4. Volume is low on market up days and every 10 years, with numerous time-consum- tary and that life-long certification would be high on down days. This indicates the ing and costly steps along the way; or they honored, as promised. ABMS continues to professionals are selling. can work within the MOL framework of maintain that certification will be voluntary 5. The advance-decline line (i.e., the ratio of state boards, sacrifice privacy of test scores, and life-long certification will be recognized, the number of stocks that have advanced and pay even higher fees. at least by ABMS; yet its alliance with FSMB to the number that have declined) points ABMS recommends that physicians, who regarding MOC/MOL could effectively vio- downward over several weeks. were granted lifetime certification prior to late both agreements with its subscribers. 6. There is market divergence. This means its 10-year recertification rule, should be The “transformation of health care” may that one segment of the market is exempted from MOL, components 2 and 3. entail the new MOC/MOL, as FSMB asserts. advancing while another is not. Presently ABMS nevertheless strongly encourages The American Medical Association, American this is so because while the DJIA and the those physicians to participate in MOC/MOL Psychiatric Association, and many other phy- S&P 500 have been advancing on new and promises that even if they fail the recer- sician-led organizations, along with accred- highs, the DJ Transports are lagging. tification exam, they will not lose their life- itors and credentialing agencies, all agree 7. Time Magazine and other important time certifications. Regardless of what ABMS and support the proposed MOC/MOL. (It is periodicals place a bull or bear on their and state boards decide, eventually creden- worth noting that the American Psychiatric cover. This signals a market turn. tialing offices and state boards may take it Association supports MOC/MOL despite a 8. When 60 percent or more of market upon themselves to require participation in referendum in which 80 percent of the vot- newsletter writers are bullish. MOC/MOL in order to grant privileges to ing membership objected.) The integrity of All this begs the question as to what physicians. This will have a direct and immedi- the physician’s role in the physician-patient investors should do today. There are enough ate effect on physicians who practice in hos- relationship constitutes the essential core of danger signals that investors should be pital settings or serve on insurance panels, medical practice, and it is an unfortunate fact increasingly defensive by decreasing the per- both of which generally require board certifi- that our changing health care system increas- centage of their portfolio invested in equi- cation (and consequently will also require ingly creates tension between that core and ties. The problem is where to go because maintenance of certication). the exigencies of the system itself. bond yields are pitifully low. There is no really Just as the Committee on Governmental good answer to this. Most professionals have OTHER CONSIDERATIONS Affairs and Insurance (CGRI) advocates for fled to solid dividend-paying blue chips. This Whatever the implications are for all psy- preservation of patient consent for disclo- is the safe haven of the moment, but the choanalysts, FSMB’s new MOC/MOL is sure of protected health information, so we danger exists that this sector is becoming unprecedented and should be considered a are obliged to advocate preserving physician overpriced to the point of becoming a new violation of physician boundaries, because it consent regarding certification, and to pro- speculative bubble. radically redefines physician competency. tect the boundaries of the physician, patient, Whatever you choose to do with the Instead of being a function of acquired edu- and physician-patient relationship. We believe non-equity portion of your portfolio now, cation and experience, and presumed on that that these boundaries may be compromised it should over-emphasize safety.

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 25 APsaA FELLOWS

APsaA’s Excellent New Fellows for 2012-2013

The American Psychoanalytic Association Fellowship Program is designed to offer additional knowledge of psychoanalysis to outstanding early-career mental health professionals and academics, the future leaders and educators in their fields. The 17 individuals who are selected as fellows each year have their expenses paid to attend the national meetings of the American Psychoanalytic Association during the fellowship year and to participate in other educational activities. The biographies below introduce this year’s excellent group of fellows. We enthusiastically welcome them to APsaA.

Kristina M. Anton- women’s health, geriatric psychiatry, and end Bodenheimer has pub- son, M.D., Ph.D., is a of life care. lished in peer-reviewed fourth-year resident at journals on the role of UC Davis Medical Cen- Elizabeth Freidin non-erotic love in the ter. She received her Baumann, Ph.D., is a treatment relationship M.D. from Cornell and postdoctoral fellow at and on the relational her Ph.D. in cell biology McLean Hospital, Har- history of Sigmund from Rockefeller Uni- Kristina M. Antonson vard Medical School, Freud and Sandor Danna R. Bodenheimer versity. This year she is where she conducts Ferenczi. She is cur- beginning the Psychodynamic Psychotherapy psychological and neu- rently working on a book that aids clinical Training Program at the San Francisco Center ropsychological assess- Elizabeth Freidin Baumann social workers become oriented to the field. for Psychoanalysis. Antonson and her hus- ments with children The book is informed by her work with band Paul are attempting to publish their first and adolescents. She holds a B.A. in creative recent graduates in clinical supervision children’s book together. writing and psychology from Columbia Uni- groups. Bodenheimer’s primary treatment versity and a Ph.D. in clinical psychology from population is LGBT adults struggling with Alexis D. Armenakis, the City College of New York, City University addiction and trauma. M.D., is a chief resident of New York. She has a research interest in at the University of Cal- attachment theory and completed her dis- Sylvia Shin Huey ifornia, San Francisco. sertation on the influence of attachment and Chong, Ph.D., is associ- She received her B.A. trauma on sexual risk-taking in adolescence. ate professor of English summa cum laude in Throughout her training Baumann has been and American Studies psychology from Bos- deeply committed to psychodynamic work, at the University of ton University. Prior to Alexis D. Armenakis especially from the perspective of attach- Virginia, where she also medical school at the ment, trauma, and community mental health. directs the program in University of California, San Francisco, she She has fostered a passion for multicultural Asian Pacific American Sylvia Shin Huey Chong conducted clinical research focused on the and psychodynamic work within community Studies. She received a neurobiology of schizophrenia and worked settings and has presented on the topic of B.A. from Swarthmore College, an M.A. from abroad in Latin America with the global health invisible and visible minority identities at Stanford University, and a Ph.D. in rhetoric organization Child Family Health International. multiple conferences. from the University of California, Berkeley. Throughout her psychiatric training, Armena- Chong comes from a strong background kis has been interested in clinical education, Danna R. Bodenheimer, M.S.W., D.S.W., is in psychoanalytic theory and has become psychodynamic/psychoanalytic therapy, and a lecturer at the University of Pennsylvania’s increasingly interested in its history and prac- working with older adults. She will be taking School for Social Policy and Practice and also tice. Her first book,The Oriental Obscene: classes at the San Francisco Center for Psy- maintains a private practice in Center City, Violence and Racial Fantasies in the Vietnam Era, choanalysis this year. After finishing residency, Philadelphia. She graduated with a B.A. in investigates the role that race plays in nar- she plans to complete a geriatric fellowship Women’s Studies and an M.S.W. from Smith ratives of “national trauma” used to describe and aspires to a career as a clinical educator College, and received her doctorate in social the Vietnam War. Her current project, with an emphasis on psychodynamic therapy, work from the University of Pennsylvania. Continued on page 27

26 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 APsaA FELLOWS

Yellowface Peril, draws parallels between the child and adolescent training, Gray has clinical work with her background in mental performance of race in films and the “sci- become interested in eating disorders and health policy. ence” of race being developed by social sci- athletes. She co-facilitates a teen mentor entists around the mid-20th century. group through the Harris Center at MGH Peirce W. Johnston, targeting body image and self-esteem and M.D., M.F.A., is assistant Alicia J. Christoff, plans to do research on eating disorders, professor of psychiatry Ph.D., is Mellon Keiter athletes, and oxytocin. at the University of Postdoctoral Fellow Cincinnati and is the and Visiting Assistant Hsuan-Ying Huang, U.C. College of Medi- Professor of English at M.D., M.A., is a Ph.D. cine’s psychiatry clerk- Amherst College. She candidate in the ship director. He is a Peirce W. Johnston received her B.A. and Department of Anthro- former English profes- M.A. from New York Alicia J. Christoff pology, Harvard Uni- sor with a B.A. from Kenyon College, an University and her versity. He received his M.A. from Miami University, and an M.F.A in Ph.D. in English from Princeton University. M.D. and psychiatric fiction from the University of Massachusetts, Her teaching and research interests include residency training at Hsuan-Ying Huang Amherst. His interests include emergency Victorian literature and culture, the novel, National Taiwan Uni- psychiatry, narrative medicine, and medical critical theory, psychoanalysis, and the history versity. Since 2007, he has studied the recent student and resident education, as well as his of psychology. Christoff’s book project, Novel rise of psychotherapy in urban China, with a outpatient practice, where he combines psy- Feelings, explores the way the Victorian novel particular focus on psychoanalysis or psy- chopharmacology in refractory illness with teaches us to read, to feel, and to experience choanalytic-oriented therapies. Huang grad- most aspects of psychotherapy, especially our own subjectivity, both by placing the uated from the Boston Psychoanalytic insight-oriented approaches. One current 19th-century novel within the history of psy- Institute’s Fellowship Program in 2008. focus is bringing tenets of psychodynamic chology and by helping us to understand feel- Between 2008 and 2011, he spent two psychotherapy to his work supervising psy- ing as a matter of literary form. Her work has years doing ethnographic research in Beijing chiatry residents. appeared in the journals English Language and Shanghai and is currently working on his Notes and Psychoanalysis, Culture & Society. doctoral dissertation. Ryan E. Lawrence, As a fellow, Christoff’s particular interest is M.D., MDiv, is a third- connecting literary theory with contemporary Nora M. Hymowitz, year psychiatry resident psychoanalytic thought. M.D., M.P.H., is chief at Columbia University/ resident of outpatient New York State Psychi- Emily K. Gray, M.D., is psychiatry at the Uni- atric Institute in New a second-year child and versity of Pennsylvania. York City. He received adolescent psychiatry She received her medi- his MDiv from Gordon Ryan E. Lawrence fellow at MGH/McLean, cal degree, along with Conwell Theological Boston. She attended a master’s in public Nora M. Hymowitz Seminary and his M.D. from the University of the University of Cali- health, from New York Chicago. During medical school and resi- fornia, San Diego, for Medical College. For her thesis, she studied dency, he studied interactions between physi- undergraduate, medical Emily K. Gray mental health policy among veterans return- cians’ religious commitments and their ideas school, and adult psy- ing from Iraq and Afghanistan. Prior to medi- about the ethical practice of medicine, pub- chiatry training. While in college, she studied cal school, Hymowitz studied literature at lishing on a variety of topics including free- psychology and competed on the varsity Amherst College, where she cultivated an dom of conscience, substituted judgment, crew team as a three-time All-American. As interest in character narratives, in particular birth control and assisted reproduction, and an adult psychiatry resident, she led a pro- in relation to one’s culture and background. substance abuse. cess group for pediatric residents, partici- During her training in residency, she has pated on the Well-being Committee for become interested in how a traumatic child- Lisa Madsen, M.D., is a faculty psychiatrist impaired physicians, and contributed to hood might inform a patient’s current life with the Seton Mind Institute in Austin and research on the treatment of disruptive predicament. She is particularly interested in assistant professor at the University of Texas behavior disorders in children. During her resiliency in trauma and plans to combine Continued on page 28

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 27 APsaA FELLOWS

2012-2013 Fellows intellectuals and authors reworked and drew Yan Xuan, M.D., is a Continued from page 27 on aspects of affect as they reflected on the fourth-year psychiatry past in the immediate postwar period. resident at the Univer- Southwestern Medical sity of Pennsylvania. He Center Austin. She David A. Ross, M.D., received his B.A. magna received undergradu- Ph.D., received his M.D. cum laude in biochem- ate degrees in psychol- and Ph.D. degrees from ical sciences from Har- ogy and French from Yale University, where vard College and his Yan Xuan the University of Iowa his dissertation research M.D. from the Perel- and her M.D. from explored the neurobi- man School of Medicine at the University of McGill University. Mad- Lisa Madsen ology of music percep- Pennsylvania, where he conducted research sen completed her tion and “perfect pitch.” David A. Ross in transcranial magnetic stimulation. His inter- psychiatry residency at the Emory Univer- He remained at Yale ests include food and cooking and their rele- sity School of Medicine, where she served for psychiatry residency and joined the fac- vance to psychotherapy and mental health, as outpatient chief resident and president of ulty in the clinician-educator track in 2009. the development and ethics of neuro- the Psychiatry Resident Association, and was Ross divides his time between clinical work at enhancement and “cosmetic psychiatry,” and awarded the Emory Medical Student Teach- the West Haven VA Hospital treating veter- the impact of technology and the Internet on ing Award. Throughout her training, Madsen ans with post-traumatic stress disorder, and psychiatric practice. He is also interested in has been deeply interested in psychody- his position as one of the associate program the interface of psychiatry and psychody- namic psychotherapy and psychiatric educa- directors for the Adult Psychiatry Residency namic thinking with society and the law and tion. She is dedicated to caring for patients, Program. His primary academic interest is plans on entering a fellowship in forensic psy- teaching, and advocating for patient-cen- finding innovative ways to apply principles of chiatry at the conclusion of his residency. tered medicine. Madsen is currently working adult education to resident training. Over on designing an innovative psychotherapy the next year, he looks forward to consider- Genevieve Yuen, curriculum and serves as chairperson for ing novel ways to introduce trainees to the M.D., Ph.D., is an assis- the Student Resident Associate Committee core concepts of psychodynamic psycho- tant attending at New of APsaA. therapy and to exploring areas of com- York-Presbyterian Hos- monality and difference between CBT and pital-Cornell and a Anna M. Parkinson, psychodynamic approaches. postdoctoral research Ph.D., is assistant pro- associate at the Weill fessor in the Depart- Lisa C. Valentine, Cornell Institute of Genevieve Yuen ment of German at M.D., is a fourth-year Geriatric Psychiatry, Northwestern Univer- psychiatry resident in where she also completed clinical fellowship sity. She received her the Menninger Depart- training in geriatric psychiatry. She received a B.A. in English and Ger- ment of Psychiatry at B.S. in biology from Yale University where she man from the Univer- Anna M. Parkinson Baylor College of Medi- first became interested in neurobehavioral sity of Melbourne, cine. She received her research, a Ph.D. in neuroscience from Rock- Australia, and her Ph.D. in German Studies undergraduate degree Lisa C. Valentine efeller University where she studied the role from Cornell University. Her work draws on in biomedical ethics of estrogen in the regulation of hippocampal theories of psychoanalysis, intellectual history, from Brown University and her medical synaptic plasticity in the aging female brain, and theories of gender and sexuality as they degree from Baylor College of Medicine, and an M.D. from Weill Cornell Medical Col- relate to literature, film, and other cultural where she also completed additional study in lege. Yuen completed her residency at the artifacts. Parkinson is completing a book ethics. In residency, she has been involved in Payne Whitney Psychiatry Program. She is manuscript, In an Emotional State: The Politics both basic science and clinical teaching to currently engaged in clinical research focused of Emotion in Postwar West German Culture, medical students and has coordinated the on the neuroanatomical substrates of apathy which elucidates the often-repeated claim department film club. Her interests include in late-life depression and is interested in that after 1945 the German population the intersection of psychiatry and ethics as contributing to a better understanding of evinced an inability to mourn. She argues that well as the use of humor in psychotherapy how the mind works in depressed and non- this claim overlooks the ways in which and its role in therapeutic change. depressed states.

28 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012

Boston Landmark One can imagine fine homes in Vienna, at the The volume concludes resplendently, with Continued from page 13 time psychoanalysis was born, ornamented a photo on the back cover of the block at very much like Number 15. night, lights aglow. Number 15 is framed on And there is resonance for psychoanalysis in It is the photos of empty offices and class- either side by trees wrapped in glowing white all the fin de siècle finery. Ogden Codman rooms that I keep coming back to. They are Christmas lights. Allen Palmer’s book cap- was shaping 15 Commonwealth Avenue just haunting. There are no people, although the tures the glow of our feelings for this remark- as Freud was creating psychoanalysis. The desks and tables remain cluttered with the able building, the building that we were proud Ames family moved in the same year that stuff of a busy working office. The way these to call home for 60 years. Freud published The Interpretation of Dreams. empty rooms remain fully intact creates an elegiac mood. It is as if the people of BPSI had suddenly been evacuated, leaving the building Editor’s Note: The book 15 is available on waiting, in vain, for our return. The building Blurb.com. Allen Palmer’s artistry can also almost grieves for us—“almost,” because it be sampled at his website, AllenPalmer seems not yet to have quite accepted that Photography.com. Among other delights we will not be returning. Palmer has effected found there are his superb portraits of a subtle reversal here, projecting our grief senior analysts. Click on the Additional onto the building. It is poignant and perfect for Projects tab, then on The Face of evoking simultaneously our sadness and our Experience. love for our Commonwealth Avenue home.

A Dangerous Method aggression, which are now Continued from page 11 part of our vernacular. Jung recovered from his psychosis Sabina does become a doctor and psycho- and has left us with a better analyst who challenges Freud himself but understanding of the deepest returns to her perverse relationship with of individual and social deter- Jung, and then rejects him. Yet there is far minants of behavior. There was more going on, and the film seems not to far more going on than Carl appreciate the history of early 20th-century bedding and beating Sabina or Freud frown- theater without indelible images of abuse in Europe with the rise of totalitarianism, the ing upon that disgraceful behavior, which the the forefront of their experience. They could persecution of Jews, and the nightmare of film tends to leave you recalling. have been illuminated by the mental and Hitler. It also does not credit these two psy- David Cronenberg, the film’s director, and spiritual human wellsprings revealed by these chiatrist pioneers with advancing theories of the writers appear to have missed the plot. great men, despite all their limitations, that the mind that changed the Western World. They had a phenomenal story and the finest are among the most profound influences we Freud had to flee his country to escape of actors. The audience could have left the have on our minds today. the Nazis. Many contend that Jung became a Nazi sympathizer. Jung had a severe and sev- eral yearlong episodes of psychosis, recently Film Seminar illustrated in the publication of The Red Book, Saturday, January 19, 2013 full of mysticism and primary process mate- rial. Freud did open his mind to the role of The Life and Work of Sabina Spielrein in Film and Historical Documents the ego, the rational part of the mind, and Chair: Bruce H. Sklarew his daughter, Anna, was extraordinary in her Co-chair & Presenter: Henry Zvi Lothane work. She explained how our mind works Presenters: Harold P. Blum, Lissa Weinstein and Michael Vannoy Adams through “defenses,” like denial, intellectualiza- From being a footnote in the Standard Edition, Sabina Spielrein was catapulted to tion, repression, sublimation, and passive the larger idea of boundary crossing in the course of therapy, a topic exploited in plays and films. The presentations will be accompanied by clips from three films: Elisabeth Editor’s Note: Bruce Sklarew’s film column Marton’s 2002 documentary My Name was Sabina Spielrein and two feature films, will return in the next issue of TAP. Roberto Faenza’s 2002 Soulseeker and David Cronenberg’s 2011 A Dangerous Method.

THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 29 THE NEW VOICE OF ALISON BECHDEL

Alison Bechdel reading his biography, personal letters, and that she portrays in her autobiographical Continued from page 19 interviews. In such manner she interpene- graphic novels. They provide a creative nursery trates the history of psychoanalysis itself into to foster her nascent self. Illustrating both the influence and the her own personal quest and utilizes its vivid, Thus Bechdel’s new narrative demon- impact of Winnicott’s work on her psychic iconic moments to memorialize her own strates how literary and psychoanalytical and creative transformation, Bechdel history. In a winsome turn to historical fic- texts take on allegorical personification in inscribes key passages from his essays over tion, Bechdel goes so far as to draw pictures Bechdel’s life, even as they populate the the pages of her own journals, strewn amidst of this same young Donald Winnicott pass- pages of her books. Literally walking off the the scenes she portrays from therapies with ing, en route to his analysis, the figure of Vir- pages of their books onto hers, the dramatic two different female therapists who speak ginia Woolf as she strolls in Gordon Square, embodiments, drawn in vivid and engaging from the pages of her memoir. Cutting and Bloomsbury, on her way to publish the comic illustrations make a home in her pasting his prose into her book, Bechdel papers of Sigmund Freud. imagination like so many idealized, longed grafts Winnicott’s writing into her own, cre- Thus creating a chorus of guardian angels to for parental imagos. Are You My Mother? ating her own textual transitional phenom- her autobiographical aspirations, Bechdel takes up these titans of modernism and psy- enon. What’s more, Bechdel illustrates the turns adaptation into a fantasy of adoption as choanalysis in ways that remind us of the imagined history of the young Winnicott’s she searches for the lost mother among trans- endurance of the embodied self in an artistic own analysis as he journeys through the ference figures of the past. As she sighs, at one and literary tour de force that should tanta- London Underground, to his destination on point, to her therapist: “I wish Winnicott was lize readers of The American Psychoanalyst. the couch of James Strachey. Bechdel reen- my mother!.” Indeed, Woolf and Winnicott, She is someone indeed to watch out for acts and records Winnicott’s free-associating among others become idealized literary par- by any American psychoanalyst who seeks to dreams about his own depressed mother ents—bookends—to substitute for the pro- attunement to our times. Hers is a new voice upon this couch that she has recreated from foundly disappointing and narcissistic parents to heed.

30 THE AMERICAN PSYCHOANALYST • Volume 46, No. 4 • Fall/Winter 2012 SILENCE

Silence Silence can represent the continuity of once she gets there. Using her phone to cre- Continued from page 18 space that contains the analytic relationship ate activity she preempts contact with poten- and from which the symbolized emerges and tial associations and deeper anxieties. Her John Cage, musician and composer, made the time or timelessness through which they text message diverts our exchange from an the point even more clearly that silence has move. The line that frames the beginning and exploration of what lateness stirs in her imag- meaning and is not just the absence of sound. end of each session also demarcates the ination into the realm of social civility. With In his famous composition 4'33" (Four min- absence of contact in between. Silence as seemingly eager intentions she continues to utes and 33 seconds), the pianist walks to the negative space between sessions is not just control the session by filling it, speaking in full piano, sits down, and opens the lid. Then absence but replete with possibilities for con- paragraphs. She does not allow me to enter 4'33" later, he closes the piano and the piece tinuity or disconnection, for the ongoing self- her space until there are few minutes left in is over. In the absence of piano notes, the reflection we value and hope to engender in the session. She fears the uncertainty of her audience hears not silence but the presence our work, or for its failure. own mind and the possibility of feeling of unintended sounds. The absence of inten- Like Rauschenberg’s white paintings or between us in quiet moments. Speech itself tional composition creates space to hear the Cage’s composition, silence inside the con- creates subject matter, and negative space is ambient sounds often overlooked, sounds sulting room is neither meaningless back- restricted. the composer did not intentionally put there. ground to the process nor emptiness, but The edge of silence sharpens the edge of The piece thus varies depending on context the opportunity to collect sounds, thoughts, what is said in sessions. My patient creates where it is performed, whether an orchestra and feelings yet to be formulated. Silences noise to avoid this articulation, not yet ready hall, the outdoor urban garden, or in a silent that punctuate or trump the flow of an ana- to shape personal meaning or demarcate the chamber quiet enough to hear only the lytic hour hold meanings unique to the given unique products of each mind in the room. sound of one’s breath and heartbeat. treatment dyad at a moment in time. Silence Refrain from speaking allows a working space can appear quiet and calm or can be inten- for expressed words and feelings to be tional and very busy. Clinical experience tells turned over and viewed from different angles, us that the silent patient may be frightened questioned and elaborated on the way to and avoidant, or profoundly thoughtful. taking positive form. Laser techniques in art Silence can hold anger, submission, and false history show us the many changes in the art- compliance or peacefulness and trust. It can ist’s mind and canvas on the way to a com- reenact profound loneliness or suggest evac- pleted painting. Silence in the relationship is uation and retreat from danger and turmoil the living canvas inviting patients to hear their within. Or silence can indicate a less toxic and own thoughts, and formulate and revise self more productive pause from the interactive experience and understanding in our pres- nature of analysis to claim space for self- ence, with clearly delineated sense of owner- directed contemplation and consolidation. ship of their work. The analyst’s silences range as well, from Contemporary culture threatens to fill those reactive to all that might be communi- patient and analyst alike with the noise of cated by the patient to those responsive to plenty. Technology has offered a class of con- John Cage performing 4'33" at a toy piano. the analyst’s inner life and preoccupations. crete objects that physically occupy much space and functionally provide constant The analogy to psychoanalysis is apt. We are IN THE CONSULTING ROOM access to connectedness that can easily dom- not limited by the deliberate notes our I recognize that I am not quiet just to hear inate the foreground. Communications from patients orchestrate or by the predictions of my patient nor in compliance with technique. multiple devices shrink the negative space of any singular theory. While we are inclined to I ground myself in silence to push away what silence that encourages us to hear the con- track and share changes in the positive form of lingers from the previous session and from tents of our own minds to gather our what is symbolized and verbalized, psycho- intrusive personal concerns. I connect with thoughts and feelings and remember our analysis is distinguished by its attention to what the interior space that allows access to inner dreams. The cacophony from our culture and is not apparently perceptible but there to be reverie as experience unfolds in the context from within our expansive field cannot help found. We mine all that can be projected or of the unique relationship created with my but impinge upon the interiority precious to enacted around defined foreground. Focus next patient. She texts that she is running a psychoanalysis. As guardians of the process, in treatment oscillates between figure and bit late, even though she arrives on time. The we need to preserve and respect, regulate ground, shifting between the known and the motivation and sincerity she exhibits about along with words, affects, and actions, the unconscious, reality and fantasy, and between getting to my office contrasts with her char- meaningful and generative possibilities of multiple ways of organizing experience. acteristic avoidance of silence and reflection quiet negative space.

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