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Two central questions raised by Spezzano's commentary have to do with the extent to which we seek objectivity in psychoanalytic theory and practice, and the extent to which one or another set of methods (e.g., clinical observation) is adequate or optimal for generating that knowledge. A discipline and treatment devoted to understanding subjectivity is nevertheless devoted to objective knowledge about a patient's subjectivity, defenses, and so forth and requires valid theories to guide exploration, inference, and intervention. Seeking objective knowledge does not require a naïve empiricism ignorant of the limits of objectivity. We would do well to use multiple methods to learn about how the mind works and what leads to therapeutic change.
This paper is a response to an essay by Drew Westen. The author agrees with many of Westen's arguments about problems in the psychoanalytic literature and adds that the psychoanalytic literature has always been a problem for psychoanalysis. If we think of psychoanalysis as an ongoing experiment, then its >trials< are all the analytic sessions that have been conducted. Our >literature< has never systematically drawn on those. Westen critically scrutinizes certain habits that, in his view, haunt our literature, but that we do not explicitly note or disown as conceptual contrivances we mean to get rid of, while they are often misguiding clinical thinking and practice. I suggest that a fascinating question riding below the waves of Westen's paper is why patients and analysts accept this situation. I suggest that we all treat psychoanalysis as wisdom, art, relationship, skill, and something other than the application of established scientific findings because we recognize and accept it as that kind of human activity. It is unclear if patients care whether or not their analysts are scientists, but it is clear that analysts are not optimistic about sifting the research literature and finding clear clues to more effective clinical thinking, work, or writing.
Chronic and complex posttraumatic stress involving terrorization and betrayal by a caretaker can result in a particular kind of psychic organization that is structured largely by underlying, alternating victim/masochistic and abuser/rageful states. When we move our view of experience >back< to its underpinning in states, we can see how the oscillation between these states is a continual reenactment of the traumatic violation of the relational boundary. While >borderline< persons are capable of conscious awareness of their dramatically differing behaviors, the meaning of the behavior is disavowed. These unlinked, but switching states are decontextualized. Inasmuch as context provides meaning, the acted-out parts remain encapsulated as unowned experience. Diagnostic formulation in terms of these dissociated states supplies a needed cohesiveness for the criteria given in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM – IV) and adds specificity to the >borderline< defenses as spelled out by Kernberg. These shifting victim/masochistic and abuser/rageful self-states can be observed and talked about and are accessible to experience. Themes of behaviors that are typically enacted have to do with boundary violations, destructive entitlement, betrayal, and mirroring the earlier experience, particularly of traumatic betrayals of attachment, of these survivors.
In this discussion, I nest Howell's work in a broader psychoanalytic look at trauma and dissociation. I approach Howell's paper as a trauma narrative situated in the context of emergent relational theory and practice. A critique is offered that focuses on the way trauma is vocalized and inscribed in psychoanalytic writing and reading. In particular, I examine the problematic aspects of that inscription and suggest that trauma resists psychoanalytic articulation in both writing and reading. I suggest that, as an alternative model, psychoanalytic reading must become psychoanalytic witnessing. Such witnessing is demonstrated in the analysis of style and content in Howell's work. In this context, contemporary definitions of trauma and dissociation are challenged, insofar as they occlude the traumatic history they attempt to elucidate.
An overarching thematic implication of both Grand's discussion of my article and my. Reply to her discussion is the need for sharing and integration of knowledge and concepts belonging to the separate fields of psychoanalysis and the trauma/dissociation. Grand and I have different expressive voices, both singular and plural, which, I conjecture, are in part reflective of different traditions. Grand's response demonstrates eloquently a problem facing both psychoanalysis and the field of trauma treatment: the tendency of fields, like individuals, to proceed in isolation deprives all from the benefit of shared information. Procrustean beds cannot be shared.
Although an intersubjective analytic approach reflects postmodern concerns about the problems associated with authority and influence, it does not altogether escape them. Interpreting subjective states invokes a veiled analytic authority, and labeling them as dissociative creates a pathway for the influence of questionable assumptions about the origins of dissociation as a defense against trauma. Harris and Gold's paper can be used to illustrate these ideas.
The Closing of the Western Mind. The Rise of Faith and the Fall of Reason. London (Pimlico) 2002.
(2002)
Reviews the unique contributions of Harry Stack Sullivan and Erich Fromm in synthesizing a psychoanalytic outlook with concern for political, economic, and social issues. Discusses some of the reasons why succeeding generations of interpersonal psychoanalysts have lost touch with these issues. Concludes with suggestions about how contemporary psychoanalysis might expand its vision to include the study of race, gender, and class issues.
The author describes the historical pathway trailed by a psychoanalytical institution (C rculo Psicanal tico de Minas Gerais) in a developing country (Brazil) and the structural consequences to this institution. As this institution was founded according to Igor Caruso's non-orthodox proposals, it has been destined to be a pluralistic society, composed of members who follow multiple theoretical orientations. As all of these members are united in the same institution, they all have the same hierarchical rights. The author discusses the difficulties encountered in maintaining this sort of institution.
Our profession is being challenged theoretically and by practical realities. Many of its basic premises are being questioned and a hostile managed care bureaucracy has been curtailing treatment opportunities. These challenges force a latent issue into full view: Is psychoanalytic wisdom tied to its dogma and technical rituals or can much of its wisdom be integrated into a more inclusive interdisciplinary perspective? Psychoanalysis has a history of resisting change. It defined too early what was and what was not to be considered psychoanalysis. Dogmatization made idols out of theories and the rituals of techniques. Theories are valuable tools only and not scientific truth. While institutes and official sanctions have lacked in open-mindedness, the unofficial practicing psychoanalyst has been far more creative in adapting psychoanalysis to the patient's needs and embracing the freedom to develop his or her idiosyncratic ways, wisdom, and skills. We need to increase our therapeutic repertoire beyond those that carry the label of psychoanalysis. I present some considerations that derive from my experience as a psychoanalytically trained dynamic psychotherapist.
Our profession is being challenged theoretically and by practical realities. Many of its basic premises are being questioned and a hostile managed care bureaucracy has been curtailing treatment opportunities. These challenges force a latent issue into full view: Is psychoanalytic wisdom tied to its dogma and technical rituals or can much of its wisdom be integrated into a more inclusive interdisciplinary perspective? Psychoanalysis has a history of resisting change. It defined too early what was and what was not to be considered psychoanalysis. Dogmatization made idols out of theories and the rituals of techniques. Theories are valuable tools only and not scientific truth. While in-stitutes and official sanctions have lacked in open-mindedness, the unofficial practicing psychoanalyst has been far more creative in adapting psychoanaly-sis to the patient's needs and embracing the freedom to develop his or her idio-syncratic ways, wisdom, and skills. We need to increase our therapeutic reper-toire beyond those that carry the label of psychoanalysis. I present some con-siderations that derive from my experience as a psychoanalytically trained dy-namic psychotherapist.