The dynamics of the larger society inevitably are manifest in intrapsychic dynamics, as well as interpersonal interactions, in and out of the psychoanalytic consulting room. Traditional psychoanalytic inattention to the social world predisposes analysts to enact unreflectively some of the racist and classist patterns in the social world around us in our clinical work. This author argues first that U.S. psychoanalysis, as a field, has sought to define itself as white, thereby demonstrating the influence of racism in this country. Second, in a clinical example, the author demonstrates the subtle imprint of racism and classism in a dyad in which both participants are conventionally classified as white. He concludes that open discussion of U.S. history and of the past and current social location of psychoanalysis as a field goes hand in hand with increased awareness of the ways in which social forces organize psychoanalytic interactions.
I argue that on both the small-scale level of the interpersonal relationship, and the large-scale level of society, the manic defense makes it difficult to care about others, and so militates against a sense of social responsibility. I address four basic questions: what is the nature of social responsibility? What is the nature of the manic defense? How does the manic defense interfere with the potential for social responsibility? And, on a more general level, what are the issues with respect to methodology for efforts such as this one to link psychoanalysis and social theory?
This paper considers, from a psychoanalytic point of view, work with urban poor patients. A previous attempt, from an ego psychological perspective, to adapt psychoanalytic theory and technique for work with such patients is reviewed. An attempt is then made to elaborate an object relations perspective, based largely on the work of Fairbairn. The two approaches are compared and contrasted, especially with respect to common problems that arise in work with this group of people, such as missed appointments, crises, and requests for >concrete< help. Finally, there is a review of how the structure and policies of the public clinics in which most poor patients are seen impact on analytically oriented work.