Psychoanalysis: The Impossible Profession

Janet Malcolm writes in this 1982 book:

* THE PHENOMENON OF TRANSFERENCE—HOW WE ALL INVENT each other according to early blueprints—was Freud’s most original and radical discovery. The idea of infant sexuality and of the Oedipus complex can be accepted with a good deal more equanimity than the idea that the most precious and inviolate of entities—personal relations—is actually a messy jangle of misapprehensions, at best an uneasy truce between powerful solitary fantasy systems. Even (or especially) romantic love is fundamentally solitary, and has at its core a profound impersonality. The concept of transference at once destroys faith in personal relations and explains why they are tragic: we cannot know each other. We must grope around for each other through a dense thicket of absent others. We cannot see each other plain. A horrible kind of predestination hovers over each new attachment we form.

* Freud took up in forthright detail the delicate and weird task of persuading a female patient to regard her love for the analyst both as a normal part of the treatment (“She must accept falling in love with her doctor as an inescapable fate”) and as something unreal and hallucinatory—an artificial revival of early feelings that has nothing to do with the person of the analyst. Then, in one of those startling and beguiling reversals that characterize his writings, Freud turns on his own argument and says, But isn’t all love like that? Isn’t what we mean by “falling in love” a kind of sickness and craziness, an illusion, a blindness to what the loved person is really like, a state arising from infantile origins? The only difference between transference-love and “genuine” love, he concludes, is the context. In the analytic situation, nothing is permitted to come of the patient’s love; it is a situation of renunciation. Both parties must “overcome the pleasure principle” and renounce each other for a higher goal—the doctor for the sake of professional ethics and scientific progress, the patient in order to “acquire the extra piece of mental freedom which distinguishes conscious mental activity—in the systematic sense—from unconscious.” Freud describes the temptations for the analyst that are inherent in the situation—especially for “those who are still youngish and not yet bound by strong ties”—with rueful candor:
Sexual love is undoubtedly one of the chief things in life, and the union of mental and bodily satisfaction in the enjoyment of love is one of its culminating peaks. Apart from a few queer fanatics, all the world knows this and conducts its life accordingly; science alone is too delicate to admit it. Again, when a woman sues for love, to reject and refuse is a distressing part for a man to play; and, in spite of neurosis and resistance, there is an incomparable fascination in a woman of high principles who confesses her passion. It is not a patient’s crudely sensual desires which constitute the temptation. These are more likely to repel, and it will call for all the doctor’s tolerance if he is to regard them as a natural phenomenon. It is rather, perhaps, a woman’s subtler and aim-inhibited wishes which bring with them the danger of making a man forget his technique and his medical task for the sake of a fine experience.

* “Until Freud’s discovery,” they write, “psychotherapists had been haunted, whether consciously or not, by the possibility of erotic complications in the relationship. They could thenceforth feel reassured.” That Breuer took Anna’s sexual feelings toward him personally, whereas Freud discovered transference as a result of the importunities of his importuning patient is the difference between ordinary intellect and genius.

* Freud likens the feat of the patient who suspends his critical faculties and says everything and anything that comes into his mind, regardless of its triviality, irrelevance, or unpleasantness, to that of the poet during the act of creation. He quotes from a letter that Schiller wrote in 1788 in reply to a friend who had complained of meagre literary production: “The ground for your complaint seems to me to lie in the constraint imposed by your reason upon your imagination. I will make my idea more concrete by a simile. It seems a bad thing and detrimental to the creative work of the mind if Reason makes too close an examination of the ideas as they come pouring in—at the very gateway, as it were. Looked at in isolation, a thought may seem very trivial or very fantastic; but it may be made important by another thought that comes after it, and, in conjunction with other thoughts that may seem equally absurd, it may turn out to form a most effective link. Reason cannot form any opinion upon all this unless it retains the thought long enough to look at it in connection with the others. On the other hand, where there is a creative mind, Reason—so it seems to me—relaxes its watch upon the gates, and the ideas rush in pell-mell, and only then does it look them through and examine them in a mass.… You critics, or whatever else you may call yourselves, are ashamed or frightened of the momentary and transient extravagances which are to be found in all truly creative minds and whose longer or shorter duration distinguishes the thinking artist from the dreamer. You complain of your unfruitfulness because you reject too soon and discriminate too severely.”

Just as there are few people who can write poems like Schiller, there are few analytic patients who can free-associate easily, if at all. Analysts today don’t expect the free-association process process to take hold until well into the analysis; in fact, some regard the appearance of true free association as a signal to terminate the analysis.

* Along with free association and dreams, Freud goes on to cite (we are in the third Clark lecture) a third entrée into the unconscious: the various small “faulty actions,” or “para-praxes”—slips of the tongue, misreadings, the forgetting of names, the losing and breaking of objects, and so on—by which we daily betray ourselves.

* “Suppose an analyst were to fall asleep during a session, or to forget an appointment with a patient. Should he apologize, explain, and discuss the reasons for his action with his patient?” Brenner asks in his book Psychoanalytic Technique and Psychic Conflict (1976). He gives this rather magnificent answer: “Many analysts would say he should … and their arguments for doing so are persuasive. Yet I believe the better course to follow is the usual one of encouraging a patient to express his thoughts and feelings about what has happened. Only in that way can one learn whether a patient has taken his analyst’s mistake as a slight that has offended and angered him, or as a sign of weakness that allows him to feel superior and even triumphant, or as a welcome excuse for anger, etc. A conscientious analyst will naturally regret such a mistake, he will certainly try, through self-analysis, to discover his unconscious reasons for having acted as he did, but he will be well advised to maintain an analytic attitude even to such an event, and not to assume what it must mean to his patient without hearing what his patient has to say. It is presumptuous to act the analyst, unbidden, in a social or family situation. It is a technical lapse to be other than an analyst in one’s relation with an analytic patient.”

* An analysis ends when the patient resolves his transference neurosis—when he finally accepts the fact that the analyst is not, not, not going to fulfill the wishes the patient had as a child toward his parents, that it just isn’t going to happen that way, that he must renounce these wishes toward the analyst and fulfill them in his own life, in his work, in his attachments, through his children. In other words, that he is an adult and must put away childish things. Which is horribly painful.

* He begins to dare hope that maybe he will , after all, be admitted into the parental bedroom, that he will be treated to the secrets of the parents, that he will find out what they ‘do’ in there, that he will be able to form alliances with one or another of them.

* I’ve never felt ‘in’ anywhere—not in school, not in college, not in medical school, not in psychiatric training—and now I’m playing it out in relation to the analytic community. Everyone’s analysis unearths a central fantasy, and mine is that of an outsider looking into the bedroom: feeling excited and scared, getting aroused, trying to figure out what is going on, but not having to get involved, not having to risk anything. There are many ways of playing out this fantasy. I could have become a Peeping Tom, for one extreme possibility, but I became a scientist instead—a psychoanalyst, a person who gets to know another person very intimately but doesn’t have to get involved with him. I’m very much a Jew—another kind of outsider… I have all kinds of fantasies about what goes on in the inner sanctum, most of which aren’t true.

* This kind of hierarchy and infantilization exists in every other profession. It’s in law, in business, in science, in education. There are Oedipally significant positions in every profession, and when people are up for them it creates a crisis that infantilizes them—causes grown men to squabble like kids about trivial things.

* “The sources of motivation and pleasure are infantile wishes.”

* “In both analysis and life, we perceive reality through a veil of unconscious infantile fantasy. Nothing we say or do or think is ever purely ‘rational’ or ‘irrational,’ purely ‘real’ or ‘transferential.’ It is always a mixture. The difference between analysis and life is that in analysis—in this highly artificial, extreme, bizarre, stressful, in some ways awful situation—these infantile fantasies come into higher relief than they do in life, become accessible to study, as they do not in life. The purpose of analysis isn’t to instruct the patient on the nature of reality but to acquaint him with himself, with the child within him, in all its infantility and its impossible and unrepudiated and unrepudiatable longings and wishes. Terms like ‘the real relationship’ and ‘therapeutic alliance’ and ‘working alliance’ simply obscure and dilute and trivialize the radical nature of this task.”

* THE SECOND PATIENT A ARON RECEIVED FROM THE T REATMENT Center was a refined, cultivated woman, eager to do the analytic work, appreciative of Aaron, extremely pleasant and interesting to be with, and very good-looking. As he had cursed his luck with the first patient, he couldn’t believe his good fortune in having drawn the second. She was the most gratifying of patients. She made literary allusions, and understood the ones he made. She worked on a magazine and had an impressive-sounding circle of literary acquaintances. As he had dreaded the sessions with the first patient, he looked forward to the ones with the second. He was dazzled by her, a little in love with her. After two years, the analysis ground down to a horrible halt. It was a total failure. “I was blinded and lulled by her charm,” Aaron recalled ruefully. “I fell down badly on the job. Instead of pointing out to her the nasty, harsh things I should have pointed out, I exchanged literary references with her. I didn’t see the trap I had fallen into until it was too late. In the first case, where the patient gave me no pleasure whatever, to put it mildly, I was able to hew to my course and be of some help to her. In the second case, I failed the patient utterly.”

* “Benvenuto Cellini was casting a statue, and he needed some calcium for his bronze alloy. He couldn’t find any around the studio, so he picked up this little boy and threw him into the pot for the calcium in his bones. What was the life of a little boy to the claim of art?”

* a clitoral orgasm may be accompanied by feelings in the vagina and thus, properly speaking, can be called a vaginal orgasm.

* “I did a hatchet job on [Otto] Kernberg. I had done my homework, and I crushed him, and everyone knew I had. After that, I became socially acceptable. People who had dismissed me as a computer nut started being nice to me. All kinds of people started noticing me, inviting me to parties.”

* “And such small edge as analysts have they exercise in only one situation in life—namely, the analytic situation. In that most unnatural, highly artificial, stressful situation, the analyst’s small advantage of self-knowledge and self-control comes into play. But when you take him out of his consultation room, his advantage recedes and he becomes just like everyone else—he begins to act just like other people.”
“This is ironic,” I said. “The analyst works with his patients to get them to behave more rationally and reflectively, and remains irrational and unreflective himself.”
“But that isn’t what the analyst works to achieve with his patients. This is a popular myth about analysis—that it makes the patient a clearer thinker, that it makes him wise and good, that people who have been analyzed know more than other people do. Analysis isn’t intellectual. It isn’t moral. It isn’t educational. It’s an operation. It rearranges things inside the mind the way surgery rearranges things inside the body—even the way an automobile mechanic rearranges things under the hood of the car. It’s that impersonal and that radical. And the changes achieved are very small. We live our lives according to the repetition compulsion, and analysis can go only so far in freeing us from it. Analysis leaves the patient with more freedom of choice than he had before—but how much more? This much: instead of going straight down the meridian, he will go five degrees, ten degrees—maybe fifteen degrees if you push very hard—to the left or to the right, but no more than that. I myself have changed less than some patients I’ve analyzed. Sometimes I get discouraged about myself. Sometimes I worry about myself. A few weeks ago, I did something that still bothers me and worries me. My wife and I were having dinner with some friends in SoHo. We were lingering at the table, drinking wine and laughing a lot, and the conversation turned to analytic fees. Someone—these friends weren’t analysts—started making jokes about them. Now, fees are a subject that I’m very sensitive about, for a number of reasons. First of all, because the whole subject of money is a charged one for me. I frankly want more money than I have, and I’m envious of analysts who are rich, yet I can’t bring myself to do what’s necessary to increase my income—that is, to beg for referrals. That, at any rate, is how it looks to me—the whole business of younger analysts sidling up to older colleagues at parties and meetings, like mendicants clutching at the robes of the nobility, and saying with apparent nonchalance, ‘Oh, I have some free hours.’ That’s how it’s done, and it seems degrading to me, and I can’t do it. So I have unfilled hours, and am bitter.”

* When Kernberg talks about a patient, he talks as if he understood him inside and out, backwards and forwards, with relatively little effort, and he is just dazzling. Dazzling, brilliant, impressive, and”—Aaron paused to bang his fist on the arm of his chair for emphasis—“ unconvincing.

* “If you try to understand the patient in the overwhelming fullness of his individuality and idiosyncrasy, you will not have the easy time of it that Kernberg has had with his schematic methods. You will feel discouraged, guilt-ridden, depressed, lost, confused, and deluged by the quantity of data and by its ambiguity and complexity. You will suffer back pain, indigestion, headache, fatigue—all the afflictions the flesh is heir to—because of the guilt you constantly feel about not understanding the data. And this isn’t even to speak of the other kind of guilt that analysts feel over the pain and frustration they regularly inflict on the people they analyze. Analysts keep having to pick away at the scab that the patient tries to form between himself and the analyst to cover over his wound. That’s what the patient keeps trying to do—it’s what’s called resistance—and what the analyst won’t let him do. The analyst keeps picking away at the scab. He keeps the surface raw, so that the wound will heal properly.”

* AT OUR NEXT MEETING , I CONFESSED TO AARON THAT I sometimes got tired of hearing him talk—that I rather resented always listening to him and never talking about myself.
“There it is,” Aaron said, with an ironic gesture of his hand.
“Is that how you feel with your patients?” I asked.
“And how!”

* “I had a patient once who made me horribly sleepy. I couldn’t understand it at first. She was by no means a boring person. She associated well, and she was someone I liked and respected—a very fine, a truly good person. So it just didn’t seem possible that this almost suffocating sleepiness could be a reaction to her personally. I thought it must be the time of day I saw her—but that couldn’t be, because she had different hours on different days. I thought it might be the result of staying up too late, so I drank black coffee. But the sleepiness persisted, and finally it dawned on me what it was all about. I realized that the patient had developed an erotic transference to me and was defending herself against it by making herself uninteresting and dreary—as she had done throughout her childhood with her father, and as she was doing in adult life with the men with whom (for some strange reason) she could never get into any sort of satisfying lasting relationship.”

* Like a good messiah, he keeps himself further and further away, sequestered from the masses. When he’s invited to speak, he sends his emissaries, his true disciples.

* “One becomes a psychiatrist by first working with very, very sick patients and only gradually moving on to less sick ones. Then, when one does analysis with a healthy patient, it’s easy, like cutting butter.”
“So analysis is for the healthy?”
“It works better for the healthy. But I haven’t seen anything in general medicine where that wasn’t the case. The healthier the patient, the better the treatment.”

* Chekhov: Gurov reflects on the double life he is leading and ponders the paradox that “everything that was important, interesting, essential, everything about which he was sincere and did not deceive himself, everything that made up the quintessence of his life, went on in secret, while everything that was a lie, everything that was merely the husk in which he hid himself to conceal the truth, like his work at the bank, for instance, his discussions at the club, his ideas of the lower breed, his going to anniversary functions with his wife—all that happened in the sight of all… He and Anna Sergeyevna loved each other as people who are very dear and near, as man and wife or close friends love each other; they could not help feeling that fate itself had intended them for one another, and they were unable to understand why he should have a wife and she a husband; they were like two migrating birds, male and female, who had been caught and forced to live in separate cages. They had forgiven each other what they had been ashamed of in the past, and forgave each other everything in their present, and felt that this love of theirs had changed them both.

* In Yalta, after they make love for the first time, the woman weeps with shame for her fall from virtue, and the man sits down at a table and callously cuts himself a slice of watermelon and eats it. It is an absolutely idiosyncratic, banal, and metaphorically perfect action. It is the same thing with patients—their stories are full of just such arrestingly rich detail, as if a gifted writer had composed them.

* “If someone outside of analysis came up to me and said ‘I’m desperately in love with you,’ and I responded by saying ‘What comes to mind about that?’—that would be a horrible thing to say! Just horrible! But when a patient comes in and says ‘I’m desperately in love with you,’ and I say ‘What comes to mind about that?’—that’s absolutely appropriate.”
“But what if the patient finds it horrible?”
“She leaves the analysis. There are patients who cannot tolerate the frustration—it calls up too many painful feelings or too much anger—and the analysis breaks off. There are forest fires that get out of control. There are gas mains that blow up. There are buildings that buckle and crumble. There are wars that break out. There are diseases that kill. Sometimes in regular medicine the patient dies . Sometimes in psychoanalysis the analysis doesn’t survive an erotic transference.”

About Luke Ford

I've written five books (see Amazon.com). My work has been followed by the New York Times, the Los Angeles Times, and 60 Minutes. I teach Alexander Technique in Beverly Hills (Alexander90210.com).
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