Saturday, June 28, 2014

On Transference and Introversion - The Reluctant Psychoanalyst Rereads Freud and Finds Him Haunting His Dreams

I am part of a summer reading group at my local psychoanalytic institute and we are looking at some of Freud's papers during a time of year when there is a little more time to think about and reflect on them.  I was not prepared to have those readings intrude into, or to guide my thinking, in quite the way they did.  Lots of things have changed since Freud wrote, including the ways that we conduct analyses.  Also the papers we were reading, at least to my way of thinking, were papers that were a bit dry and theoretical.  I wasn't expecting them to come to life.  So forgive me if this blog imitates life and is a bit dry in terms of introducing some terms before I let you know how this material came to life.  I found it worth reading "dusty" papers because they led me to think differently about how I connect with people in my life, including my patients, and hopefully that will help me improve the usefulness of the connections that I offer.

In 1915, Freud wrote a series of papers on how to conduct an analysis.  Psychoanalysis was about 30 years old - which sounds ancient but, when you are inventing a discipline, or even learning one as complicated as Psychoanalysis, 30 years is but the blink of an eye.  The technique papers, as they came to be called, are somewhat sketchy.  There are very clear directives, but they read more like notes than like a textbook on how to do something.  Indeed, an analytic scholar has maintained just this year that they are really more like musings - notes to self - less about how to do psychoanalysis than what NOT to do.  Sort of a collection of reminders, many of which grow out of mistakes made and lessons learned.

In the midst of these papers, and considered part of them, is a short paper titled "On Transference Love."  Now transference is a very basic psychoanalytic concept - and one so basic that it has slid into psychology proper.  We know it there from stereotyping - the application of a set of expectations to a group of people without regard for their individual differences.  Freud's transference is a much more intimate kind of thing, though he used the idea which was originally translated as a psychological "stereotype plate", and in the most recent translation has also been called a "cliche" to describe the ways in which we use our earliest relationships - with our parents, siblings, caregivers, teachers, etc. - as templates to understand and anticipate how to interact with other individuals, individuals who remind us in various ways of these people, throughout our lives.

Now this is not something pathological in and of itself.  It is something that we all engage in - in no small part because it is much more efficient than learning how to interact with each individual we encounter from scratch.  Indeed, much of our culture is built up around creating cliches - whether in terms of table manners or traffic laws - that make the behaviors of others predictable.  Transference becomes pathological, and psychoanalysis is called for, when we become attached to a particular way of interacting that we continue to engage in despite it not having a useful outcome for us.  We get stuck in a pattern - and here Freud made one of his sweeping generalizations and simplifications that makes a great deal of sense, though it necessarily leaves out variations and subtleties of diversity (it is applying a stereotype plate); we get stuck in a pattern of demanding from others what they cannot give us.

Why would we demand from others something that they cannot give us?  Part of Freud's genius is that even though he could, for some of the things that he observed clinically, only come up with somewhat lame explanations that felt like a stretch, he didn't allow the limits of his theories to interfere with what he observed - and he observed the phenomenon of transference, reported it, and tried to explain it.  I think today we would explain problematic transference as a vestige of the attachment that an infant feels to an inadequate, but desperately needed caregiver.  The way of being attached - one that to the outside observer looks puzzling because it doesn't result in achieving what the person apparently wants - becomes a repeated pattern because, while it doesn't achieve what others would label a useful connection - it achieves the kind of connection that the person has come to experience as being life-giving and sustaining.  It was the best thing they could get at the time - and it allowed them to survive what was a harrowing, lonely, scary experience, and therefore it has come to be highly valued and, indeed, sought after, even if, or more precisely because, it eventuates in a rough, even painful (but familiar), connection and this kind of connection is vastly preferable to being abandoned.

The idea of attachment wouldn't be articulated until 40 or 50 years after Freud's paper.  What Freud used to understand this, then, was more descriptive than explanatory.  He borrowed Jung's term introversion to describe the ways in which people can rely on their internal experiences, blocking out contact with reality (so we can think of the extroversive style, from this vantage point, as a reality connected style), in order to hang onto this internal reality.  Now introversion and extraversion turn out to be very complicated styles, but also perhaps the most reliable and consistent axes along which our personalities, as measured by modern personality scales, move.  Indeed, one of the consistent findings in psychotherapy outcome research is that patients, after treatment, are more extroverted than they were before treatment.  This is a good thing, as the first and biggest factor of the extroversion scales is happiness.  But I think it is also getting at something that Freud and Jung were able to see 100 years ago.  We can get pathologically connected to stuff - to a way of dealing with the world - and we can stamp the world to conform to this system over and over.  Part of becoming healthier is becoming more open to the world as it is - this doesn't mean there isn't room for considerable introspection - God knows I may be reluctant, but I am still an analyst - but that there is also room - as there was for Freud - to be informed by the world - to notice it and to let it change who it is that we are - in a word, to be extraverted - even if we also reflect on that and try to make sense of it - indeed, if we don't, what good has it done to be informed?

So how did this rather abstract set of notions intrude into my dreams?  I awoke last night, or early this morning, from a dream that I found quite disturbing.  I don't remember the beginning of the dream well, but a group of four of us, friends from my college days, were hanging out together.  We became frustrated with one member of the group, and we decided to teach him a lesson.  We knocked him out - quite violently (one of the other members of the group did this, though, as author of the dream, it was certainly me who was doing this powerfully violent act), stripped him of his clothes, which we donated to a charity auction that was taking place in the large house/hotel that we were in, and we stashed him somewhere - perhaps under a bed.  I feared that we had killed him.  I wanted to get out of the building before he woke up and fingered us - or before he was discovered dead and we were implicated.  But things got in the way of getting out of the building and I saw him later in the dream at a distance - he saw me as well - but rather than fingering me, or confronting me, he noticed me- almost gave me a high sign - and then he slunk off.  Now the odd part of the dream - or the part that woke me up (apparently I was OK with the violence or had removed myself enough from perpetrating it to disown it) is that I felt guilty about what I had done - even though he, apparently, wasn't upset enough to bring it to the attention of the authorities or to confront me about it.

I puzzled about the dream, fell back asleep, woke up, still puzzled but realizing more and more clearly that part of who the character symbolized for me is someone in my current life with whom I am quite angry.  The interesting part, though, is that the part that was problematic was that I was feeling guilty about my actions.  This helped me see that beating him up, knocking him out, and stealing his clothes was NOT what I was feeling guilty about.  What I was feeling guilty about was that those actions had not caused him to change.  He was still, in some weird way, connected to me - he wasn't going to confront me or to go to the authorities.  He was going to acknowledge me - as if we were going to go on being friends.  As I was thinking about this, and thinking about the person in my real life with whom I am furious enough to dream about this, I thought about something that someone had said when I was complaining about the situation and other people had stated they had similar concerns.  This person said that I should not welcome this support because it was pity, and therefore was not helpful.  I was puzzled by this, but now think I have a clearer understanding of what they meant.

Empathy, or social support, is a terribly important component of healthy psychological functioning.  Without some support, we are vulnerable to all sorts of psychological ills.  Pity is, I think, related to empathy, but is also incredibly different.  Pity is what we feel (according to Aristotle and Nietzsche) towards tragic heroes.  And tragic heroes have a flaw - a flaw that can't be changed.  Empathy is what we feel towards someone who is confronted by difficulties, and we imagine ourselves in their shoes and imagine their predicament, and what it must feel like to be confronted with what they are facing.  Pity is when our empathy leads us to believe that what they are facing can't be overcome.  We are connected to them, but we give up on them.  We feel badly for them and we conclude that they can't get out of this situation; that they are doomed.

The dream awoke me because I was communicating to myself that I had given up on this person.  I believe he is doomed.  I believe that his introversion - his tie to his internalized frustrating but terribly important way of doing things - is more powerful than even the most violent means of shaking him out of it will lead him to be able to shift.  This is something that I work very hard to avoid doing - indeed it is a fault that has been pointed out to me - I do not bring the hammer down when that needs to happen and say that this person is not able to do what is required of them.  And I think my inhibition is counterproductive in life and in a clinical setting.  It leads me to stay connected with people in ways that are not useful to them or to me.

So what would true empathy, rather than pity, look like?  It would look like this.  Dear friend: I believe that you are engaging in behaviors that are not bringing you the outcomes that you desire.  I also believe that you are powerfully attached to doing that.  There is nothing that I can do to help you, other than to try to minimize the damage - including to me as well as to you - by distancing myself from you or, when I can't do that, defending myself when I am in your range, as long as you continue to be attached to doing this.  When you are ready to make shifts, I believe that you can do that, but I do not believe it is in my power to make you make those shifts, nor is it the case that I can wish them away by pretending they are not as damaging as they in fact are.

As I write this, I become aware of two things.  First of all, even in a clinical situation, I don't know that it is wise to say all of that - and it is certainly not wise to say it in the other situation(s) I am thinking of.  And the second thing is that the dream is representing many situations, not just one, some of them are clinical situations, some of them are "real life" situations.  It is not just the first person that I thought of in the dream who is being represented by this friend, but a slew of people with whom I am currently interacting, some of them quite closely and intensely and others of them more peripherally.  As was the case for Freud, I don't know what it is that shaped the actions that they are engaging in (for Freud it was because he didn't get attachment, for me it is because I don't have direct access - through the transference, which I am actually experiencing with my friends - but through the working through of the transference - talking about it - trying to understand how it arose in the first place and what has activated it currently - that occurs in treatment when treatment is going well, but that rarely occurs in friendships gone awry).  But I do know, and sometimes try not to know, that something has gone terribly awry for them (and for me) in past relationships, and we are stuck in a cliche - in a stereotyped way of not working things out.

This rush of ideas interferes with my intent to clarify the important distinction between empathy and pity.  Empathy supports forward movement.  Pity does not.  Empathy indicates that there is a way through.  Pity indicates that there is not.  Sometimes there isn't a way through, though.  Pity underscores that but also promotes it because, by the very act of pitying, we are continuing to emotionally engage with the other.  Disengagement rather than pity at these moments may, paradoxically, be a much more powerful way to evoke the possibility of change.  Disengagement says, in effect, I am unwilling to continue to play the games by these rules.  You profit from this game, but it is in a perverted manner - you are using me not to solve a problem - not to joyfully connect with someone else - but to stay stuck in the introverted solution that you have come to trust.  That solution harms me, and actually harms yourself because it prevents your engaging with the world in ways that would allow you to grow.  Despite your need for me, I am going to pull back because that will get your attention- because I know, even if you don't, that you need me and need this relationship and, if you truly value yourself and me, you will come back to it with an interest in playing by a different set of rules.

Brave words when they are shouted into the internet cloud.  More difficult to live by in relationships where we are bound together by the twists and tangles of blood, paycheck, or the obligation of a treater to his (in my case) patients.   Despite that, I think the distinction between empathy and pity and being sensitive to when we have moved into responding to others with pity, or to ourselves with self- pity, can be useful because this is an indication that we are no longer engaging from a position of compassion, and it is likely that, unless we radically and uncomfortably change things, we are, indeed, going to be stuck, and pity is going to be all that we have for others and for ourselves.

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Monday, June 23, 2014

Blue Jasmine - The Reluctant Psychoanalyst Reverts to Type

Woody Allen is the poster boy of psychoanalysis - famous for featuring it in his films and in his life - sometimes twice a day with two different analysts...  After one of his very public peccadilloes twenty five years ago - let's just say it was when he married his stepdaughter - I was working at a psychoanalytically oriented hospital and thought to myself - if there was ever proof that psychoanalysis does not work, Woody Allen is it.  But one of my trusted supervisors had a different view - that his behavior demonstrated how pernicious - how difficult to change - character pathology is.  Currently I suppose that there is something to both of these thoughts.  There are certainly limits to the ability of psychoanalysis to create change, particularly in people who are attached to their pathology - and Woody Allen's latest movie, Blue Jasmine, demonstrates the complexity, and insidious nature, of character pathology.

OK, so it is a cliche for an analyst, reluctant or not, to write about Woody Allen's movie; but wait, it gets worse!  I watched it at the psychoanalytic institute with a bunch of analytic types and then we discussed it afterwards.  How cliche is that?  The discussants had done their homework.  One area they talked about was the apparent relationship between Blue Jasmine and the play "Streetcar Named Desire".  Another was in reviewing interviews with Mr. Allen, but also archival interviews with Tennessee Williams.

Blue Jasmine mirrors Tennessee Williams' play Streetcar Named Desire.  The dramas are set in different parts of the country, in different decades, and have very different plots.  To my way of thinking, what unites them is that the central character in both is challenged by her need to be dependent - or more particularly to ward off the awareness of just how vulnerable her wish (and need) to depend on another makes her - especially in the context of an intimate relationship.  The character - or character pathology - of the lead has changed, however.  Blanche Dubois, the lead in Streetcar, can be understood as having an hysterical character.  Her chief motivation is to be loved - and she is willing to overlook many faults - to repress her awareness of them - in order to hang onto her high regard of others - and to let them have, in turn, a high opinion of her.

Hysteria was the most frequent diagnosis that Freud made.  He learned about hysteria from the French.  He traveled to France and observed Charcot treating hysterics using hypnosis and took this treatment home to Vienna where he found no shortage of patients with hysterical character styles.  The famous Anna O. who, as Bertha Pappenheimer, went on to found the social work movement in Germany and who was credited by Freud with discovering the psychoanalytic cure - chimney sweeping she called it - of saying whatever came to mind in relation to hysterical symptoms - using this technique, with her Doctor Joseph Breuer, to break through the repressive barrier - discovering the unwanted thoughts that had been discarded, and dealing with them in the light of day, finding another way to cope with them, and moving on.  Freud saw Hysteria everywhere, including, as he engaged in self analysis and the analysis of others, in himself and other men - something the establishment couldn't bear - Hysteria, etymologically based on the Greek word for Uterus is, by definition (they maintained), a female disorder.

In fact, I believe it to be a means of coping with the world that was much more prevalent in times when authority figures were relied on in ways that they aren't currently.  I remember watching that transition as my grandmother sat transfixed day after day by the Watergate hearings.  Pundits at the time claimed that it was the end of an age of innocence, and it was.  Nixon, a man grandmother had voted for three times - a man she trusted to have integrity - was not trustworthy, and his band of henchmen were too graphic and three dimensional in all of their shiftiness for us - individually or collectively - to repress.  We learned that authority was not to be trusted.  But of course authority has to be trusted for the system to work, so there continue to be hysterics among us and hysterical streaks within each of us, but as a dominant style, it became more difficult to maintain.

So what did we replace the hysteric style with?  I am indebted to a fellow analyst for pointing out that Woody Allen's answer, in the character of Jasmine, played by Cate Blanchett in a performance that won her an Oscar, is that we have become narcissistic - or, in Jasmine's case, brittle narcissists - believing that we do not need others because we are self reliant and, unlike the hysteric who represses information that would interfere with our being able to be cared for by the other, we divide ourselves not between what is known and what is unknown, but between what is known when things are OK and what is known when things are not OK.  This way of not knowing is what we call a vertical split (between parts of the self that can be consciously in control - between the part that intermittently is in charge and feels independent and the part that intermittently is in charge and knows that we depend, despite what we tell ourselves, on others) rather than a horizontal split( a repressive split between what the trustworthy things are that are known about the other and the parts of the other - and ourselves - that is not trustworthy - parts that remain consistently unknown or unconscious).

But before we get to splitting, let's talk about narcissism.  First of all, narcissism is a normal part of our development.  It is, quite literally, self esteem.  It is self love, which is an important, perhaps even crucial part of a "healthy" personality.  The character (and dramatists are enviable because they create characters rather than the messy self-contradictory things called people), the character of Jasmine is a person who has loved herself.  She has been wealthy and stylish.  Her husband (played by Alec Baldwin) was suave without being smarmy.  While he was wheeling and dealing, she was entertaining his business associates and their wives.  She was also managing the charitable endeavors, the "noblesse oblige", that this couple of tremendous privilege engaged in as an integral part of the rounding out of their lives.

We meet her after all the trappings of wealth have been stripped away and get to know her former life only in flashback.  We see her in a raw state - one where her own self-involvement - her need to not just survive but thrive - is paramount, and these needs outweigh the agendas of those around her, including her adoptive sister on whom she is imposing - and whom she was party to swindling in her former existence, demonstrating that this is not just a means of functioning in the present, but a style that she has relied on forever, part of her character.  She does not just have self esteem, but self love that eclipses her ability to resonate with the needs of those around her.  She overlooks the shadiness of her husband's business dealings until he betrays her - not just her family - at which point, when things are not OK, she "recovers" her memory of his shenanigans and seeks terrible retribution - publicly exposing his private matters.

It quickly became clear to me that the movie was a condensed and highly symbolized version of Woody Allen's experience.  Jasmine (who changed her name from the drab given name that her parents chose for her) becomes a glamorous, competent person, but is also aware of the ways in which it is a sham - she is playing a role rather than being a person - and this is the vertical split - I both am and am not the person that I am pretending to be.  I remember an ancient interview where Woody Allen was asked about being married to a movie star - to Mia Farrow - and how did that feel to a nebbish kid from Brooklyn.  He responded that, as a world class director, of course he was married to a movie star.  And that statement rung to me as both true and not true.  He is a world class movie director.  But he is also a nebbish kid from Brooklyn and, at least in my memory, he did not say that he was a director AND a kid from Brooklyn, but that he was JUST a world class director.

This kind of split is evident in Jasmine.  She tries, in the wake of her dislocation, to play herself again, and is initially successful, catching the eye of a man who would remake her into who she was before - perhaps even more legitimately, but she can't - or doesn't - do this honestly and straightforwardly.  Instead she pretends to be someone she isn't - even though the man she discovers is attracted to the person she is - and when she is caught at being who she is not, she is abandoned by him, and she begins to totter on the edge of madness.

What I found compelling about the interviews - those with Allen and Tennessee Williams, is the contrast between Williams comfort with himself and his characters as projected aspects of himself (see a discussion of this in a post about The Glass Menagerie) - he states, in effect, that he is writing about parts of himself that he knows - parts that he isn't proud of, but that are very human, and he would never place himself above his characters while Allen, who denies any relationship between himself and his characters (and any relationship between his movie and Streetcar), creates distance which seems disingenuous at best.

Woody Allen depended on Bernie Madoff - a wheeler dealer like the Alec Baldwin character who disappointed him and absconded with a fortune.  Woody Allen depends on his audience, and they can turn on him, especially when he engages in behaviors that they find reprehensible (marrying his daughter), though he denies the reprehensibility (she is adopted).  And he denies a connection between his life and the movie, where the adopted daughters are, not surprisingly, all but unrelated to each other.

Both Williams and Allen, I believe, write incredibly presciently about female characters.  I think this is partly because those characters are, indeed, projected and, in Allen's case, apparently disowned aspects of themselves.  They are writing about their own psyches, or the feminine aspects of them, and allowing them to infuse the characters that are also based on people that they have interacted with.  This suggests that the chief characters they create may mirror the dominant characteristics of their own personality styles and that the character's means of managing what they don't want to know - in Williams/Blanche's case through repression - in Allen's/Jasmine's case through splitting, may mirror the functioning of the author's (even if, or, weirdly, particularly if, one of them denies it).  And Allen's denial through splitting - if that's what it is - may make the treatment of that aspect of the character structure particularly resistant to a treatment that relies on insight to achieve cure.  Interestingly, then, if this is true and Allen were to read it, he would both agree with it and deny it - the latter part would not be something that we, and perhaps not even he and his analysts, would be able to access.

To access a narrative description of other posts on this site, link here.     For a subject based index, link here.

Post script: Rereading this after Bruce Jenner's transformation into Caitlyn this year, I am struck by the frustrated response of a feminist writer in the New York Times who railed that she was tired of men defining what it means to be a woman.

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What is Porn? A Psychoanalytic Reaction.

I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description ["...