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Between Freud and Klein

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This book shows how important it is to take different theories and frameworks into account in order to understand the complexity of psychoanalytic phenomena. It is about observing and asking questions, and is less a textbook, but rather an intimate insight to the author's quest for truth and understanding.

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1 Between Freud and Klein

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TO BE INVITED to speak in memory of Anna Freud, or if I preferred, on Melanie Klein’s contribution to British psychoanalysis, presented me with an almost impossible choice which provoked a wave of memories as distant as they were still alive in myself.

I owe it mostly to chance to be in the position of being someone who appreciated the qualities and gifts of these two exceptional leaders, without the tie of loyalty that goes with the full acceptance of an orthodox system such as the Freudian or the Kleinian. As far as Anna Freud is concerned, the support given to me by colleagues over the years allowed me to meet her to an extent which could not occur with Melanie Klein. In this presentation, however, I wish to offer my impressions, gathered over many years from the time I was a candidate in training to the drastically different position of being a psychoanalyst nearing the end of his career.

I shall also attempt to expose some of those anxieties and indecisions attributable to belonging to the Independent group of the British Psycho-Analytical Society, also known as the Middle group.

 

2 The Orpheus myth as reflected in problems of ambivalence and reparation in the oedipal situation

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I ORPHEUS OBSERVED

MANY YEARS AGO I had a patient who was identified with Orpheus. The identification with the Poet-Hero of classical antiquity came to light suddenly and unexpectedly at the end of the fourth year of a psychoanalysis which my patient, whom I shall call Mr A, had requested on account of deep depression, inability to use his intellectual resources and a tendency to find himself rejected by men and women.

Mr A believed, with some justification, that all his problems were due to the fact that, owing to the war, he had been separated from his parents for long periods from the age of two and a half onwards. His state of mind during those early years could be reconstructed in the analysis when, during the first three years, Mr A would often phone the analyst late at night, ‘just to hear [his] voice’. In due course this was understood as an attempt to resuscitate the analyst who was felt as having died during the unbearable twenty-three hours’ separation. The only improvement at the time of the session I wish to report was shown by the abandonment of a search for a homosexual solution to his problems and the development of a well defined heterosexual disposition. Just as he was beginning to feel more secure in his dealings with women, Mr A suffered one more rejection as a result of his unwillingness to commit himself. The young woman with whom he had been in love for some time had finally married someone else. Mr A came to his session after attending the wedding ceremony, looking depressed but unusually willing to talk about his feelings, claiming that this time he had really lost everything. Admitting that he felt extremely jealous of the newly wedded couple, he insisted he was fully justified in feeling sadistic and murderous.

 

3 A re-evaluation of acting out in relation to working through

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IT SEEMS LOGICAL that any discussion on acting out, in order to be meaningful, would have to be related to the concept of ‘working through’. There are few aspects of our daily analytical work which are more challenging than acting out and more directly pointing to the necessity and arduousness of working through the patient’s resistances, as Freud (1914) has warned us. The problem is not only that the tendency to act out needs constant attention by the analyst but also that disturbing episodes of acting out may well occur in the course of working through anxieties and conflicts under apparently quite satisfactory circumstances. I am referring to those optimal conditions where analyst and patient work well together and, of course, where the analyst has in no way contributed to force the patient to act out as a result of his own incompetence or because of the persistence of unresolved conflicts in himself. However, it would be fair to say that there are many instances when the analyst may unwittingly play a part. The experienced analyst is not only disappointed at seeing years of insightful working through wasted but may even come to the conclusion that the patient’s resistances are intractable to the point of abandoning analysis.

 

4 The assessment of analysability : a major hazard in selection for psychoanalysis

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THIS PAPER is based on observations derived from my work as an evaluator of applicants for psychoanalytic training and as a consultant with the responsibility of selecting patients for psychoanalysis to be treated either privately or by students in training. Selection under such different conditions and for such a variety of purposes is made more difficult by the lack of well-defined criteria of indications and contra-indications for psychoanalysis. In the course of a week’s work a psychoanalytical consultant may be called upon to evaluate the chances of breakdown, severe enough to require hospitalization, in a patient who has been recommended for psychoanalysis. Such event, if foreseeable, is no bar in the case of private treatment, but it would certainly be a contra-indication for a supervised analysis, although the reasons for depriving a student of the opportunity to gain experience in a special aspect of his future work are not altogether clear. More understandably in the case of an applicant for training the expectation of a psychotic breakdown inevitably leads to rejection. In these examples, rationalization plays a part in decision-making. But the situation becomes rather confusing when we consider specific symptoms such as the sexual perversions. Although most psychoanalysts do not hesitate to undertake their treatment in their private practices, sexual perversions are generally regarded as being unsuitable for supervised analyses, whilst they are the basis for automatic disqualification in the case of applicants for training in some countries at least. This wide range of outlook in relation to a symptom or the possible course of an analysis can only be accounted for by the variability of our assessing capacity and predicting ability, together with the possible over- or under-estimation of analytical skills. This is a puzzling state of affairs, considering that we are dealing with a systematic form of psychotherapy, which has stood the test of time in spite of its limitations and the numerous attempts to modify and distort it by its admirers and imitators, to say nothing of the sustained attacks of its denigrators,

 

5 The training analyst and the difficulties associated with psychoanalytic training

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TRAINING IN PS YCHOANAL YSIS has been at the centre of debates ever since the International Psychoanalytical Association created a Training Commission in 1925 to control the spreading of ‘wild analysis’ and the troubles caused by self-appointed teachers. The Commission did not last more than a few years, owing to the difficulty in establishing any kind of uniformity of training within the increasing number of psychoanalytic groups.

For the last twenty-five years, psychoanalytic educators have met at two-yearly intervals under the sponsorship of their Association to discuss their work. In 1973 I was invited to chair a conference on the difficulties experienced by training analysts in their capacities as therapists and educators. In that capacity, I entered into a correspondence with senior colleagues from all over the world. The response indicated not only an interest in the topic but considerable anguish aroused by the dual role forced on the training analyst, as well as a need to confide in someone. In addressing the two hundred delegates who attended the conference in Paris, I used many of those statements made to me in confidence, as well as points raised in the course of open discussions by many speakers of different nationalities over the years.

 

6 Object choice and bisexuality

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INTRODUCTION

PSYCHOANALYSIS HAS THROWN much light on the factors which enable some people to retain their homosexuality in a latent state, while others can successfully satisfy the needs of the male and female parts of their personality without being compelled to act out their id experiences in a fully fledged perversion. The capacity of certain individuals to engage in sexual activities with members of both sexes continues to present a challenge to our theoretical understanding of human sexuality and of the perversion as such. In general, theoretical and clinical discussions tend to concentrate our attention on the homosexual aspect of the dichotomy, neglecting Freud’s reminder that even heterosexuality requires justification (Freud, 1905a, p. 146).

In this context defence is understood to be directed not only at protecting the ego against anxiety aroused by instinctual drives, the superego, or external dangers, but also and preferably at including all the techniques used by the ego to dominate control and channel forces which might lead to neurosis or psychosis. In those bisexual cases where homosexuality is predominant, the heterosexuality may well assume a defensive role, which does not become apparent until one outlet is suddenly unavailable.

 

7 Clinical types of homosexuality

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INTRODUCTION

IN RECENT YEARS there has become apparent an increasingly marked division in the attitude to homosexuality: at a time when there is a growing tendency for people in all walks of life to regard homosexuality as normal, there remain many who use the term in a derogatory and insulting manner, quite often with an implication of social menace.

With the abolition of the more restrictive of the laws touching on relationships between individuals of the same sex, and the increased permissiveness in contemporary society, it has become apparent that homosexuality remains a condition which may in certain specific instances require treatment.

When treatment is discussed among psychotherapists, opinion is sharply divided: quite apart from doubts and divergent theoretical considerations as to what constitutes homosexuality, views appear to range from unreasonable pessimism to excessive optimism. This state of affairs is particularly unwelcome in a field which demands both co-operation and a multilateral approach to the patient’s problem, taking into account that where one form of treatment may fail, another may succeed.

 

8 Affects and the psychoanalytic situation

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I

IN ANNOUNCING the main topic for the 30th Congress of the International Psychoanalytical Association in 1977, the Programme Committee noted that the problem concerning affects seemed appropriate as a focus for the discussions, since no two theories agree on it. The truth of this statement is affirmed by the most casual reappraisal of the literature as stated in a number of outstanding contributions such as those of Brierley (1951), Rapaport (1953), Rangell (1967) and André Green (1973a). The discrepancy of approach to the problem in various parts of the world is due not entirely to parochialism on the part of some writers, but rather because of the disparities between theory, technique and clinical practice. The major areas of theoretical research are: (1) the drive discharge theory, (2) the debate on the existence of unconscious affects, (3) the relationship to their mental representations and fantasies, (4) the issue concerning the possibility of affects dissociated from the object, (5) the ego as the only seat of anxiety,(6) the problem of narcissistic and schizoid personality disturbances, and (7) the widespread calls for adjustments and modifications of the classical method in the treatment of borderline and narcissistic states, which has generated further complications in the matching of theory with practice. In this paper I shall not concentrate on any one aspect of the theory of the affects or of a specific clinical phenomenon, nor will I attempt to supply any answers. I shall, however, underline certain diagnostic features which are fundamental to an understanding of the state of malaise existing in the relationship between theory and our clinical daily work.

 

9 The significance of transsexualism in relation to some basic psychoanalytic concepts

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I INTRODUCTION

TRANSSEXUALISM HAS HITHERTO been largely ignored by psychoanalysts as being a defence against homosexuality or a bizarre and rare disorder of gender identity. In recent years a serious problem has arisen as a result of the publicity afforded to sex change operations and the unwelcome glamorization of such operations. The accumulation of clinical reports and information has not been accompanied by a substantial advancement in our theoretical understanding of the condition. When theory fails to develop at the same pace as clinical practice there will inevitably be adverse repercussions often leading to dangerous generalization and reflecting on the handling of, and approach to, each individual case.

The aim of this paper is to deal with those aspects of transsexualism which seem to challenge basic psychoanalytic concepts, and in particular castration anxiety, the oedipal complex and the role of conflict especially in relation to gender identity formation.

A further purpose is to stimulate amongst psychoanalysts the formation and expression of the psychoanalytic point of view. One recalls the time when prefrontal leucotomy was being hailed as a great advancement in the treatment of the mentally ill, neurotic and psychotic alike. This treatment is seldom used now and if lessons from the past are to be of value then a repetition of the indifference and laissez-faire attitude which was prevalent in the profession at that time should be avoided.

 

10 On some positive aspects of the negative therapeutic reaction

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Restoration of health is only the incubation of another malady.

T.S. ELIOT, The Family Reunion

IN THIS PAPER I wish to explore those aspects of the negative therapeutic reaction (NTR) which can be of value in revealing deep-seated fears about the meaning of health for certain patients. Quite apart from being indicative that something is seriously amiss in the analytic situation, the syndrome is complex clinically and conceptually. That it does occur is not open to doubt, although in recent years there has been a tendency to dismiss it as an irrelevant usage of a term to describe a course of psychoanalytic treatment which has failed. Analysts’ opinions have been divided in attributing the failure to a special psychopathology in the patient or to faulty technique. Its confusion with various resistances is only too apparent in some case reports, just as it is clear that the term is applied even when therapy has not actually occurred. When the condition tends to be repetitive, it is possible to predict that a NTR will follow a piece of reconstruction or attempted integration, but in most cases it will occur when we least expect it, to coincide with the healing of a split or in the course of psychosyn-thesis. Freud (1919) insisted that synthesis is achieved in psychoanalytic treatment without any intervention, automatically and inevitably. He also suggested that ‘Whenever we succeed in analysing a symptom into its elements, in freeing an instinctual impulse from one nexus, it does not remain in isolation, but immediately enters into a new one’ (p. 161). As the psychosynthesis is not a wholly silent process it is understandable that there will be some acknowledgement of progress, or indeed of improvement, on the part of the patient or the analyst. The response will vary from patient to patient.

 

11 From denial to self-awareness : a 20 years’ study of childhood delinquency evolving into adult neurosis

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TWENTY YEARS AGO two children, a girl aged ten-and-a-half and her brother a year older, were referred for psychotherapy to the Portman Clinic, London, with a long history of behaviour disorder, delinquency and severely disturbed family background. In the case of the boy, analytical psychotherapy was terminated after two years with good results, whilst the girl’s treatment, having been brought to an end after three years, was resumed shortly afterwards and continued at intervals until 1979. Although it is possible that this report may stimulate a discussion on the value and limitation of psychotherapy in the management of delinquent children, my main concern is in showing the evolution of the delinquency into a neurosis, a development which could only be dealt with by prolonged psychotherapy. To make the presentation easier, I have adopted the artificial method of dividing it into three phases, though in reality the development was gradual and contact was almost uninterrupted throughout the period.

 

12 To the limits of male heterosexuality : the vagina-man

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THE MEN I DESCRIBE in this paper may go through life without acknowledging any difficulty with their heterosexuality. They are intelligent, gifted and usually untroubled by the variations of their sexual drives, or the occasional fleeting interest in people of their own sex. Their femininity, only faintly noticeable to others, is as a rule well integrated and often put to good use in their professional lives. On the debit side, although they are capable of fairly lasting and deeply satisfying relationships with women, we find a high divorce rate and frequent changes of partners. Some of them can be exceptionally promiscuous, exploiting their capacity to attract women in a wholly effortless manner. Their promiscuity has a striking oral quality, in so far as they give the impression of being sexually insatiable, thus confirming the psychoanalytic observation of the equation penis=mouth. Many of them are little affected by an orgasmic incompetence which is hidden by a reasonable sexual performance. All these men are incapable of a full homosexual contact, though some have experimented with boys in childhood or early adolescence, but never intensely.

 

13 On some aspects of human violence

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AS VIOLENCE APPEARS to have a particular attraction for human beings, not all its manifestations should be regarded as abnormal. Let us consider, for instance, acts committed in the course of wars, revolutions, and even terrorism, when a different view will be taken according to the side taken by the observer.

My interest in this theme is derived from a sense of unease caused by serious contradictions about what experts have to say on this topic. Some will argue that any attempt to understand human violence is a waste of time, whilst others insist that we should take into account the rights of individuals against those who wish to protect the interests of the community, and so on. I do not wish to appear an alarmist, even if I refer to the unchecked increase in violence in all kinds of societies right across the globe. On the other hand, I feel that we should not ignore the fact that many of us no longer feel safe in the environment in which we live. The prevalence of violent material offered by the media to the public, whether it is based on fact or fiction, needs to be justified and explained. It is possible that these so-called artistic expressions, or the desire to disseminate the truth, are not harmful; indeed, it will be contended that they provide a useful outlet to the aggressivity of the majority. Others will observe this phenomenon with apprehension and fear. Ernest Jones tried to assume an unbiased position, in 1915, when he posed many questions in his essay on ‘War and sublimation’: ‘In war, things are done by a large number of men on both sides, of a kind that is totally foreign to their accustomed standard of ethical conduct during peace, and the question arises, what is the source of the impulses thus vented and the relationship to the controlling forces of civilized life?’ Jones goes on to note that

 

14 On the psychodynamics of drug dependence

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AS THE CAUSES OF DRUG dependence are multiform and exceedingly A complex, I shall refer to them only briefly in this essay. Many readers, perhaps, have some idea as to what causes drug addiction, and concurrently will hold definite views on how to prevent or treat it.

It is hard to maintain an unbiased and balanced attitude to the problem, which inevitably attracts the attention of the press because of its tragic consequences. The ordinary person will rightly become emotional if he or she is at the receiving end of thefts perpetrated to obtain drugs. The euphoria resulting from drug-taking stimulates vandalism and attacks on persons, often causing understandable public outcry.

In general, the epidemic which has hit the world during this second half of the century has caused a great deal of thinking which has not yet come to fruition. In the past, it was generally accepted that the compulsion to take drugs was linked with psychopathic characteristics. Nowadays only the more severe cases are thought to have a pathological nucleus with a clearly defined mental disturbance. Even then we must distinguish them from those cases where there is physical or mental stress, and we shall often be confronted by a temporary disability. The anxious person will take any drug; the psychopath will turn to whatever drug accelerates the mental processes; whilst the persistent use of morphine is suggestive of a psychotic disturbance on a depressive background.

 

15 Perversions : treatable and unbeatable

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TO BE INVITED to give a Glover Lecture for a second time is an honour which is difficult to decline. It also seemed an impossible challenge considering Edward Glover’s contributions to the study of sexual deviations covering a period of forty years. Atter some hesitation, I found the stimulus for this presentation in something Glover said in his paper on ‘Aggression and sadomasochism’ which he gave at a symposium organized by the Portman Clinic in 1963: ‘it will be maintained that one of the important functions of sexual perversions is defensive in nature, a kind of organized sexual adaptation which, however, may in many instances bring a variety of ego-disorders in its train.’ He added: ‘the pervert protects his reality sense from gross interference’ (Glover, 1964, p. 159).

Those words had been in mind for a great many years but now with my own added experience, I asked myself the question: Is that the reason why perverts are so difficult to treat? In the case of a fetishist, for instance, the psychic reality which he protects is that there are no sexual differences, a wholly illusory belief, shared by the man or woman who dresses or acts as a person of the opposite sex. Is it possible that by protecting their distorted reality sense perverts succeed in protecting some hard core of ego disturbance, which threatens the whole of their being? It seemed that perhaps this could be a better line of understanding the therapeutic challenge we constantly face in this field, rather than the popular misconception that a perversion is not given up because it is pleasurable. On the contrary, we know the misery of the perverts’ lives as they go in search of their ephemeral satisfactions.

 

16 Variations on some Freudian themes

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AS WE HAVE REACHED the end of a long week in the course of which most of you have been working very hard, I felt that in this address I should offer you something of a diversion. All I propose to do is to share some thoughts that have occurred to me during the last few years on all kinds of subjects that matter a great deal to all of us. I may have already published some of them in one form or another, but the majority of them are casual reflections or old annotations hurriedly scribbled on a scrap of paper in response to contributions from colleagues and patients. What I have to offer could well be regarded as somewhat iconoclastic but wisdom does not come with age, as Bernard Shaw once said. Only experience increases as we get old and that can be oppressive or liberating.

As we approach the end of the century, psychoanalysis appears to become even more difficult than we ever suspected. Some of the changes that have been introduced have certainly not been easy to accept. Yet whenever a more audacious view, possibly a challenge to classical analysis, is put forward, it is de rigueur to quote Freud, no matter how often he had already contradicted or altered that view himself. The haunting thought for most psychoanalysts is: What would Freud have said about this or that?

 

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