Confidentiality and Revelation in Psychoanalytic Discourse: Christopher Bollas’s Point of View

 

Shall I part my hair behind? Do I dare to eat a peach?

I shall wear white flannel trousers, and walk upon the beach.

I have heard the mermaids singing, each to each.

 

I do not think that they will sing to me.

. . .

 

We have lingered in the chambers of the sea

By sea-girls wreathed with seaweed red and brown

Till human voices wake us, and we drown.

                    

    —T. S. Eliot, “The Love Song of J. Alfred Prufrock” (1917)

 

Point of View about Point of View

 

Christopher Bollas’s I Have Heard the Mermaids Singing is unusual in that it is a work of fiction written by a clinical psychoanalyst, indicating either dissatisfaction of the traditional psychoanalytic case study as practiced in the discipline, a fascination with a sister discourse, or some of both. Interestingly, in the course of the story Bollas touches on one of his major research preoccupations, namely, patient confidentiality (1995), which goes to the heart both of Bollas’s creative contribution to our discipline and some of the problems raised but not resolved by his chosen approach. Mermaids is both a work of fiction necessarily caught up in the history of imaginative writing in our time and offers itself as an implicit critique of psychoanalytic writing. As such, we can use it to examine these ideas as they relate to the trope of confidentiality.

 

First, imaginative writing broadly conceived. In his title Bollas gestures openly not to Eliot’s now canonical poem of high modernism, “The Waste Land,” with its exploration of fractured identity through multiple voices, but to his lesser known “The Love Song of J. Alfred Prufrock.” which is more suggestive of an oedipal/neurotic voice or position. Bollas asks us to compare his nameless analyst’s frame of mind with that of the alienated, drifting, and emotionally deadened Prufrock confronting his mortality and insignificance at mid-life quite in the typical way a neurotically organized individual of similar age might come for therapy. Bollas’s protagonist in this way conflates both sides of the therapeutic dyad. As the narrator says, “I cannot speak my unconscious knowledge and, as I know this, I am excluded from the imaginary possibility of such a song. I believe that as we all suffer from this gap between what we know but cannot think, much less speak, and the little we do know and speak, we are all liable to depressions arising from this divide. . . .” followed by references to Whitman, Shakespeare, and Dostoevsky (p. 134). In this way Bollas incorporates his idea of the “unthought known” (see Bollas’s The Shadow of the Object).  The psychoanalyst speaks in an emotionally muted language of abstractions. The brilliance of Eliot’s poem lies in his simultaneous careful control of multiple levels of poetic language. Prufrock expresses himself mostly in the first person, as would an analytic patient, communicating fully in character and with great poignancy his sense of disconnection, intense isolation, and sadness (putting the reader in the position of the analyst): “I am not Prince Hamlet, nor was meant to be . . . At times, indeed, almost ridiculous— / Almost, at times, the Fool” (Eliot, 1958, p. 7), and “I grow old . . .  I grow old . . . / I Shall wear the bottoms of my trousers rolled” (p. 7). Life’s lessons have exceeded Prufrock’s ability to integrate them, and he is left with a puzzling sense of sadness, loneliness, and dissatisfaction. Moreover, his isolation from human contact results in a kind of activation of his imagination in a process analogous to mild dissociation (“. . . I have seen them riding seaward on the waves . . .” (p. 7). Because Eliot is working in the tradition of lyric poetry, he is able to create the illusion of the interior of a character directly through the first-person point of view, bringing about a heightened sense of intimacy between speaker and reader that enhances our responses to the emotions he is interested in exploring. We recognize the writing as lyric poetry and are not left questioning the poet’s choice of point of view. In fact, Eliot, especially in “The Waste Land”—along with Henry James in “The Turn of the Screw,” James Joyce in Ulysses, Virginia Woolf in Mrs. Dalloway and The Waves, and Ezra Pound in The Cantos, all roughly contemporaneous with Freud—was one of the great literary innovators of his time who stamped into our awareness the formal necessity of strictly controlling point of view in a way that had not been so rigorously pursued beforehand. The implied correlatives of restricted point of view are the following: like the analyst listening with technical neutrality or with evenly hovering attention, we learn what is happening as the speaker or narrator learns; there is no objective oversight viewpoint possible any longer, as we are all caught up in the proliferating webs of signification; any third-person or omniscient viewpoint must be seen as ironic, or it becomes anachronistic. This of course parallels developments in analytic theory leading from a one-person to a dyadic or relational model and a concomitant foregrounding of the importance of countertransference. In literary theory countertransference goes under the name of the “untrustworthy narrator,” related to the twin themes of uncertainty and ambivalence.

 

Why would Bollas point so dramatically towards these central contributions of literary early high modernism through the title he selected for his novel (beyond the superficial reason already cited above)? More significantly, why would he do so in a fiction told from the third-person, omniscient point of view? This goes back to my comment above about Bollas’s interest in patient-therapist confidentiality. In the case study, protecting confidentiality cannot be ignored. According to Michels (2000), “Freud, Stein, Lipton, Goldberg, Gabbard, and others see the analyst’s obligation to protect the patient’s confidentiality as overriding. However, there is an even more fundamental ethical obligation—respect for the patient’s autonomy” (p. 368). In the written case study if the analyst/writer adheres to the literal reality of what he or she is describing, patient-therapist confidentiality may be breached. However, if these vital details are masked or changed “to protect confidentiality,” they will inevitably alter the basis upon which the clinical conclusions are drawn. To respect the patient’s autonomy, in the clinical case study, a trade-off occurs, making possible only a limited depth of analysis. Bollas seems to have recognized some such limit, and through his fiction, he is attempting to go beyond the limit. For this he is to be praised as being one of the very few writers on clinical theory who have not naively rejected figurative writing in favor of a style of discourse stripped of figures of speech and metaphors in the drive towards so-called scientific objectivity (see Derrida’s treatment of this theme in the history of philosophical discourse in “White Mythology”).

 

However, despite his dissatisfaction with the various erosions to patient-analyst confidentiality that have plagued the profession, and especially in the vexed context of the published case history, Mermaids does not significantly address this core concern, which is not to say the book is uninteresting in other ways. It is; Bollas is able to establish a fictive scene and the basics of several characters. There are humor, pacing, and a sense of place. His protagonist, who is perhaps somewhat heavy-handedly never named but is merely called “the psychoanalyst,” calling attention to the theme of identity, undergoes a kind of crisis, a depressive episode that seems to overlap a stage-of-life crisis. But how he emerges from his conflict is skirted: “Fortunately, he awoke the next morning cured by sleep” (p. 158). One would expect more from an analyst/author writing about an analyst, unless the narrator/author is subtly trying to make the obvious point that analysts are also human and disturbed by unconscious conflicts. Also, the narrator occasionally steps out of his neutral mode and becomes pontifical, for example, in various reflections on depression (pp. 10, 11, 163, 164) that are only loosely integrated into the character of the narrator.

 

Who is this narrator? What does a free-floating point of view such as we have in Mermaids tell us about the patient-analyst relationship? By this point in the history of the discipline of psychoanalysis and its high degree of cultural saturation, the figure of the analyst has become archetypal in the Western world. But as the relationalists keep reminding us, you can’t have an analyst without a patient or a Winnicottian infant without a mother; these are inherently relational terms. In the patient-analyst dyad, meanings are at least in part co-constructed based on two intrapsychic structural systems interlocking and evolving through the shoals of the transference, resistance, dreams, projective identifications going both ways, and so on. A modestly privileged viewpoint thus exists only in the strictly defined sense of the treatment frame. This being the situation, how can a fictive analyst’s inner world be accurately revealed to a reader as told by an omniscient narrator short of postmodernist experimentation, which Mermaids avoids? In other words, what is the fictional necessity for the protagonist to be specifically a psychoanalyst? Couldn’t the job be done just as well, or even better, with a counselor protagonist (not to mention an introspective writer)? Unfortunately, such questions are raised because of the narrative point of view adopted by Bollas. Lying behind these considerations is the debate between empirical/scientific and hermeneutic discourse in psychoanalytic theory.

 

Art and Science in Language

 

Hermeneutics vs. Science: A Real Dichotomy?

 

In his discussion of reconstruction, Blum tries to capture the hermeneutics position of the dichotomy mentioned above. He says,

 

The past is “reinvented and recreated” in the context of the present. Hence, the past is not only not reconstructed in analysis, it cannot be objectively reconstructed since there are multiple probable realities. Personal history thus becomes a “story line” with its own coherence and internal consistency, but an autobiography written with a great deal of poetic license. Analyst and patient incorporate varying degrees of fiction and take their own liberties with facts which, in any case, cannot be fully ascertained. (p. 140)

 

Perhaps a way beyond this impasse would be to broaden out the discussion by a reconsideration of Freud’s approach not only to his own case studies but also to his so-called clinical papers and other works as well. Late in life (1934) in an interview Freud said the following:

 

Everybody thinks . . . that I stand by the scientific character of my work and that my principal scope lies in curing mental maladies. This is a terrible error that has prevailed for years and that I have been unable to set right. I am a scientist by necessity, and not by vocation. I am really by nature an artist. . . . And of this there lies an irrefutable proof: which is that in all countries into which psychoanalysis has penetrated it has been better understood and applied by writers and artists than by doctors. My books, in fact, more resemble works of imagination than treatises on pathology. . . . (in Hillman, p. 3)

 

Are we to take these comments as representing Freud’s view or an ironic subversion of the majority of his own writings? If the former, and in the absence of persuasive evidence that Freud subsequently adopted a contrasting view, we can only conclude that perhaps his greatest contribution was not his creation of the structural model of the mind, or his theories of resistance, transference, the significance of dreams, the Oedipus complex, psychosexual developmental stages, or any of the others, but his fashioning of a new synthesizing mode of discourse.

 

We see this mode in its purest form not in the case histories, Moses and Monotheism, Civilization and Its Discontents, or Totem and Taboo, all of which have been carefully picked over by literary critics and theorists for evidence of the “literary” or “imaginative” Freud, but in his technical papers, for as much as Freud loved to uncover what had been repressed and hidden he also loved to conceal, to mask, and he had good reasons for doing so. As Conan Doyle taught us, what better place to conceal something than in plain sight? Thus, Freud’s innovation was to combine fictional or imaginative discourse with empirical, descriptive, expository discourse in such a way that neither the one nor the other could be privileged without leading to insuperable critical difficulties. The technical papers, then, must be read constantly asking ourselves, “Who is the narrator? What does knowing who the narrator is contribute to what is being said?” while the works that manifest relatively more literary devices must be read constantly asking ourselves, “Where is the truth value here, and what does this tell me about the world and more specifically about myself?” This shuttles us back and forth between the equally arbitrary poles of the abstractly theoretical and the personal or experiential, that is, the clinical moment. Ultimately, then, the question Freud’s work forces is an acknowledgement of the inseparable involvement of the imaginative, literary mode and the empirical scientific mode (roughly equated to his own notions of primary and secondary thinking) of writing, both in the case history and in the technical or theoretically oriented scientific paper. We learn about this fascinating and elusive narrator at various points, most seductively perhaps in The Interpretation of Dreams, but indirectly throughout Freud’s works written in a wide variety of discursive modes.

 

The language of exposition mediates power specifically through concealment of the personal dimension; the transparency of this kind of writing as a purged system of point-for-point referentiality exactly mirrors and transmits the mythological donnée of power as an absolute category. It is the language of the law, of pronouncement, of analytical philosophy. Meaning passes through, as it were, undisturbed on its frictionless way to passive consumers of truth, who receive and are remolded. There is no room for ambiguity or differential interpretation, since tropes have been sublimated or stripped away altogether. Where is the unconscious of such language?

 

Transparency and Opacity

 

As if perhaps aware of some such problems with expository prose as the exclusive, privileged mode of expression for psychoanalytic discourse, Bollas has decided to augment his linguistic armamentarium with fiction. Mermaids is presented in the first instance as a work of unambiguous fiction in the tradition of psychological realism. There are distinct characters who interact in a kind of plot to create the illusion of the passage of time leading to a conclusion of sorts, giving the work its sense of overall shape or form as fiction. That this kind of fiction is centrally preoccupied with time we see in the first line of the story: “It was 6.19 a.m. and the psychoanalyst, as always, anticipated his 6.20 alarm call by one minute” (p. 1). There follows a report of his ruminations about time. The story unfolds through characters interacting, simultaneously creating this sense of time and the groundwork for an emotional structure that must form the core of a well-written novel, giving us the basis for rational critique after having experienced the story.

 

But Mermaid’s concern with psychological and chronological time is complicated by an unavoidable consideration, as indicated above: with regard to the psychoanalyst’s thoughts, how does the narrator know these things? On one hand, as readers we are asked to accept the transparency of the descriptive language—the words refer to something out there in a kind of reality, a simulacrum of the world; on the other hand, we are left with what turn out to be unanswerable questions about the narrator, pointing towards a non-metaphorical opacity in the depths of the fictive language that blocks the transmission of meaning.  

 

Confidentiality and Certainty

 

Finally, we return to where we began. In the psychoanalytic scene, the patient mostly talks while the analyst mostly listens. Occasionally the analyst makes an interpretation, confrontation, reconstruction, or clarification. When a third party breaks in, the intrapsychic movement that it constellates must change, and there have been long-standing debates about how significant such change might be. From the perspective of an empirically based science, how does the anthropologist observe indigenous people interacting without altering the interaction? How does the particle physicist observe the motion of electrons without affecting that motion? How does the observing ego carry out its function without altering what it observes? We have had to accept a measure of uncertainty, the other side of the certainty about the world that such observation delivers. Some of these considerations Bollas has explored in The New Informants. “What better way to spread the good news than to go into print? We must also consider the view that psychoanalysts themselves, in their clinical writings, were occasionally compromising the patient’s sense of confidentiality” (p. 125), and “. . . the writing of psychoanalysis is part of the culture of disclosure and not without its problems” (p. 126). Throughout his discussion Bollas argues for strict confidentiality in order to protect the core of psychoanalysis, both for the patient to be able to trust the analyst and for the analyst to be able to engage in evenly hovering attention without having to worry about invasive reporting requirements, the police, the courts, and so on.

 

Psychoanalysis has inadequately resisted incursions on patient-analyst confidentiality, as Bollas acknowledges, struggling to retain the very foundation of its uniqueness as a mode of human interaction. One of the exceptions is rationalized as having to do with psychoanalysis’s research dimension as seen in the written case study. What must be done for the analyst to make his or her work known to others for the purposes of furthering the discipline, even of establishing this discipline as such? All theorizing about the analytic scene of necessity remains based on those concrete experiences of a given analyst as generalized onto an abstract level, since direct observation by a third party will never be possible. As Bollas says in this connection, “how can writing about a patient ever be warranted?” (p. 186) He answers by going briefly into the subject of identity, or “benign revelation” (p. 187). Identity is concealed in various ways so that “the patient cannot be identifiable in any way other than to the psychoanalyst himself” (p. 189); fiction as surface disguise enters in. But “The press and popular fiction have also done their part to arouse the public” (p. 37), that is, against child abusers, which lead to the current erosions of confidentiality not sufficiently resisted by the psychoanalytic community, according to Bollas.  

 

By turning to fiction, and specifically a story about a psychoanalyst at work, Bollas is attempting to answer the latter question posed above. As noted, there is a return to metaphor, to figures of speech and the whole rich linguistic world of the poetic imagination with its age-old conventions (related to Freud’s primary process thinking). Mere factual identity, then, is given an emotional dimension to go along with its more superficial markers. But only through the fictive patterning of sensory detail can credible characters be achieved in fiction, just as in the written case study vital details contribute to the veracity of clinical conclusions always at the cost of the patient’s autonomy.

 

Confidentiality can be understood as a coded way of referring to a unique state of mind, the very foundation for psychoanalysis and psychoanalytic psychotherapy. This state of mind is dyadic, perhaps somewhat comparable to the infant-mother relationship. The psychoanalytic scene generates the dyadic (two in one, one in two) quality of this early emotional bond, enabling its eventual internalization on the patient’s part. Trust and its counter-condition of risk or danger alternate as structure is slowly built. Only when sufficient psychic structure has been accomplished can room be opened for a third.

 

Ultimately, the problem of protecting confidentiality while writing and publishing the psychoanalytic case study is not resolved, but we are given a valid, defensible way around the difficulty if we keep in mind the shaping influence of literary point of view and the poet’s attention to all the levels of language, not just the semantic/syntactic. The third-person narrator becomes the observing part of the ego, registering the impact of and thinking about the emotional parts of the ego, both conscious and unconscious. That is, in order for Mermaids not to be seen as structurally flawed the narrator and the psychoanalyst must be viewed as parts of a single intrapsychic whole. Careful readers of fiction are used to such interpretations. What about writers and readers of the psychoanalytic case study? Can they come to see the corresponding limitations of their preferred modes of expression?

 

Bibliography

 

Blum, Harold P. (1994). Reconstruction in Psychoanalysis: Childhood Revisited and Recreated. Madison: International Universities Press.

 

Bollas, Christopher. (2005). I Have Heard the Mermaids Singing

London: Free Association Books.

 

_____. The Shadow of the Object. (1987). New York: Columbia University Press.

 

_____, and Sundelson, D. (1995). The New Informants: The Betrayal of Confidentiality in Psychoanalysis and Psychotherapy Northvale, NY: Aronson.

 

Derrida, Jacques.  (1982). White Mythology, in Margins of Philosophy, Chicago: University of Chicago Press,

 

Eliot, T. S. (1958). The Complete Poems and Plays 1909-1950.  New York: Harcourt, Brace and Company.

 

Hillman, James. (1983). The Fiction of Case History: A Round with Freud, in Healing Fiction. Woodstock, CT: Spring Publications.

 

Michels, Robert. (2000). The Case History. JAPA 48(2): 355-375.

 

Preminger, Alex, ed. (1974). Princeton Encyclopedia of Poetry and Poetics. Princeton, NJ: Princeton UP.

 

 

Psychiatric Diagnosis and Culture

 

Harry Polkinhorn

 

 

Diagnostic Criteria for Narcissistic Personality Disorder (301.81)

 

(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is "special" and unique and can  only be understood by, or should associate with, other special or high-status people (or institutions)

(4) requires excessive admiration

(5) has a sense of entitlement . . .

(9) shows arrogant, haughty behaviors or attitudes

 

                   —Reid, et al. DSM-IV Training Guide, p. 290

 

 

 

Introduction: Background and History

 

         Today, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is ". . . the most frequently used book among all mental health professionals" (Kirk and Kutchins, ix). As such, there can be little doubt that it plays a central role in most mental-health diagnoses. What is this book? Who wrote it, and why? How does culture figure as a factor in the formula?

         In the counseling relationship, one might argue that diagnosis is the narrow gate through which the process of healing must pass. This gate can be configured many different ways, and until recently the role of culture in the configuration was not foregrounded. Perhaps in some quarters it still isn't. In addition, no one would be able defensibly to deny that the fine details of how diagnoses are arrived at become integral to those diagnoses. That is, the diagnoser enters into his or her own relevant conclusions, since that which is being diagnosed (i.e., some aspect of psyche) appears filtered through the medium in which the entire procedure is being conducted. There is no way around this aspect of diagnosis, just as in particle physics one must confront the fact that the measuring mind and its instrumentation radically determine the result of the measurement, making it uncertain.

         With these general provisos in mind, let us turn to the "clinical" setting (most often not set in a clinic). In practice, a mental-health diagnosis may be conducted in a variety of ways. The client/patient himself may offer an understanding or formulation; a friend or family member might; the counselor may arrive intuitively at a tentative conclusion; formal tests may be used; and so on. In whatever the method adopted by a given counselor, it appears that the majority have succumbed to the convenience of a kind of technologization that has occurred since the 1970s, as instigated, orchestrated, and controlled by the American Psychiatric Association. In what follows, I would like to retrace the history of what I would call the exploding syndromes, culminating in the full-scale collapse of a unified view in favor of an almost exclusively physicalist or mechanical/technological conception of the object of analysis (i.e., the psyche in all its variety).

          Whereas some treatments of this subject begin with the Greek theory of the four elements and proceed through different systems that people have devised to typologize human personality, I would like to start closer to the present, in the nineteenth century. Also, I want to emphasize that my discussion limits itself to the Euro-American context, because this is the reality in which we live today, although our social sphere is undergoing rapid change due to population influx from around the world, especially Latin America and Far East. In the middle to late nineteenth century, relatively few "psychiatric syndromes" were recognized in the West. The "U.S. Census . . . played a predominant role in psychiatric nosology for almost a century . . . In the 1840 census there was only one category: idiocy, which included insanity" (25). Interestingly, this first benchmark was established by the U. S. government, an institutional practice that has continued up through the proliferating DSM manuals. Indeed, "The struggles to develop a systematic nomenclature, from the earliest decades of the 19th century, were motivated by administrative and governmental needs, not by demands from practitioners" (27), and "By 1880, there were seven categories: mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy . . ." (25). One might argue that the ongoing processes of industrialization were producing more symptomatic behavior, on the one hand, and the increasing professionalization and "scientification" of medical psychiatry were producing more differentiable categories of classification, on the other hand. But perhaps these processes were not proceeding in step with each other. In any case, whether or not the above hypothesis is accepted, these processes have not ceased, since "By 1918 . . . [there were] 22 principal categories" (26). Twenty-two seems like a workable number. But how about  almost 300 by the late 1980s? "DSM-I (1952) contained 106 different diagnostic categories; DSM-II (1968) had 182; DSM-III (1980) offered 265; and its revision, DSM-III-R (1987), raised it to 292" (199). Is this a geometrically increasing series?

         In itself, this series is thought-provoking. First, one asks what is being categorized. Second, one wonders about the social processes at work behind the scenes (but still very visible in their crass manipulation of power) that seem to require an always greater number of designations, and presumably a more highly filtered class of professionals to work the differentiations. Finally, how does culture as such figure into this process?

         From the mid-nineteenth century, medical psychiatry was plagued by the problem of variable diagnoses. This variability may have been attributable to methodological inconsistencies of observation, disagreement about the meanings of key terminology, the specific or local nature of medical education programs that of necessity emphasized different matters in their curricula, slowness of transportation and communication means, and other such social factors. Furthermore, one can trace a similar trajectory in physical medicine. Into some such a conjuncture of circumstances Freud stepped, and a review of his early career reveals his success at medicalizing the diagnosis and treatment of mental illness, bringing it securely under the wing of academic medicine. There was a subtle but definite distinction (and connection) between mind and body, so that only a socially approved expert in the latter could really distinguish where its influences left off and those of the former began to make themselves felt in symptoms. In order to practice psychoanalysis (i.e., Freudian therapy), one first had to be a licensed physician. Indeed, both Freud and Jung began as medical doctors, and although today one can practice Jungian analytical psychology without a medical degree, for psychoanalysis the more conventional claims of academic medicine persist. Many of Freud's and Jung's papers show their desire for "scientific" status for psychotherapy. There are appeals to reason and demonstrations of its functioning in the rhetorical quality of their argumentation (hypothesis, citation of evidence, tone of balance and fairness, and so on).

         In the early to mid-twentieth century, the Freudian psychodynamic approach held sway, but after the war things began to change quickly.

 

What was the nature of the revolution signaled by the appearance of DSM-III? Maxmen claims scientific psychiatry replaced psychoanalytic psychiatry and that the contrasts between the two are profound: "Psychoanalytic psychiatry bases truth on authority; something is true because Freud said so. Scientific psychiatry bases truth on scientific experimentation . . . . The old psychiatry derives from theory, the new psychiatry from fact" (31) (Kirk, 7)

 

This, however, doesn't seem quite accurate. A better formulation would indicate that one "authority" was replaced by another (the "facts" being always radically in question). The old psychiatry did derive from theory, but so does the new; it's just a different theory. Whenever the supposed facts are appealed to, that is precisely when theory is functioning in its most duplicitous and destructive fashion.

         In order to place this sea change in a more useful perspective, let us consider the economic forces that impelled the change of views. "What was at stake was the fate of the psychiatric profession and the enormous, multi-billion dollar mental health industry," (7) since by now ". . . the direct economic costs of mental health care is (sic) close to $55 billion per year (NIMH, 1991:29)" (9). Among these costs, of course, are those for psychotropic drugs, most of which did not exist in Freud's time. Hence, the invention of a new sub-specialization: "Biopsychiatry is an attempt to secure a more powerful base for psychiatry within the jurisdiction of both medicine and mental health" (10). To make the matter more complex, primarily because of the problem of variable diagnoses mentioned above, psychiatrists, in the medical profession as a whole, according to one source, ". . . sit at the bottom of the totem pole of medical specialties" (10). That is, there was a perceived need for validation on the part of the profession of psychiatry (i.e., the ruling cliques of the APA). As with any profession, the first task is to define the object of analysis, making certain that it is distinguishable from neighboring terrain. If this "object" can be rhetorically inserted into the overall spectrum of accepted social discourse conventions, then there is a need for a corresponding set of social practices oriented towards that object. It is not surprising that this need did not become acute until after the middle of this century, given the social and historical forces outlined above.

         It was at the time of the fashioning of the third edition of the manual (1968-1980) that matters crystallized. The "DSM-III contains the official classification system of psychiatric disorders and as such sets the boundaries of the domain in which psychiatry claims expertise and exclusive authority" (12). With the population growth and changes in patterns of care that occurred leading up to and during this period, one-on-one psychodynamic approaches proved of limited benefit to the masses requiring service. The profession found itself ". . . hopelessly impotent in confronting what were being recognized as the public mental health needs of the nation" (18). Furthermore, Kirk refers to studies demonstrating empirically that ". . . psychotherapists preferred clients who were young, attractive, verbal, intelligent, and successful" (19), thereby excluding even more people from treatment, successful or otherwise. In short, a radical overhaul was needed, precisely in those areas whose validation would return to psychiatry the genteel respectability it had enjoyed in earlier decades.

         This overhaul was undertaken not by the American Psychiatric Association's membership as a whole, nor even by a significant representative sampling of the organization, nor was it called for by practicing clinicians across the board. Rather, it was launched, guided, and brought to fruition throughout by a small group or inner core of psychiatrists who sought diligently to mask their maneuverings through making their activities appear to be the result of extensive consensus-building across the profession. Kirk goes so far as to claim that contemporary psychiatric nosology, "To a great extent . . . has been a product of committee meetings and smiling faces" (29). In contrast to historical example, the new group set out to define as carefully as possible symptoms, rather than their causes. "Their approach [the makers of DSM-III] was a radical departure for American psychiatry, which had accepted as a first axiom that its task was to identify and treat causes, not symptoms" (77). Thus, the working group saw practical benefits to the solidification of the profession in terms of its rhetorical practices in offering an inventory cross-referenced to diagnostic categories.

         The utility of such an approach, of course, cannot be questioned, if it is based on defensible methodology, valid and reliable (replicable) field data, and in fact is representative of a broad range of opinion. However, none of these conditions was met. New categories were added, old ones deleted, symptom characteristics altered. Also, "[the decision-making group] did not represent a diversity of opinion, but a rather narrow range of interests" (98), and furthermore ". . . the essential decisions about its approach, structure, and contents were made quickly by [Robert] Spitzer and this small group" (99). What about their decisions? Kirk offers evidence that "Spitzer dismissed questions about the adequacy of representation by minorities and women" (101), and "As for racial minorities, none were members of the DSM-III Task Force in 1975 or at any later time. . . . When DSM-III was finally published, not even this condescending suggestion was included, that racism would be described as an example of nonoptimal psychological functioning. . . . rejecting a request for minority representation" (102). In order to defuse criticism, as soon as a version of the manual is published, "research" (i.e., committee meetings) begins on its successor. The fact that hardly any opposition to these scientifically shoddy and morally questionable practices has arisen from within the profession is indicative of its lamentable state-of-siege mentality, traceable to two main causes: the high economic stakes of the game; and perhaps Freud himself, who was in the habit of deflecting any critique of his methods by personalizing the commentary as nothing but "resistance," "envy," and so on. Kirk sums up the problems discussed so far as follows:

        

none of the revisions has been stimulated by clinical practitioners demanding a new classification system . . . the process of decision-making has become more elaborate. . . . new diagnostic categories are frequently added and old ones are split into two or more. . . . the process of revising each version of the DSM begins with the first official questioning of the scientific status of the current nosology, proceeds to tout the superior process being used for the version being developed, moves to proclaim that the brand-new version represents vast improvements over the old, encourages everyone to purchase the new publication with its paraphernalia. . . and ends with a new task force questioning the scientific status of the latest version. (214-15)

 

Given such conditions, it is hard not to conclude that official nosology is in trouble, despite any bland appearances to the contrary. As I hope to demonstrate in the following section, central to this structural inadequacy is the filter of "culture," more or less systematically excluded from the manuals.

 

II. Culture

 

         The real significance of "culture" as a consideration in diagnosis is its starkly relativizing characteristic. By admitting that culture plays a role in psychiatric diagnosis (and treatment, by implication), which I suspect many hard-line psychiatrists would not do, one is forced to undercut the totalizing push of the so-called scientific method. Consequently, the DSM series downplays or altogether ignores culture. Even without taking it into consideration, other, arguably more basic difficulties exist, such as the lack of an agreed-upon definition of "mental disorder," or how a practitioner should distinguish between mental illness and mental health in the first place. Castillo claims that we face the client ". . . with no clear boundary between mental illness and mental health"(3), and Kirk and Kutchins argue that "Mental illness is merely a residual category of behavior, an explanation of last resort" (21). How does one respond to such condemnations, except to submit that a clinician will deal with his or her client using the most comprehensive form of evaluation of which he or she is capable, despite the logical fallacies of the procedure? Whereas this won't answer the objections raised by thoughtful criticism, it very well may serve the client's immediate interests.

         But let us pursue the notion of culture further, especially the theoretical quandary into which it leads the voluntarily blinded discourse of the officialized medical psychiatry of our times. Castillo wants to attack this dilemma by approaching the mind/body dyad from the other perspective from that usually adopted. He says,  ". . . cultural learning also has a biological basis in the brain and, therefore, in mental disorders" (5), and ". . . neural structures in the brain are altered in adaptations to emotional stress and trauma, medications, psychotherapy, personal experience, and cultural learning" (6). What he doesn't tell us, however, is the degree of these adaptations; nevertheless, his point remains, allowing him to advance telling arguments about the biases of the manuals. In pointing to the culture references in the appendix of the fourth edition, he says, "The cultural information in DSM-IV is, in effect, 'tacked on' to the preexisting classification structure based on the disease-centered paradigm" (16). The implication is that this added information is only in response to cultural politics; the real science is up front in the body of the manual.

         Castillo's analysis proceeds to a close examination of some of the unavoidable rhetorical shortcomings built into the manuals. First is the underlying assumption that an inventory of mental disorders actually "describes" something out there in the world of human personality. He says, "The collective cognitive process of treating a human-made product as if it was something possessing its own independent reality in nature is called reification" (19). The manuals, that is, pretend to describe that which they themselves are positing. All too often, the superstructure of the manuals beguiles their users into forgetting this fundamental flaw.

         In order to add a greater sophistication to the discussion, Castillo adopts the discourse of anthropology, which is precisely what has been lacking. He gives a useful definition of culture as ". . . the sum total of knowledge passed on from generation to generation within any given society" (20), which, if it ignores the difficulties inherent in glossing over "knowledge," at least provides us with a workmanlike approach to a term that is customarily used in ways that obfuscate more than they clarify. More specifically, what about the culture of illness and its particular rhetorical tropes?  First and foremost, "If their cultures are different, the 'illness' experienced by the client is not likely to be the same as the 'disease' diagnosed by the clinician" (31). Illness, then, is more than a set of purported symptoms susceptible of diagnosis, that is, of empirical description within the nosological categories of the day; it is how the client may experience them. This is a phenomenological approach that seems consistent with the object of analysis, namely, the psyche and its purposes. As Castillo puts it, ". . . in many ways a mental disorder is a complex system of meanings" (33). Freud offered the observation that symptoms of neurosis were doorways to the unconscious, and analytical psychology, indeed, has fastened directly on this insight, opening it up through the complicated processes of symbolic amplification that make the DSM characteristics look like the crude scrawlings of a child compared to a master's design for a great cathedral. Moving his discussion finally to a broader level, Castillo says that ". . . the personality disorders listed in DSM-IV are still largely based on western conceptions of normative modern personality development" (45), and, to underscore how limited these descriptions are, he points out that ". . . the majority of humans on the planet live in societies that could be described as at least marginally premodern" (101). This essentially does away with the universalizing claims of the manuals' methods, none of which have been conclusively tested for validity even within the narrow sphere of Western societies. Why, then, are the manuals used at all?

 

III. Critique

 

         I think this question can be answered fairly easily if one adopts the perspective of a thorough-going social critique. I have already gestured in this direction several times. That is, without a critical social theory, the structural claims of the manuals take on the power that was cultivated by their designers. This power, real as it may be in terms of its effects, remains a complex optical illusion. In what follows, I propose to analyze critically a series of works published in part by way of apology for the manuals and in part as a reaction to them.

         First is the primary caregivers' version of the fourth edition of the manual itself. As was the case with the third edition, this one puts first things first; it opens with a page of authorities (Pincus, et al., vii). The rhetorical force of this move cannot be overlooked or minimized. "If all these authorities authorize the following," it indirectly says, "then how can anyone doubt the authenticity of the inventory?" As if to drive home this point, the manual also closes with a long list of authorities, thereby encapsulating the entire project within an impenetrable circle of authorities, sealing off dialectical interchange. As we will see, the power of citing long lists of authorities—which has its origins as a rhetorical practice in the early Latin Middle Ages at a time just preceding the establishment of empirical science in Western societies and when argumentation was conducted almost exclusively on this basis and frequently had a religious or theological thrust—has not been lost on other apologists, who routinely resort to it, even initiating the list on one book's cover!

         In the "primary care" version of the fourth edition, we are told somewhat hyperbolically in the introduction that "The Diagnostic and Statistic Manual of Mental Disorders, Fourth Edition—Primary Care Version (DSM-IV-PC) is the product of an unprecedented collaborative effort among the primary care specialties and psychiatry to develop a useful approach for diagnosing mental disorders in primary care settings" (xi) What this conveniently sweeps under the carpet is the fact that "mental disorder" remains undefined, not to mention the degree of real collaboration, not rubber-stamping of the APA's previously established lists of characteristics. In the manner of the world's myths, this book starts with "origins" (xi). Implicit in the return to origins is the desire to validate the world of fallen history, death, and suffering, specifically mental illness, through a return to what Eliade calls illo tempore, the eternal time.

         In a section on "issues" in the use of the manual, culture is broached, but inadequately and in passing. The authors say, "Clinicians are called on to evaluate individuals from numerous ethnic groups and cultural backgrounds. Diagnostic assessment can be especially challenging when a clinician from one ethnic or cultural group uses the DSM-IV-PC to evaluate an individual from a different ethnic or cultural group" (xiv). This is putting it mildly, given the lack of attention paid to the dimension of culture throughout the preparation and presentation of the manual. What exactly could "especially challenging" mean in this context, except to say that the manual provides little (or no) assistance in such cases, which are becoming the norm? (As a sidelight to the above, I would like to introduce here the real motivation to use such a manual, which is for purposes of reimbursement from insurance companies and health-maintenance organizations that now dominate the entire field of mental-health care.)

         Later, in a section on psychosocial problems, the authors continue to reify their categories of classification.

 

The primary care clinician is likely to encounter individuals who have psychosocial problems that are a focus of clinical attention but that are not considered true mental disorders. These problems are related to the mental disorders in this manual in one of the following ways: 1) the problem is a focus of clinical attention, and the individual has no mental disorder . . . ; 2) the individual has a mental disorder, but it is unrelated to the problem . . . ; or 3) the individual has a mental disorder that is related to the problem but the problem is sufficiently severe to warrant independent clinical attention. . . (137)

 

"True mental disorders" begs the question, again. What the authors are trying to do, clearly, is to show that they are taking into account the influence of the social and physical environment on an individual, without throwing overboard their medical/physicalist model of illness. The suggestion is that some clients may have culture-bound symptoms, but perhaps the clinician should regard these as "problems" (not defined, of course), rather than as "true mental disorders."

         In order to try to cover themselves, the authors go on to detail a "psychosocial/environmental checklist" (137), which includes everything from abuse to housing and academic problems, acculturation problems, problems related to interactions with the legal system, and so on (137-38). Some of these they then refer to as "culture-bound syndromes," saying:

 

The term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be "illnesses," or at least afflictions, and most have local names. These syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations. (143)

 

The implication is that these syndromes may (or may not!) be related to the manual's categories, an ascription one might make of anything under the sun, therefore yielding nothing of value. This piece of specious work merely seeks to keep the categories intact, completely begging the question of the ontological claims of symptoms that they don't fit. As indicated above, the book closes with overbearing lists of authorities.

         The canonical list opens John Livesley's edited collection The DSM-IV Personality Disorders. This list is two pages long and includes titles and affiliations. I am emphasizing the rhetorical thrust of this since it is a practice that does not exist at all in publications in the humanities. Furthermore, note the implication of the book's title: the disorders; they exist; they have been classified. By including several articles that are critical of the whole project of the manuals, Livesley is attempting to incorporate the opposing viewpoint, much as the Catholic hierarchy has repeatedly embraced heretical positions, thereby rendering them impotent.

         In "Conceptions of Personality Disorders: Historical Perspectives, the DSMs, and Future Directions" by Theodore Millon and Roger Davis, the attempt is to give us a balanced overview of the field. Yet the authors begin their article with the following statement: "A survey of these notions can be found in the detailed reviews published by Roback (1927), Allport (1937), and Millon (1981). Given these fine [sic] secondary sources, there is no reason to record here . . ."  (3). Note how Millon refers to his own previous study as "fine"! How can such an attitude, then, result in a balanced treatment of a subject as ethically complicated as that of the APA's manipulation for profit of medical nosology? Later, Millon and Davis make the following, patently naive and theoretically indefensible statement: "In light of the foregoing, the DSM-III Task Force agreed to take an explicitly nondoctrinaire approach . . . avoiding theoretical biases concerning the nature and etiology of mental disorders . . . "(16). This recalls the fake distinction mentioned above between "facts" and "theory." Not to acknowledge that the whole area of mental disorders is inextricably enmeshed with all manner of theoretical and doctrinaire considerations is tantamount to disrespecting the intelligence of readers, if not playing a crassly unethical game with them. Then we are told, in a discussion of antisocial personality disorder, that "despite serious objections from many quarters, the criteria were retained with only modest alterations" (18). Why? If this kind of high-handedness occurred with antisocial personality disorder, perhaps it affected many other disorders as well. The attitude is revealed that the task force knew what it wanted and sought agreement rather than genuine critical review.

         Peter Tyrer's "Are Personality Disorders Well Classified in DSM-IV?" attempts to take a higher ground, finally, and the rarity of such discussions among the literature spawned by the manuals is noteworthy. This very point is echoed in his notion that  "An addition to the famous laws of C. Northcote Parkinson could be 'Research creates unproductive research,' and this is exemplified by much of the activity in psychiatric classification since the introduction of DSM-III" (30). That is, most research is apology rather than critique. Tyrer calls for a broader, more historical approach to the subject. He makes the point, which shouldn't need reiterating but apparently does, that "The unreliability of psychiatric measurement in the distant past detracts little from the fundamental validity of many observations" (31). This, of course, returns us to the core of the problem, namely, validity (and reliability), which continues to be lacking. "In the absence of good data, as is common in personality disorders, the committee is subject to pressures that are more political than scientific" (31). Is it any wonder that the majority of practicing psychiatrists, conditioned as they have been by the profit-generating biomedical model, flatly reject such statements and their unsettling implications? Then Tyrer introduces another telling and generally overlooked critique: " . . there is no satisfactory way of classifying patients who have more than one personality disorder" (31). Moreover, "At present there are no links between the specific operational criteria for each disorder and the general description quoted above" (33), and he comments on the lack of discrimination in terms of degree of the categorizations. He says, "Nowhere in these criteria is there any indication of the persistence or level of subjective distress or social dysfunction that needs to be created by the attribute in question in order to qualify for the label of personality disorder" (34).

         But Tyrer is not satisfied with these criticisms. He introduces the chronological dimension, saying that "Societies change and vary from culture to culture, so it is likely that diagnoses of personality disorders will also vary similarly" (34). Although he touches on the subject of culture here, he does not pursue it. Instead, he advances an argument based on the purported relation of personality to diagnosis. He tells us that recent advances have been motivated by " . . . the separation of personality and mental state diagnoses" (35), asserting that "These studies have shown that personality diagnoses do not remain consistent . . ." (36). Another problem lies in the area of the psychoses. "Neither DSM-III nor DSM-IV can be used to assess personality disorders in the presence of a major psychosis, and this is an important handicap of the classification" (37). In order to arrive at diagnoses, the clinician is always faced with the dilemma of the source of information: informant (family member or friend), or the client himself? However, informants bring biases. "It is therefore much easier to forget about informants and concentrate on patients  alone. This is head-in-the-sand mentality . . . " (37), and ". . . access to independent information is really essential before personality status can be determined satisfactorily" (38). But no such independent information is available. What is more, "The results of almost all the structured interview schedules based on

DSM-III suggest that a single personality disorder is much less common than multiple ones" (38), and "The aim of identifying mutually exclusive personality disorder categories therefore seems to be a mirage; it can be achieved only by distortion of natural data" (38). Given these arguments, it can be argued that anyone who consults the manuals for the purpose of psychiatric diagnosis is engaged in unethical professional behavior.

         Millon and Davis weigh in with a moderating opinion in their "On the Importance of Theory to a Taxonomy of Personality Disorders," first continuing in the critical vein laid out by Tyrer. They say, ". . . Despite many prolonged and brilliant ruminations, the current state of psychopathological nosology resembles Ptolemy's astronomy of over 2,000 years ago: Our diagnostic categories describe, but they do not really explain" (377). One could question whether they even describe. "Our star 'charts,' our DSMs, remain aggregations of taxons, not true taxonomies. Their reliability, but dubious validity, lend our field the illusion of science but not its substance" (378). However, Millon and Davis are not content to close the case against the manuals. In true apologist fashion, they feel that "Even if the formal categories that constitute a taxonomy are but convenient fictions of dubious reality, some groups are better than no groups at all" (378). This is a very questionable conclusion even given the predictable proviso on the part of the manuals' writers that they should be used only by highly trained professionals.

         M. Tracie Shea, in "Interrelationships among Categories of Personality Disorders," picks up the theme of slippery diagnoses touched on by other authors. In a good summary passage, Shea says

 

The DSM classification system for personality disorders, like that for the Axis I disorders, is a categorical one, based on the medical model/disease-oriented approach to diagnosis. By definition, this approach assumes that a disorder is present or absent, according to the presence or absence of specified criteria. It has become increasingly clear that this classification approach is not well suited for the domain of personality (e.g., Grove & Tellegen, 1991; Livesley, 1991; Widiger, 1991b).Whereas categorical systems depend upon clear boundaries, most personality features appear to be continuously distributed, without clear separation of abnormality from normality. In addition, the features defined by the various categories are not mutually exclusive; patients can and do show features of more than one disorder. Thus, the boundaries among the categories and between abnormality and normality are inherently indistinct (398)

 

This goes to the heart of why systematized psychiatric diagnosis is ultimately a doomed project. The refusal of the profession to acknowledge this truth in its ideological defenses of the manuals simply underscores its own duplicity and goes a long way towards explaining why psychiatry continues to be regarded by the rest of the medical establishment as "low man on the totem pole." Shea continues:

 

. . . certain features of Axis II criteria sets are likely to contribute to the problems of unreliability, overlap, and heterogeneity within disorders (Shea, 1992). These include (1) lack of clarity regarding the definition and number of constructs covered by the criteria; (2) differences among criteria in level of inference; (3) overlapping criteria, and (4) differences among criteria in terms of explicit statements about motivation. (399)

 

Despite these stinging indictments, as I have indicated above their subversive potential has been more or less eliminated through a process of rhetorical incorporation. Also, the infrequency of expression of such arguments is indicative of the fact that the position represented by the manuals brings with its adoption significantly greater economic power.

         As we have come to expect, Alfred M. Freedman, et al.'s Issues in Psychiatric Classification: Science, Practice and Social Policy begins with a list (three pages long) of contributors and conference discussants with their titles and affiliations. Impelled by the centrality of the subject of classification for the profession of psychiatry, these articles examine the topic from various perspectives, some of them critical. For example, in

A. M. Freedman, et al.'s "The Range of Issues in Psychiatric Classification" economic issues are frankly discussed.

 

In the United States, the development of third party payment made it vital that more accurate and defensible diagnoses be made in order to obtain reimbursement. . . . the denigration of mental illness in public programs because of alleged lack of scientific rigor in regard to diagnosis and treatment mobilized the field to protect itself . . . (2)

 

This is no small matter, even if there is a host of other legitimate objections to the manuals' classificatory apparatus. Indeed, "It has been said by many that in the United States reimbursement determines medical practice" (4), and of course the situation between 1986, when this book was published, and today has deteriorated in this respect, with the seizing of the field of medical care by insurance companies and health-maintenance organizations.

         In "What Are Mental Disorders?" R. E. Kendell feels we should return to the drawing board at the level of definition of basic terms; even here, or especially here, lack of clarity leads to a variety of other difficulties. He speaks  ". . . of what are variously described as mental or psychiatric disorders, diseases, or illnesses. For whatever one chooses to call them, they have never been satisfactorily defined . . ." (23). If this is true, then how can one base satisfactory diagnoses upon them? Kendell feels that "The most fundamental issue . . . is whether disease and illness are normative concepts based on value judgments, or whether thay (sic) are value-free scientific terms; in other words, whether they are biomedical terms or sociopolitical ones" (25). If they are the latter, then culture has found a chink in medical science's wall. In an excellent review of the evolution of our current notions of "syndromes," Kendell comments on:

 

. . . medicine's ever changing conception of the fundamental nature of its subject matter. . . . in the 17th century, Sydenham developed the idea of disease as a syndrome, a constellation of related symptoms and signs with a characteristic time course and outcome . . . . from a syndrome observed at the bedside to a characteristic morbid anatomy observed in the cadaver. . . . cellular derangements . . . abnormal chromosomes, genes and molecules. (27-28)

 

concluding that ". . . only organisms suffer from diseases, not isolated organs" (31). He focuses on the criterion of "significant impairment" of functioning but cautions rightly that "The problems of deciding when functioning is significantly impaired are greatest of all where mental or psychiatric disorders are concerned" (34). In the last analysis, disease and health, for some, "are not scientific or biological terms at all. They are fundamentally evaluative or normative terms"(36). This line of reasoning leads him to the heretical conclusion that the best would be "to concede openly that psychiatric classifications are not classifications of diseases or disorders, but simply of the problems psychiatrists are currently consulted about "(41), which would undermine the credibility as science of what the profession professes.

         P. Pichot picks up the thread of critique in "Bases and Theories of Classification in Psychiatry." He distinguishes between social, descriptive, and theoretical levels, which he claims are collapsed in the manuals. He says:

 

The present, usually acknowledged psychiatric nosologies, of which ICD-9 is a prototype, are a hodge-podge. . . . they are pseudo-classifications. . . where social practical considerations are foremost in the definition. . . . some categories (manic-depressive psychosis, schizophrenia, or the subtypes of neurosis) belong to a descriptive label . . . others (the organic psychotic conditions) belong to a theoretical level (67)

 

Then, in "On the Uses and Misuses of Psychiatric Classification" I. Silverman identifies how classification is used "politically" (pace Foucault). "The relevance of psychiatric classification to social control applies in all three arenas of political action—class politics, power politics, and status politics" (202), each of which he defines and discusses. If one admits the possibility of this position, then it becomes clear why culture has been so thoroughly excluded from the manuals, designed as they have been in a racially and ethnically repressive society, which is perhaps arguably most so at the heart of its most conservative institutions, such as academic medicine.

         As a last example, I want to cite William H. Reid and Michael G. Wise's DSM-IV Training Guide. Since the manuals themselves are so unwieldy, a whole series of ancillary "training" materials has grown up around them. True to form, this book begins with the hallowed listing of names and affiliations; here, however, we find them even on the cover and title page, so as not to miss the point that we are dealing with a consecrated book. (Even the Bible doesn't have God's name on the cover or title page!) In this guide, we find an unusual consideration of culture.

 

Limitations in transcultural applications of DSM-IV disorders and techniques. Many persons live in, or come from, cultures different from that of the evaluating clinician or those on which most of the DSM-IV criteria are based. A clinician involved in transcultural assessments should understand both normal and psychopathological aspects of individuals in the "foreign" group and be sensitive to the possibility of misunderstanding, even when he or she has considerable clinical experience. . . . Appendix I outlines a method for cultural formulation and presents a brief glossary of culture-bound syndromes. (15)

 

This represents an improvement over previous manuals but, of course, is too sketchy to be of any clinical value and seems to have been included more for purposes of pretending to be inclusive rather than to prepare the reader for better diagnoses.

 

IV. Conclusions

 

         My conclusions can only be rather bleak ones, most of which have already been suggested. First and foremost, even though the perspective of alternative cultures is clearly all but completely absent from the current manuals, what good would it do to include this perspective in a work that is so fundamentally flawed as to be scientifically useless if not actually damaging? A solid basis in social theory and medical history makes evident that, except for purely academic purposes that can have little benefit for practitioners, psychiatric nosology is not a domain for empirical/statistical research. The use by insurance companies, health-maintenance organizations, and other organizations such as hospitals and nursing-care facilities of diagnoses generated by "professionals" referring to the manuals is reprehensible, unethical, and possibly actionable in courts of law. This is true despite the heavy-handed wielding of "authority" by the authors of these documents, which should be able to stand on the basis of their own internal consistency, backed up by replicable validity and reliability field studies, which, of course, they are not.

 

References

 

Castillo, Richard J. Culture & Mental Illness: A Client-Centered Approach. Pacific Grove: Brooks/Cole, 1997.

 

Davis, Roger, and Theodore Millon. "On the Importance of Theory to a Taxonomy of Personality Disorders", in Livesley.

 

Freedman, Alfred M., et al. Issues in Psychiatric Classification: Science, Practice and Social Policy. New York: Human Science Press, 1986.

 

_____, et al. "The Range of Issues in Psychiatric Classification," in Freedman.

 

Kendell, R. E. "What Are Mental Disorders?", in Freedman.

 

Kirk, Stuart A. and Herb Kutchins. The Selling of DSM: The Rhetoric of Science in Psychiatry. New York: Aldine de Gruyter, 1992.

 

Livesley, W. John, ed. The DSM-IV Personality Disorders. New York: The Guilford Press, 1995.

 

Millon, Theodore, and Roger Davis. "Conceptions of Personality Disorders: Historical Perspectives, the DSMs, and Future Directions," in Livesley.

 

Pichot, P. "Bases and Theories of Classification in Psychiatry," in Freedman.

 

Pincus, Harold, et al. Diagnostic and Statistical Manual of Mental Disorders: Primary Care Version. 4th ed. Washington, D. C.: American Psychiatric Association, 1995.

 

Reid, William H., and Wise, Michael G. DSM-IV Training Guide. New York: Brunner/Mazel, 1995.

 

Shea, M. Tracie. "Interrelationships among Categories of Personality Disorders," in Livesley.

 

Silverman, I. "On the Uses and Misuses of Psychiatric Classification," in Freedman.

 

Tyrer, Peter. "Are Personality Disorders Well Classified in DSM-IV?", in Livesley.

 

 

 

Edward F. Edinger. The Eternal Drama: The Inner Meaning of Greek Mythology. Boston: Shambhala, 1994. Edited by Deborah Wesley. xiv + 210 pp. 0-87773-989-7, $14 paper. Reviewed by Harry Polkinhorn, English, San Diego State University.

 

         At the end of the twentieth century, why myths, and why Greek myths at that? According to Edward F. Edinger (d. July 17, 1998),* myths provide us with a means of achieving a relationship between ego consciousness and the transpersonal realm of the Jungian collective archetypes. If we are careful to bear in mind Eliade’s insight that “Not a single Greek myth has come down to us in its cult context,"** Greek myths offer the Westerner access to stories that embody elements analogous to many of our most basic psychological predispositions. If we can “build a personal connection to the myth” (3), then we may come to see the sources of meaning they reflect. Edinger’s program, like Jung’s, is the improvement of our common lot. “To the extent that we can cultivate awareness of this transpersonal dimension,” says Edinger, “life is enlarged and broadened” (3).  Calling on sources as diverse as Milton, Bunyan, Clement of Alexandria, Euripides, Hesiod, Jung, Nietzsche, Sophocles, and Virgil, among others, Edinger pursues a systematic, insightful, and wise analysis of some of the main Greek myths and related subjects, always presented in the balanced, accessible, clear, yet probing style he made his own over the course of his scholarly career.

         In an introductory chapter Edinger lays out an understanding of mythology in straightforward, comprehensible, yet penetrating terms, always approached from the point of view of Jung’s analytical depth psychology. Myths are seen as a special kind of story, “the self-revelation of the archetypal psyche” (2). As such, and especially given the necessary condition of the “personal connection” mentioned above, the author establishes a theoretical framework for his reading of Greek mythology. Analytical psychology, founded as it was on a basis of “amplification” of the symbol through comparatively relating it to myths, fairy tales, religious traditions, art, and fantasy, provides him with such key concepts as individuation, the ego, the Self, the shadow, anima and animus, and the ego-Self axis.  In so doing, and much to his credit, Edinger avoids attempting to elucidate one complicated, interlinking, comprehensive, open-ended, and long-lived set of imaginative constructs by rigidly applying what some have seen as an overly arcane psychological theory. 

         Edinger starts at the beginning with the myth of origins. In this discussion, just as in those that follow of individual gods, goddesses, Titans, heroes, and so on, Edinger gives the reader a quick summary of the central version(s) of the myth, which he then goes on to elucidate from the perspective of contemporary depth psychology. The stories, then, retain their primary attraction as fascinating narratives of how the world came into being, the hero’s adventures, breaking away from the family influence, achieving a position in the world, confronting one’s fears, finding the balance between self and community, religious transformation, and so on, while at the same time lending themselves to a mode of psychological interpretation that makes sense specifically to the contemporary reader in ways that would probably not have been the case in earlier times.

         Each of the gods, goddesses, and heroes, as a relatively pure carrier of a given archetype or predisposition for human transformation, can be seen as concretizing a set of possibilities for relatedness (or its failure), action in the world, or moral growth. Edinger is especially good at suggesting the relevance of narrative sequence and conflict to psychological development. His work enlivens Greek mythology, which has been abandoned in the Western world, and therefore, according to Jung, it has retreated to the unconscious where it appears in dreams, symptoms, and fantasies. Edinger’s discussion enriches the original stories through opening up a deeper set of connections to the structures and processes of the psyche. After being exposed to the predominantly intellectualized and somewhat abstract, dry approaches to mythology found in thinkers even as close to Jung as Eliade, Campbell, Kerényi, and (with qualifications) Rank, readers will find Edinger’s voice to be warm and engaging. This book is highly recommended for those with an interest in approaching Greek myths from a new perspective, one that promises to keep them alive during a period of increasing cynicism, materialism, and spiritual aridity.

 

 

_____       

 

*The Friends of Jung Newsletter, 22:1 (Spring 1999), 3.

 

**Mircea Eliade, Myth and Reality. New York: Harper & Row, 1963, p. 158.

 

 

 

 

Hysteria

 

                       ". . . the key to hysteria as well really lies in dreams"

                                                                                   

                                                             —Freud (St. Ed: I, p. 276)

 

         Sta. Teresa's ecstasies can be understood as reverse hysteria.  As the vision of God throws her into a divine swoon, the social/biological world is forgotten. Hysteria's mute language of local deadening spreads to her entire body, whose nullification in the apotheosis of its own repressed desires operates the conversion at the level of totality. It was not until the late 1880s that Freud began to reformulate this repressed dimension through his work on hysteria. In Stuart Schneiderman's formulation, "analysis was taught to Freud by hysterics."1

         As the medical/mechanistic model of human reality was losing its hegemony over the European mind, strictly mental phenomena increasingly fascinated thinkers and researchers. Charcot's work with hypnosis was a bridge crossed by Freud on his way to formulating a general theory of the relationship between the conscious and unconscious modes.2 Breuer and Freud, for example, based their early work on strategic differences of position from Binet and Janet, as the following demonstrates:

 

If it seems to us, as it does to Binet and Janet, that what lies at the centre of hysteria is a splitting off of a portion of psychical activity, it is our duty to be as clear as possible on this subject. It is only too easy to fall into a habit of thought which assumes that every substantive has a substance behind it—which gradually comes to regard 'consciousness' as standing for some actual thing; and when we have become accustomed to make use metaphorically of spatial relations, as in the term 'sub-consciousness', we find as time goes on that we have actually formed an idea which has lost its metaphorical nature and which we can manipulate easily as though it was real. Our mythology is then complete. All our thinking tends to be accompanied and aided by spatial ideas, and we talk in spatial metaphors. . . . We shall be safe from the danger of allowing ourselves to be tricked by our own figures of speech if we always remember that after all it is in the same brain, and most probably in the same cerebral cortex, that conscious and unconscious ideas alike have their origin. How this is possible we cannot say. (St. Ed.:  2, pp. 227-28)

 

Through clinical experience, Breuer and Freud came up against observable phenomena for which medical science with its physicalist models did not provide an explanation. As they focused in tightly on the complex of symptoms known under the rubric "hysteria," the principle of difference emerged with compelling force. Thus, according to Ernst Kris, "Fliess's Aufstellung der Nasalen Reflexneurose rührte an eines der lebhaftesten Interessen Freuds, an das Problem der Differentialdiagnose hysterischer und somatischer Störungen, das Freud schon in Paris beschäftigt hatte." ("Fliess's conception of the nasal reflex neurosis touched on one of Freud's keenest interests, the problem of the differential diagnosis of hysterical and somatic disturbances, which Freud had already concerned himself with in Paris." HP; in Sigmund Freud, Aus den Anfängen der Psychoanalyse: Briefe an Wilhelm Fliess, Abhandlungen und Notizen aus den Jahren 1887-1902, London:  Imago, 1950, p. 30). Here, Freud and Breuer begin by agreeing that hysteria is characterized by a "splitting off"; then in a dialectical turn, they shift to a linguistic analogy between what syntax dictates about the world of the signified, and how we think this splitting off as an image of the greater division between consciousness and unconsciousness; such a move is viewed in the earlier formulation with derision as "mythology."  This then allows them to begin to establish a fresh position, "safe from the danger of allowing ourselves to be tricked by our own figures of speech". To finish the movement, the unavoidable spatial metaphor is indeed invoked; however, it proves unworkable:  "How this is possible we cannot say."  Indeed, the structural inability of expository syntax to "say" anything about the genesis of hysterical symptoms becomes a central concern at the dawn of psychoanalysis and of early modernism, which can be effectively viewed as coterminous efforts. Even as Freud failed to bring the analysis of Dora to completion, so failure becomes a constituting feature of modernism. 3 Language, then, was implicated almost from the beginning. This was Freud's real break with Charcot; although Charcot was assured "for all time. . . the fame of having been the first to explain hysteria,"4 Rose aptly points out that Freud rejected Charcot's rigid physicalist-controlled model of hysteria.5 Freud himself went so far as to see implicit relations between poetic language and schizophrenia.  The "mechanism of creative writing is the same as that of hysterical phantasies."6

         The first effort, then, was characterized by a rethinking of the relationship between soma and psyche with relation to the hysterical symptom (in our analysis, forms of spontaneous anaesthesia, or the conversion symptoms' body discourse unable to "say" anything sensible).  On January 11, 1893, Freud addressed a meeting of the Vienna Medical Club, taking his position:  ". . . dass die nächsten Gründe für die Entstehung hysterisicher Symptome auf dem Gebiete des psychischen Lebens zu suchen sind." (". . . that the immediate reasons for the development of hysterical symptoms are to be looked for in the sphere of the psychical life." St. Ed.: 3, p. 27). Breuer's experiences with Anna O. (Bertha Pappenheim, a friend of Martha Bernays, Freud's wife7) had provided him with all the fuel he felt he needed to launch his attack on the unknown, in its manifestations in the damaged and buried psyche. 8 As a medical scientist, Freud felt compelled by his training to view the situation as a problem to be solved: "es war sozusagen der erste durchsichtig gemachte Fall von Hysterie [Anna O.]" ("we may say that it was the first case of hysteria [Anna O.] to be made intelligible." St. Ed.: 3, p. 30). I would like to place the emphasis here on sozusagen (we may say, so to say) and durchsichtig (intelligible, transparent). Whereas the clarity and resolution which Freud sought are felt in the language itself, descriptors being invoked to further this process, the impossibility of this course is sensed: sozusagen. One cannot say it directly, only approximately, through use of connotation, figures of speech, and the like. Thus, according to Michel de Certeau, "Freud opened up this perspective as early as the Studies on Hysteria (1895), with a gesture which joined the discovery of psychoanalysis with the necessity of betraying scientific discourse and of moving into the camp of the 'novelists' and 'poets'." 9

         Writing in 1900 (revisions thereafter) and basing himself on the one case of Dora (Freud wrote only five case histories), whose singularity he goes to great lengths to justify, Freud then advances his next observation, the connection of the symptom with an affect-laden experience:  "hinter den meisten, wenn nicht hinter allen Phänomenen der Hysterie ein mit Affekt betontes Erlebnis steckt. . ." ("there is an affectively coloured experience behind most, if not all, phenomena of hysteria. . ." St. Ed.: 3, p. 30). This experience or series of experiences reveals itself during the analysis, the function of which it becomes to bring the patient into an awareness of these experiences so as to be able to unlock their hold. Freud goes on to say that "Es besteht eine volle Analogie zwischen der traumatischen Lähmung und der gemeinen, nicht traumatischen Hysterie." ("There is a complete analogy between traumatic paralysis and common, non-traumatic hysteria." St. Ed.: 3, pp. 30-31). The formulation is thereby broadened. Note, however, how Freud resorts to "Analogie" in his attempts to put into syntax an antithetical dimension. In an analogy, one detects a correspondence between things which are in other respects dissimilar. That is, analogy functions on a constituting basis of partial difference. An inference is drawn. Clearly the use of verbal language becomes all important both from the viewpoint of the clinician "working up" his data and from that of the analyst digging into the psyche. "Es besteht gleichsam eine Absicht, den psychischen Zustand durch einen körperlichen auszudrücken, und der Sprachgebrauch bietet hierfür die Brücke." ("It is as though there were an intention to express the mental state by means of a physical one, and linguistic usage affords a bridge by which this can be effected." St. Ed.: 3, p. 34). The body becomes site of the (sometimes a-syntactical) "sentences" (utterances) of the unconscious; at the same time, verbal language provides the means whereby the analyst can gain access to this unconscious:  ". . . der Sprachgebrauch bietet hierfür die Brücke." (". . . linguistic usage affords a bridge. . ."). However, even at this point Freud must make use of a metaphor.

         The next move introduces the important theme of memory. ". . . so kommt eine Reihe von Erinnerungen über ihn." (". . . he will produce a series of memories" St. Ed.: 3, p. 35). These memories of course are unconscious patterns of energies which produce affective or neurological conflicts throughout the patient's body.  Freud works backwards to the notion that the hysteric suffers from traumatic experiences which have not been "abreacted." He proceeds to detail how the initial experiences conceal earlier ones, whose origins are sexual in nature:  ". . . kein hysterisches Symptom aus einem realen Erlebnis allein hervorgehen kann, sondern dass alle Male die assoziative geweckte Erinnerung an frühere Erlebnisse zur Verursachung des Symptoms mitwirkt"  (". . . no hysterical symptom can arise from a real experience alone, but that in every case the memory of earlier experiences awakened in association to it plays a part in causing the symptom." St. Ed.: 3, p. 197),  and ". . . endlich gelangt man unfehlbar auf das Gebiet des sexuellen Erlebens" (". . . in the end we infallibly come to the field of sexual experience." St. Ed.: 3, p. 199), specifically triggered during puberty. 10 Freud repeats that the symptoms are intimately bound up with memory: ". . . hysterische Symptome immer nur unter der Mitwirkung von Erinnerungen entstehen. . ." (". . . hysterical symptoms can only arise with the co-operation of memories" St. Ed.: 3, p. 197). These complexes are further explored in Freud's writing; out of them came the rudiments of the psychoanalytic technique, since "Der Moment, in welchem der Arzt erfährt, bei welcher Gelegenheit ein Symptom zum ersten Male aufgetreten ist und wodurch es bedingt war, ist auch derjenige, in dem dieses Symptom verschwindet." ("The moment at which the physician finds out the occasion when the symptom first appeared and the reason for its appearance is also the moment at which the symptom vanishes." St. Ed.: 3, p. 35).  This of course presumes that that same moment is shared by the patient, assuming a coterminous coming to awareness with the expression in language of the experience. The full power and workings of transference are not yet grasped, possibly accounting for Freud's failure with Dora, a failure of seemingly endless interest for scholars interested in debunking Freud's supposed sexism.11 In this connection, on men theorizing about hysteria, note the following: "Men, Mark Kann points out, tend to detach themselves from woman's violence and 'hysteria,' especially when it is directed against male rationality and domination. Men know (that is, can theorize envision,  overlook, oversee) what feminine 'hysteria' is about. They believe it is an untheorized practice, an unconscious rage that has not been elevated to theoretical consciousness and thereby controlled. . . Male theoretical detachment in the face of feminine 'hysteria' is, like all theory that succeeds always in balancing all the equations, simply a less evident form of hysteria and violence. And 'female' hysteria might be a 'rational,' therapeutic, and potentially revolutionary form of violence." 12

         I have attempted to trace some high points of Freud's early meditations on hysteria as he was working out the techniques of psychoanalysis and its foundation in a conception of the relation of the conscious and unconscious modes. Of perhaps greater interest, however, is the parallel, embedded tale which Freud's structures of expression tell.  Some of these I have pointed out above, that is, his reliance upon figures of speech and qualifiers such as sozusagen. As well, implicit in Freud's thinking is the audience to whom his address was directed, the Vienna Medical Club. "Meine Herren" he frequently repeats, establishing the proper sociolinguistic relationship between address and addressee. This is a man speaking to men, and what about?  About women, specifically women with mysterious symptoms of local deadening, vomiting, anorexia, convulsions, and so on, which it has become the business of the project to track down to their presumed single (monolingual) source. A linguistic model, then, hypostatizes the presence of a speaker, implying an underlying identity or subjectivity which it becomes the goal of an analysis to bring into functionality. This, however, cannot be, as the paradox is structurally built into psychoanalysis. Freud's abandonment of the seduction theory and subsequent formulation of the Oedipus complex stemmed from his realization that "fantasy" and "reality" are dialectically related, ruling out an originary position for one or the other.13 The form which the discourse then assumes, as I have indicated, is that of the empirical science of Freud's day: a drive for understanding, reason, and clarity, for a world in which everything makes sense, even the senseless or unthinkable relations between being and nonbeing receiving their grid-point within this grander scheme of things.

         That this was a doomed ambition was even then implicit in Freud's address, as his reliance upon figurative language indicates. There can be no logically necessary and hierarchically related connections between such language and that of syntax and control. Other evidence is readily at hand. In the trajectory traced by the "Fragment of an Analysis of a Case of Hysteria" (1905 [1901]), we see Freud moving further away from the sterilized, idealized  discourse of the master model in which he had been so well trained by Brentano, Meynert, and Brücke.14  As if  by way of introduction to the "tale" itself, Freud offers a long defense for the necessity of secrecy,  or "the duty of medical discretion." (St. Ed.: 7, p. 8). Again, the audience is made up of men, the moral sensitivities of whose wives and daughters Freud is implicitly and elaborately pretending to protect through this excursus. Now secrecy is the domain of the unconscious itself. Freud will even filter the experience further, he assures his audience, through publication in a "streng wissenschaftlichen Fachjournal. . ." ("purely scientific and technical periodical. . ." St. Ed.: 7, p. 8). This flatters the listeners, suggesting that their professional code cannot be deciphered by a lay audience; it also suggests access to a greater degree of truth. The unstated masculine bond upon which patriarchal scientific culture is based is thereby reaffirmed. In terms of plot motivation, these and other references function to build suspense; what will this shocking revelation be? Freud goes on to use the term "Schlüsselroman" ("Roman a clef" St. Ed.: 7, p. 9); by implication, his tale will be difficult for the lay reader to unlock15 because he is going to such lengths to disguise the main character's social identity, a curiously revealing ruse given that the goal of the analysis was to establish this identity.  Thus he finds himself resorting to aesthetic and other non-scientific categories.  As a final defense for his approach, he says, "Die Niederschrift ist demnach nicht absolut—phonographisch

—getreu, aber sie darf auf einen hohen Grad von Verlässlichkeit Anspruch machen." ("the record is not absolutely—phono-graphically—exact, but it can claim to possess a high degree of trustworthiness" St. Ed.: 7, p. 10). After all, Freud did not have a tape recorder during the sessions; to a certain degree, he may therefore have been fashioning the parts to make the story develop smoothly. Still, it is, he assures us, highly reliable.

         After these rather amazing provisos, Freud's analysis takes an even more astounding turn. "Nehmen Sie an, ein reisender Forscher käme in eine wenig bekannte Gegend." ("Imagine that an explorer arrives in a little-known region." St. Ed.: 3, p. 192). Here he drops all pretense to scientific objectivity and frankly uses structures heretofore reserved for literary purposes.16 This sounds almost like the opening of the Divine Comedy. We are introduced to an extended metaphor, and running throughout the essay is the notion of the journey over difficult terrain in search of the origin of hysterical symptoms.17  Freud, however, will guide us, and indeed the whole demonstration has something of the staged quality of Bernini's revelation of the Piazza Navona monument to the Pope, as if the narrator were withholding the denoument until its proper (i.e., most dramatically astounding) moment; how one comes on the "truth," therefore, is as important as the truth itself. Performance implicates the observer (Freud or the reader), in this important example of the method which Freud learned from Brentano, namely, granting a role to psychic contents through performing the experiment on himself (cf. "On Coca").  ". . . der Weg von den Symptomen der Hysterie zu deren Ätiologie is langwieriger und führt über andere Verbindungen, als man sich vorgestellt hätte." (". . . the path from the symptoms of hysteria to its aetiology is more laborious and leads through other connections than one would have imagined" St. Ed.: 3, p. 193). Place the emphasis here on vorgestellt  ("imagined").  But fear not, as the goal will be reached, if we can but entrust ourselves to the guide (who is pretending to defer to the "facts"). "Sie erraten es wohl, meine Herren, dass ich jenen letzten Gedankengang nicht so weit ausgesponnen hätte, wenn ich Sie nicht darauf vorbereiten wollte, dass er allein es ist, der uns nach so vielen Verzögerungen zum Ziele führen wird." ("You will no doubt have guessed, Gentlemen, that I should not have carried this last line of thought so far if I had not wanted to prepare you for the idea that it is this line alone which, after so many delays, will lead us to our goal." St. Ed.: 3, p. 202). This quite remarkably identifies the coming upon the goal with the spinning of the tale. In spite of the bravado with which Freud pulls all this off, as matters were to develop the analysis was abruptly terminated by Dora on December 31, 1900; that is, the aesthetic resolution which occurs when matter and manner successfully blend in the voice of the first-person narrator is damaged when the analysis is broken off (when "reality" asserts itself). This act on Dora's part may have been one of vengeance against the analyst for his tacit complicity with her father, Herr K., and Frau K.18  However, since the case is being written up after its interruption, and since its fragmentary nature has been made structural, the discrepancy between signifier (Ida Bauer's inner life as revealed through her words to her analyst) and signified (the tale constructed of these words)  does not prove a difficulty; what we have, what we are being provided with, is only the story, or as de Certeau puts it, "His manner of treating hysteria transforms his manner of writing. It is a metamorphosis of discourse."19

         I have tried to show how Freud's early thinking/expression moved rather quickly from the hypothetically transparent syntax of scientific discourse to a denser, figure-laden language in which we are brought from the failed Enlightenment enterprise back down into the dimension of history, specifically the flawed time of hysterical suffering in which figure and ground are intertextually related. This is precisely, I would argue, what constituted the precipitation of psychoanalysis between 1890 and 1905. Through this discipline (and specifically through its genesis out of hysteria), western thinking was returned to the repressed experiences (including the repression of the Mother) which had permitted it to constitute itself in the first place. It is only in this sense, then, that hysteria can be said to be a "period" illness, as Jameson on Lacan indicates: "'hysteria puts us, so to speak (cf. Freud's sozusagen above!), on the track of a certain original sin of psychoanalysis,' by which he evidently means the relationship of this 'science' to its historical situation. . . Hysteria in this sense may be understood as a historically new feature of the more general phenomenon of reification."20 True, but such an observation may be made about any of the classical mental aberrations. The "original sin" of psychoanalysis was not its fascination with hysteria (we only "see" the symptoms) but with the causes, which lead Freud out of safe science and into the dangerous forest.

         This forest, it has been suggested, was the transference effect which Freud was unaware of soon enough for him to be able to account for its workings in his treatment of Ida Bauer. Once transference and countertransference are recognized, goes the argument, then the analysis can proceed with greater certainty of success. However,  my interest is not in the course of therapy but in Freud's happening on a dimension of experience which is antithetical to how discourse categorizes. In order for the discussion to proceed, then, a new "turn" is necessary, namely, the dialectical-process relationship which Lacan has formulated. "For 'truth' is the name of that ideal movement which discourse introduces into reality. Briefly, psychoanalysis is a dialectical experience" ("Intervention of Transference," in Bernheimer, p. 93).  Out of this new constitution, a lopsided tension drags the hysteric back from a fuller engagement with life. Lacan pushes hysteria as a category beyond the predominantly therapeutic uses which Freud made of it.21 The former's interest, building on the bipartite structure of transference as a locus of the unknown and the unknowable, finally coheres with Freud's preoccupations in that it attempts to comprehend hysteria through redefining it. The terms of the redefinition, of course, build on those of Freud. "But it can happen that women too are soulful in love [amour-euses], that is to say, that they soul for the soul. What on earth could this be other than this soul for which they soul in their partner, who is none the less homo  right up to the hilt, from which they cannot escape? This can only bring them to the ultimate point—(ultimate not used gratuitously here) of hysteria, as it is called in Greek, or of acting the man, as I call it, thereby becoming, they hoot, hommosexual or outsidesex."22 Lacan's rejection of a position outside sex, even (especially) for the hysteric, must be read in the above context as an ironic retelling of Freud's tale.23 Metaphor24 and figuration open the gap, effect the cut,25 so that Lacan can go on in a characteristically self-implicating move to involve himself directly in the formulations:  "The truth, he said, was that he was a perfect hysteric; he added that a perfect hysteric is one without symptoms," and "the only way to talk about a perfect hysteric is theatrically."26

         This reintroduces Bernini's stagey baroque effects as seen in the iconography of Sta. Teresa's hysterically mute statements in marble of the death of identity, sexual and social. When Debord speaks of the spectacle, we know we are finally lost in the dream-like driftings of modernism:  "The spectacle, as the present social organization of the paralysis of history and memory, of the abandonment of history built on the foundation of historical time, is the false consciousness of time," and "The historical time which invades art expressed itself first of all in the sphere of art itself, starting with the baroque. Baroque is the art of a world which has lost its center: the last mythical order, in the cosmos and in terrestrial government, accepted by the Middle Ages—the unity of Christianity and the phantom of an Empire—has fallen."27 Hysteria as a period disease of reminiscences, then, leads from the late nineteenth-century crumbling ruins of reason's grand structures in idealist and analytic philosophy as well as the bankrupt "foundations" of the so-called hard sciences out of such discourse altogether. The story changes:   Word becomes image directly.

 

Notes

 

1Jacques Lacan: The Death of an Intellectual. Cambridge: Harvard University Press, 1983, p. 58.

 

2"Freud's stay in Paris and his contact with Charcot had the effect of focusing his professional interest on hysteria, and this subject provided an ideal vehicle for exploring further that border area Brentano had pointed to between the physical and psychological sides of mental life." William J. McGrath, Freud's Discovery of Hysteria: The Politics of Hysteria. Ithaca: Cornell University Press, 1986, p. 151.

 

3". . . it ["Fragment of an Analysis of a Case of Hysteria" (1905 [1901])] is about a kind of failure".  Steven Marcus, "Freud and Dora: Story, History, Case History," in Charles Bernheimer and Claire Kahane, eds. In Dora's Case: Freud—Hysteria—Feminism. New York: Columbia University Press, 1985, p. 57.

 

4Freud, in McGrath, p. 159.

 

5"Perhaps we should remember here that Freud's work on hysteria started precisely with a rejection of any simple mapping of the symptom onto the body (Charcot's hysterogenic zones). By so doing he made of hysteria a language (made it speak) but one whose relation to the body was decentered, since if the body spoke it was precisely because there was something called the unconscious that could not." Jacqueline Rose, "Dora:  Fragment of an Analysis," in Bernheimer and Kahane, p. 138.

 

6"And since such figuration, as Freud noted in 1897, has much in common with hysterical fantasies ("The mechanism of poetry [creative writing] is the same as that of hysterical phantasies"—St. Ed: I: p. 256), one might argue that Freud's ambivalence about the literary aspect of his work reflects his uneasy awareness of his own hysterical potential." Charles Bernheimer, "Introduction Part One", in Bernheimer, p. 11. Note also, "It is no coincidence that at this stage it is schizophrenia that is invoked as frequently as hysteria, since the relation between schizophrenia and poetic discourse is a recognized and accredited one within psychoanalysis." Rose, in Bernheimer, p. 137.

 

7Freud, Letters, p. 41. Incidentally, although it predated Freud's experiences with Dora, this spectacularly failed case resembles the latter in that neither was brought to conclusion at least in part because of a lack of understanding of the powerful effects of transference and negative countertransference (see note 18 below).

 

8"It was the experience inaugurated with this hysterical patient that led them to the discovery of the pathogenic event known as the traumatic experience." Jacques Lacan, Speech and Psychoanalysis, Baltimore: Johns Hopkin University Press, 1968, p. 16.

 

9Heterologies: Discourse on the Other, Minneapolis: University of Michigan Press, 1986, p. 51.

 

10Freud of course went on to generalize this discovery: "Den entscheidenden Fund, dass der Mechanismus der Angstneurose 'in der Ablenkung der somatischen Sexualerregung vom Psychischen und einer dadurch verursachten abnormen Verwendung dieser Erregung' bestehe, kleidete Freud in die Formel 'Der Neurotische Angst ist umgesetzte sexuelle Libido'." ("The deciding discovery, that the mechanism of the anxiety neuroses 'consists of the linking of the physical sexual excitation to the psychic and thereby causing abnormal expenditure of this excitement,' Freud formulated as 'Neurotic anxiety is transmuted sexual libido.'" HP).  Kris, pp. 30-31.

 

11See Maria Ramas, "Freud's Dora, Dora's Hysteria," in Judith L. Newton, et al., Sex and Class in Women's History, London: Routledge and Kegan Paul, 1983; Hélène Cixous, Portrait de Dora,  Paris, 1976; Toril Moi, "Representation of Patriarchy: Sexuality and Epistemology in Freud's Dora," Feminist Review, 9(1981), 60-73; Jacqueline Rose, "Dora:  Fragment of an Analysis," m/f, 2(1978), 5-21; Hannah Decker, "Freud and Dora: Constraints on Medical Progress," Journal of Social History, 14(1981); Ann Kaplan, "Feminist Approaches to History, Psychoanalysis, and Cinema, in Sigmund Freud's Dora," Millenium Film Journal, (November, 1980).

 

12Michael Hopkins, Marxism and Deconstruction: A Critical Articulation, Baltimore: Johns Hopkins University Press, 1982, p. 121.

 

13"Hysteria thus is implicated in psychoanalysis in the sense that the science enfolds the disease within it and is constituted simultaneously with this pathological interiority. Yet psychoanalysis contests this originary implication, insisting on its scientific authority and asserting mastery over hysteria as the illness of the other—typically of the feminine other." Bernheimer, p. 1.

 

14McGrath, pp. 135 ff.

 

15On the metaphor of locks and keys, see Jane Gallop, "Keys to Dora," in her The Daughter's Seduction: Feminism and Psychoanalysis.  (Ithaca: Cornell University Press, 1982).

 

16For an interesting if somewhat narrowly focused early analysis of this case history as a literary text, see Steven Marcus, "Freud and Dora:  Story, History, Case History," Partisan Review (Winter 1974).

 

17Wilden notes the frequency of the journey motif in Lacan and Hegel:  ". . . constant references to the journey of consciousness in the face and company of what is other in the Hegelian Phenomenology . . ." Anthony Wilden, "Translator's Introduction," in Lacan, Speech and Language in Psychoanalysis, p. xii.

 

18Maria Ramas, "Freud's Dora, Dora's Hysteria," in Bernheimer and Kahane, pp. 173-74. Also, Freud confessed, "I did not succeed in mastering the transference in good time." St. Ed.: 7, p., 118.

 

19p. 19.

 

20Fredric Jameson, The Political Unconscious: Narrative as a Socially Symbolic Act. Ithaca: Cornell University Press, 1981, p. 62.

 

21"It would appear that Lacan's crime was to have been unfaithful to hysteria, to have tried to move the psychoanalytic enterprise in a different direction." Schneiderman, p. 59.

 

22Feminine Sexuality, ed. by Juliet Mitchell and Jacqueline Rose,  New York: Norton, 1985, p. 156. Schneiderman phrases this as "The hysteric's question is: Am I a man or a woman?" (p. 59).

 

23None of this makes any sense, needless to say, if removed from the context of Lacan's orders of the symbolic, the imaginary, and the real, as well as his notion of the distinction between the phallus/law and the biological sex organ. "Lacan's writings abound with the promotion of what he calls the Imaginary order (perception, hallucination, and their derivatives) and its distinction from what he calls the Symbolic order (the order of discursive and symbolic action) and the Real. This distinction is derived from the phase of childhood which Lacan calls the stade du miroire: the primary alienation of the infans from "himself" and his subsequent discovery of his Self." Wilden, in Lacan, Speech and Psychoanalysis, pp. xii-xiii.

 

24". . . metaphor. . . the synonym for the symbolic displacement brought into play in the symptom." Ibid., p. 22.

 

25Lacan, "Sign, Symbol, Imaginary," in Marshall Blonsky, ed. On Signs. Baltimore: Johns Hopkins University Press, 1985, p. 203. In this same essay Lacan makes the crucial assertion that "the unconscious is the condition of linguistics" (p. 205), conceivably a reversible proposition.

 

26Schneiderman, p. 16.

 

27Guy Debord, Society of the Spectacle. Detroit: Black & Red, 1983, np.

 

 

 

 

Aniela Jaffé. The Myth of Meaning in the Work of C. G. Jung. Zürich: Daimon, 1983. Trans. by R. F. C. Hull. 188 pp. 3-85630-500-9, SF 29.10 paper. Reviewed by Harry Polkinhorn, English, San Diego State University.

 

          

         In this work it is the author’s intention to explore the basic philosophical/religious question of “the meaning of life” within the context of Jungian psychology. This she does admirably, negotiating the tricky ground between philosophy, theology, psychology, and physics. Part of the problem she faces has to do with the relentlessly empirically based culture in which we live and on whose terms she must present her analysis of matters that have little to do with quantifiable measurements. Rather than offering a critical summary of the philosophy-of-life dimension of Jung’s thought, of which several had already been written before Jaffé’s work was published in its original German in 1967, she organizes her argument around the underlying concepts of individuation and the individual, especially as they have been approached by the theology of Tillich and the prime existentialist question of “meaning.” These concerns lead her to detail Jung’s notion of how a schema derived from his work in the consulting room is then applied to the culture at large through his method of amplification. This line of Jaffé’s argument culminates in a chapter entitled “The Individuation of Mankind” that takes as its central document Jung’s Answer to Job, in which he traces the evolution of what he calls the “God image” in the Western world: from the distant, arbitrary Jehovah to the close, loving Christ (evil having been separated off and consigned to the flames and to Satan) to the situation today in which external religious imagery has been replaced by the internal imagery of the individual psyche.

         Perhaps Jaffé’s most creative contribution, however, can be found in her application of myth theory itself to some of these ideas. That is, Jung’s whole notion of the individuation of consciousness as a basic pattern in which the Self orchestrates (or attempts to orchestrate) meaning over the course of a lifetime is understood by Jaffé as a myth. Just as creation myths go back to origins out of chaos, the ego emerges from its background in the unconscious, then enters into a dynamic and changing relationship with different aspects of that background as it proceeds through its phases of development (order out of chaos, separation of the elements, creation of life, and so on). Meaning becomes equivalent to “ ‘fullness of life’,” and lack of meaning is “ ‘equivalent to illness’” (146). Jaffé points out how Jung always tried to hold the opposites together, in this case meaning and meaninglessness, in spite of the radical contingency involved. As she sums up his position, “A universally valid formula for meaning does not exist” (146) because each individual incarnation takes on shades of difference.

         The general applicability of these considerations has of course been a central preoccupation of much of the best cultural production of our time, which Jaffé points out through citing the entirely relevant examples of Kafka and Beckett in the domain of literature. Both of these writers brought the “no” that symbolizes a full acknowledgement of meaninglessness into the very structure and texture of their works in such a way that it is turned inside out, remaining itself while at the same time becoming its opposite, then back again, in an ongoing set of transformations. We see something similar in the late poems of W. B. Yeats, the works of Paul Celan, and elsewhere especially through mid-twentieth-century European literature, which reflected the impact of the war and the social disorganization and sense of despair that followed it. These events more or less coincided with the time of Jung’s late writings that form the basis of Jaffé’s study. It is precisely the concentration of these extremes in a single individual, poem, or novel, for example, that causes Jaffé to characterize them as manifestations of the archetype of meaning (148). One might speculate that, as in the case of the concomitant appearance of Existentialism itself, they emerged at this particular historical juncture as a kind of cultural antidote to post-war despair. When all the traditional sources of meaning in life have been definitively done away with, the individual is left with his own psyche. What is unusual is how Jaffé conceptualizes this aspect of Jungian theory in strictly mythological terminology. Because her work is ambitious in scope and daring in reach, readers unfamiliar with the disciplines she spans may have some difficulty seeing the real brilliance of her central argument.

 

 Rose-Emily Rothenberg. The Jewel in the Wound: How the Body Expresses the Needs of the Psyche and Offers a Path to Transformation. Wilmette, IL: Chiron Publications, 2001. xi pp. + [10 – 216 pp.]. 1-888602-16-3, $29.95 paper. Reviewed by Harry Polkinhorn, English and Comparative Ltierature, San Diego State University.

 

The Jewel in the Wound gives an account of how its author, Rose-Emily Rothenberg, came to find transformative meaning through the suffering caused by the early loss of her mother, the spontaneous appearance of keloids or scar tissue, physical illness, and relationship stress as an adult. To a necessarily limited degree, we experience something of her story as she recounts it, through her memories, fantasies, and narrative restructuring. The story itself could perhaps only have been told from the first-person point of view in which we get it. As such, Rothenberg is thrown back on the central dilemma of such writing at least since the early twentieth century in the West, summed up as the uncertainty of the narrator. Before going further into this, I want to summarize the content of Rothenberg’s work more directly.

     When she was six days old, Rothenberg’s mother died. She was cared for by a nursemaid, other caretakers, her older sister, and her father. Later, when she was almost 2, her father remarried, introducing another woman into the author’s life. Fear and anxiety characterized her relationship with her stepmother. As a young girl, and later on into adulthood, scar tissue appeared on Rothenberg’s body, causing her emotional pain. As she moved into her adult years she entered into the profession of speech therapy, then began an extended course of analysis with Jungian therapists. This analytic work involved painting and sculpture, as well as active imagination. One day Rothenberg discovered a reproduction in an art book of a Mesopotamian figurine that had what looked to her like representations of scars on its shoulders and breast area. This discovery lead her deeper into an investigation of the keloids, at first from the medical or dermatological viewpoint, then later from the ritualistic perspective. The categorical rejection on the part of some dermatologists of the possibility of a psychogenic origin of the scars, while frustrating, did not stop Rothenberg from pursuing what had become her Ariadne’s thread. Eventually her widening and deepening research brought her to the realization that she wanted to go to Africa to talk with people who had engaged in ritual scarification. This became a profound experience for her, in which she was able to move directly and physically through the landscapes of the projection of the sacred pole of the mother/orphan archetype. As her analysis progressed, she was able to understand the archetypal foundations of such activities. That is, she now had a way to understand her own experience in a manner that was healing and growth-furthering, thereby transforming the scars from incomprehensible, dark, painful realities into the symbolic jewel referred to in her title.

     The Jewel in the Wound is unusual because in it Rothenberg unites several of the main themes or motifs to be found in recent Jungian studies but does so in a unique fashion. First, it is important to realize that her work is not presented as a demonstration of Jung’s ideas as such. Rather, we must understand the relationship between the theory and what William Blake calls the “minute particulars” of Rothenberg’s life experiences. Jung’s work has helped Rothenberg understand something about her life, through her meditations on her dreams, the medium of her art work, and, most importantly for our purposes here, the medium of the language in which we are given the account. Frequently, works in analytical psychology will discuss a theme (that of the darker aspects of emotional experience, for example, in Swamplands of the Soul by James Hollis), citing passages from Jung, fairy tales, literature, and other sources, mixed in with material from the writer’s analytical practice, most often patients’ dreams. However, we learn little to nothing about the narrator, whose position in the telling remains largely unexamined. The Jewel in the Wound, while manifesting some of these practices, rigorously adheres to the first-person point of view, firmly contextualizing all claims about the individuation process in the detail’s of the narrator’s perceived life experiences.

     Such an approach is refreshing and has the advantage of enlivening the discussion of what could otherwise be somewhat abstract and theoretical concepts such as the animus, archetypes, and the shadow. At the same time, we are given the story of a life—one of many possible ways to see form and meaning in the welter of experience—and the bodying forth through the narrative language of the memoir of a fully developed, flexible, and powerful theory of the psyche’s inception, incarnation, structure, and wholly personalized adventure towards its own accomplishment of itself. At the center of this process we find the religious or spiritual problem that so fascinated Jung, who in his conceptualization of the psyche elevated religious experience to the level of a core instinct, a drive for meaning through the confrontation of the ego with the unconscious whereby both are forever changed.

     “The loss of my mother shortly after my birth,” says the narrator, “created the wound that made it possible for me to accomplish my task” (13). So begins this tale of suffering and transformation. Throughout, and especially because of the nature of the keloids, the narrator makes use of the quasi-medical vocabulary of “wounds.” Trauma, a rough synonym, is a term that has meanings in both everyday parlance and clinical theory. In the everyday sense of the word, trauma signifies negative experiences of many kinds, and is used to indicate through exaggeration any unpleasant experience. The dictionary defines the term as “a wound, especially one produced by sudden physical injury . . . an emotional shock that creates substantial and lasting damage to the psychological development of the individual, generally leading to neurosis” (Morris, 1970, 1366). The term derives from Greek, meaning “wound or hurt.” It’s interesting to consider where these meanings do not overlap. Physical wounds heal, whereas emotional shocks presumably do not. Rather, emotional shocks “heal” to the degree that the system produces defenses (the equivalent of scar or repair tissue) that, as a by-product, may delay development. Keloids, the cause of which “is still unknown” (Majno, 6), pose a special problem since they do not serve the purpose of sealing an open wound so that healing can occur. This and other characteristics of her experience with them allowed Rothenberg to use them as a dynamic bridge with the deepest levels of the unconscious, and one of the chief results of this process for her had to do with constellating the individuation process. Curiously, in the ancient world, people were often identified by their scars: “Since the Greeks did not have surnames, in many of these legal documents the individuals are identified by their given name plus any identifying scar (oulé) . . . Otherwise, the individual was labeled ásemos, “not marked” (Majno 316-17).

     Birth trauma (Rank, passim; see also Grof) involves extreme changes for both mother and child and is thus to be considered “social” in nature. Healing, which trauma motivates and which it simultaneously hinders, now can be seen as a lifelong process; birth traumatizes the soul, which forgets what it is and where it came from, requiring an entire lifetime to be healed, a process of remembering. Only through the experiences of a lifetime, the accumulation of the scar or repair tissue of defenses that cover over the traumatic wound, can the soul finally remember who it originally was, achieve its unique identity.  Trauma, then, is accompanied by loss of memory, which is to say that the pain of the severe wounding instantly reorganizes the entire inner world in order to bring about reduction of the pain so as to re-establish something resembling the primary homeostasis. Healing for the soul of the new individual involves remembering how things were prior to the pain, back through the pain wall. The Greek goddess Mnemosyne (memory) was the mother of the Muses (Grant and Hazel, 224). Healing for the mother occurs symbolically through her freshly established ability to project her trauma into the life of the infant, who heals her and makes her, the mother, complete. That is, the whole cloth of the original unity of mother and child is torn asunder during birth, this primal division being mirrored in the overlap between physical pains of childbirth and the emotional pain of separation.

     But what happens if the mother is not there to become the medium for starting this lifelong repair work? This is the “task” to which the narrator refers. The body itself, in her case, stepped in to keep alive the possibility of the life’s task ultimately being performed by the narrator, and it did this through generating the keloids. “Sickness,” says Max Zeller, “is an integral part of life’s totality and the shadow aspect of its eternal flame. . . . this flame . . . brings about growth, formation and transformation. It inspires man’s creativity” (179).

     This much we can understand on the content level of the account. Just as in Jungian theory the outer physical world is balanced by forces at work in the inner world of the oftentimes mysterious psyche, so too one can argue that language itself can be viewed under its outer or its inner aspect. How can we see The Jewel in the Wound’s inside, so to speak? By examining the work as “literature,” that is, as itself imaginative creation with the same ontological claims as the keloids themselves came to be seen by the narrator as having, we can begin to appreciate what is unique about this piece of writing.

     In this regard, perhaps the most important distinction to bear in mind is that between author and narrator. Part of Rothenberg’s artistry lies in how she blends them together. For The Jewel in the Wound to be considered as more than autobiographical reminiscence we must posit the hypothetical construct of the first-person narrator, the “I” or subjective ego center that tells the tale. What’s unusual is that this is specifically a tale of the founding and development of an ego which at the same time is being told by itself. In the words of William James, “The universal conscious fact is not ‘feelings exist’ and ‘thoughts exist’ but ‘I think’ and ‘I feel’” (in Kahan, p. 333). In The Jewel in the Wound  we have no pretense of a transcendental point of view facilitating an objective study of the individuation process. On the contrary, the narrative viewpoint is completely identified with the ego position, as it must be in such endeavors, in such a way that a non-ego position becomes not only possible but inevitable. Thus, her account of her earliest experiences as a very young child is presented through the memory screen of an adult consciousness, after the changes which were yet to happen over the course of the narrator’s unfolding life. In fiction ever since at least Henry James’s renowned The Turn of the Screw (1898), the narrator’s “truth” has come into question; in psychological language, the period of the ego’s hegemony has begun to come to its end. The radical undermining of the narrator continues throughout the twentieth century. What can we trust of what we are told? Because of the massive erosion of the religious attitude in the West, once the ego position has been questioned the reader has been left with either the cynical dark laughter of a Jarry or an Ionesco or the bleak hopleless emptiness of a Samuel Beckett, or, in Jungian terms, the first encounter with the long-repressed shadow elements. On the brighter side, narratively, as the ego discovers itself, we do as well, lending a sense of freshness and discovery to the writing which is meant to parallel that experienced by the narrator as seen from within the tale’s frame.

     Rothenberg’s work is patterned on a move from despair to a sense of profound meaningfulness, because of the role played by the creative relationship between the ego and the unconscious. She manages to accomplish this within the strict parameters of the first-person point of view, since the narrator acknowledges her contingent, limited status in the greater economy of the soul. As such, her position at the end of the story must remain open-ended, as is the narrator’s life. “It,” she says in closing, meaning the task of individuation, “is born as an inspiration, coming from the realm of the unconscious and the Mother, the womb of the psyche. To make the sacred visible and conscious is to discover and retrieve the jewel in the wound” (194). 

 

References

 

Grant, M. & Hazel, J. Who's Who in Classical Mythology. New York: Oxford University Press, 1993.       

 

Grof, Stanislav. Beyond the Brain: Birth, Death, and Transcendence in Psychotherapy. Albany: State University of New York Press, 1985.

 

Hollis, James. Swamplands of the Soul: New Life in Dismal Places. Toronto: Inner City Books, 1996.

 

James, Henry. The Turn of the Screw. New York: W. W. Norton, 1966.

 

Kahan, Tracey L. “Consciousness in Dreaming: A Metacognitive Approach,” in Dreams: A Reader on Religious, Cultural, and Psychological Dimensions of Dreaming, Kelly Bulkeley, ed. New York: Palgrave, 2001.

 

Majno, Guido. The Healing Hand: Man and Wound in the Ancient World. Cambridge, MA: Harvard University Press, 1975.

 

Morris, W., ed. The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin, 1970.

 

Rank, O. The Trauma of Birth. New York: R. Brunner, 1952.

 

Zeller, Max. “Sickness, Suffering and Redemption,” in The Dream—The Vision of the Night. Boston: Sigo Press, 1990.

 

 

 

 

Celebrating Soul: Preparing for the New Religion

Lawrence W. Jaffe

Toronto: Inner City Books

Publication date: Sep., 1999

128 pages

paper

ISBN 0-919123-85-6

illustrations

$16

 

reviewed by Harry Polkinhorn

 

 

 

Lawrence Jaffe’s Celebrating Soul presents a spiritual or religious meditation on Jungian psychology. Like Edward Edinger, whom he cites throughout, Jaffe feels that Jung’s central contribution lies in the area of religious renovation. Rather than recapitulate Edinger, however, it is Jaffe’s explicit task to “put into personal and feeling terms the essence of this myth,” (p. 8) that is, what Aniela Jaffé has called “the myth of meaning” in Jung (cf. her book The Myth of Meaning in the Work of C. G. Jung. Zürich: Daimon Verlag, 1986). This L. Jaffe does admirably, approaching his complex subject in a straightforward style with frequent references to his own personal involvement with these ideas, making the book valuable not only for readers new to Jungian psychology who may have been put off by some of Jung’s arcane references and demanding style of expression, but also for advanced practitioners, for in terms of the inner world of the psyche we are all on the same footing.

         Jaffe’s main line of discussion has to do with the evolution of religious belief and practice in the Western world. He sums up this development as follows: “We are in the first stages of a collective movement of the spirit, similar to the first four hundred years A.D. when Christianity displaced paganism in Europe. The current change in consciousness we call the Psychological Dispensation.”

(p. 16) Under the Hebrew Dispensation, according to Jaffe (and Edinger), “God chose a group of people, the Israelites. In the second age, the Christian Dispensation, God chose a single individual, his firstborn, Jesus Christ. In the age we are now entering, the Psychological Dispensation, God is incarnating in each of us individually. . . . Depth psychology names this process individuation.” (p. 17).  Jung took great pains to differentiate his psychology from religion, especially after the publication of Answer to Job (1952), which brought down the wrath of some theologians on him, who claimed he was being sacrilegious, and at the same time the self-righteous fury of others, who asserted he was out to found a new religion.

         However, Jung was not out to found another religion (prophets, revealed truth, priesthood to interpret it, sacraments, and the like). Rather, his intent was to address the inner experience of individuals who had lost their faith, just as he himself had. As he says in “Psychology and Religion” (1937), “To gain an understanding of religious matters, probably all this is left us today is the psychological approach. That is why I take these thought-forms that have become historically fixed, try to melt them down again and pour them into moulds of immediate experience.” (Collected Works, 11, p. 89) Late in his life Jung returns to the subject, again trying to make clear that for him what matters is the psyche, one’s inner life. He says, “I do not imagine that in my reflections on the meaning of man and his myth I have uttered a final truth, but I think that this is what can be said at the end of our aeon of the Fishes, and perhaps must be said in view of the coming aeon of Aquarius . . .” (Memories, Dreams, Reflections. New York: Random House, 1961, p. 339). Jaffe agrees with these ideas, maintaining the separation between psychology and religion as this latter term is commonly understood. In order to see the Psychological Dispensation as a “new religion,” then, one must take care to differentiate “new” from “another.”  

Despite the quarrels caused by Answer to Job, which preoccupied Jung in his later years and can be traced in his published letters, Jaffe unapologetically and non-defensively broaches the subject much in the spirit of Jung’s original writings, repeating Jung’s distinction between God as such, about whom we can know nothing with certainty, and the God-image as it appears in the psyche, the proper subject of analytical depth psychology. It is upon this distinction that much of what follows rests. If, despite Jung’s caveats, one persists in eliding this distinction between God and the God-image, nothing but confusion can result.

In his chapter entitled “The Jungian Myth” Jaffe develops his recapitulation of Jung’s argument about the nature of consciousness as bound to the unconscious, the interrelation of these dimensions, and the way the interrelation changes over the course of an individual’s lifetime. Thus, by virtue of the attention of consciousness to the unconscious, the latter begins to change: “This process is called transformation of the God-image, of which the essential ingredient is consciousness,” (p. 25) and “Consciousness combines head (logos) and heart (eros).” (p. 25) Of central importance here is the combination of “knowing and relatedness,” (p. 28) and it is Jaffe’s emphasis upon the latter that I find so valuable. Relatedness refers to our feeling nature and is a kind of binding medium by means of which the transformations Jaffe mentions can proceed. Its foundations are ideally laid in infancy and early childhood. Out of a deep and trusting relatedness comes the possibility of an ego prepared to define itself vis-à-vis this background while remaining in dynamic relationship to it. As Jaffe says, “. . . the ego cannot be unless someone perceives it”. (p. 29) By the same token, “changes in the collective psyche can be brought about by changes in the consciousness of individuals,” (p. 30) bringing in the suggestion of a political level in Jungian psychology.

In his chapter entitled “Jungian Spirituality” Jaffe makes a series of specific correlations between the theories he has been discussing and the realities of individual psychological development, faced as it is with the challenges posed by the inevitable “failings of the parents,” (p. 34) complexes, guilt, and the wounded child. “The assimilation of one’s affects, and attention to our inner wounded child, become a modern means of worship of and service to God or—the same thing—pathways toward individuation.” (p. 39) Thus, in Jaffe’s idiom the depth-psychological terminology used to describe the inner world can be roughly substituted with a religious language.

In Part Two (Practice), Jaffe explores a series of texts, showing how the above-mentioned myth has appeared at different periods in the history of the West. Some of these texts include the Gnostic “Hymn of the Pearl,” various passages from the New Testament, Jung’s letters, and the Torah. Jaffe’s discussions are presented in the form of meditations rather than as rigorous, closed arguments, thereby stimulating the work of the soul as it unfolds through mimesis and analogy. All the while he continues to flesh out his understanding of the Psychological Dispensation. “The Jungian myth, with consciousness as its central value, psychotherapy as its central ritual, and the child archetype as its initial symbol, is posited as the new world religion, so new it has only just quickened in its mother’s womb.” (p. 95)

Psychotherapy attends to this process through dissolving the myths imposed in childhood p. (97) so that a kind of rebirth into a higher consciousness might come about. As the wounds of childhood are healed, love of something greater than the ego becomes necessary. This, as Jaffe points out, “is one reason why the love relationship is so problematic in our day; the highest value, God, is projected upon our lover.” (p. 102) Hence the significance of relatedness mentioned above. As Jaffe escorts the reader through his various meditations on soul, prayer, and suffering, such as his reflections on love, illustrating his comments with references to his own personal background, the religious dimension of Jung’s contributions is enlivened and brought home in an immediate and personally moving way.