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
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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.
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Harold, et al. Diagnostic and Statistical Manual of Mental Disorders:
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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.