Robert Abzug on Rollo May

It is always melancholy for me when I reach the end of an exceptionally good book, but my consolation is that if I leave it on my shelf long enough, I can come back to it again in a few years time and enjoy its riches anew. This I will do with a fascinating biography that was melancholy for me in a second way: it took me back to a time when there seemed to be a closer, richer relationship between psychology and theology (as well as existentialist philosophy) than obtains in most places today. 

That relationship was lived by Rollo May, whom I first encountered almost thirty years ago as an undergraduate in psychology with a strong interest in theology, especially in its mid-century existentialist manifestations which I had explored in the last year of high-school when a generous French teacher (who very much saw himself as a soixante-huitard and thus indulged his contempt for rules and routine) gave me the entire semester off from class provided I show up on the last day in June after having written him a final paper on existentialism. This I gladly did, and so availed myself of the opportunity to read a lot of Paul Tillich--in English--and then Sartre and Camus in French. 

The following year, as an undergraduate, I read at least one of May's books as I recall: Love and Will. (I also read Will and Spirit: A Contemplative Psychology by his half-brother, the psychiatrist Gerald May.)

May is now the subject of Robert Abzug's brand new book, Psyche and Soul in America: The Spiritual Odyssey of Rollo May (Oxford University Press, 2021), 432pp. 

I finished this biography about a month ago on a lovely early summer evening on my patio. It is superbly written and a real treat to read. Abzug has an extremely deft touch in knowing how much detail to give about May's fascinating life and how much contextualization the reader needs without in either case overwhelming one with an excess of details. One would expect no less of so seasoned a scholar who is now professor emeritus of history at the University of Texas at Austin. 

Following standard practice, I e-mailed Dr Abzug some questions and was delighted when he agreed to my request for an interview about his new book, His thoughts are below. 

AD: Tell us about your background

RA: I grew up in a suburb of NY City, went to Harvard as an undergraduate and then to Berkeley for graduate school, both degrees in history. I was raised and remain a reform Jew by belief and tradition, though of course writing about May (and before that about 19th-century Protestant reformers) deepened my sense of the power of Christian faith and influence.

AD: What led you to writing Psyche and Soul in America: the Spiritual Odyssey of Rollo May?

RA: I tell the story of meeting Rollo in the Preface of the book, but the short answer is 1) After having taken Erik Erikson’s course on the life-cycle in college, I began to have an increasing curiosity about psychology and psychotherapy, one that had already been reflected in my first two books but only as a non-jargony use of what I would call a psychological aesthetic. 

Also, while in graduate school, had taken an external seminar in the latest psychoanalytic developments at the San Francisco Psychoanalytic Institute. And, of course, being in the Bay Area between 1967-1977, I was in a culture awash with therapeutic visions of the world. That said, it was only the accident of meeting Rollo that I became interested in writing about May and, for that matter, seeing some of the history of psychotherapy and religion through the lens of his life. Of course, the experience of knowing him and his world of friends and concerns for the last eight years of his life proved richer than I could  have imagined.

AD: I first read May in the 90s as an undergrad in psychology who also had an interest in theology, especially the existentialists like Paul Tillich. Tell us a bit about the long-term and hugely important relationship Tillich and May had. 

RA: The early 1930s were key in setting May’s future. First, while still in Europe as a missionary teacher, he encountered, and I would say “converted,” to psychoanalysis by taking a seminar in Vienna with Alfred Adler. That put a certain shape on his spiritual quest but didn’t end it, and when he returned to the U.S. he enrolled at Union Theological Seminary in New York. 

Tillich meanwhile had just escaped arrest by the Nazis by being invited to teach at Union, which he started to do in 1934. He and Rollo met early on in that year, and it began a relationship that was intellectual, spiritual, deeply personal, and lasted for the rest of Tillich’s life (he died in 1965). That relationship is certainly a central theme of Psyche and Soul in America. The mentorship of Tillich for May is clear, but it was something of a two way street. That is best indicated by the fact that Hannah Tillich asked May to deliver the eulogy at his first burial in East Hampton, NY, where the Tillichs had a summer home, and his reburial at the park named in his honor in New Harmony, Indiana.  

AD: May was also influenced by Freud, Adler, and Rank. But Adler seems to have been especially important. Tell us a bit about his relationship to and influence upon May. 

RA: Paul Tillich and Alfred Adler came into May’s life at a crucial period in his life, where his spiritual searching needed greater guidance and inspiration. Adler certainly had a life-changing influence on May, giving him a new way of envisioning the world and the possibility of a new profession. 

But Adler died in 1937, only four years after May met him and aside from a few friendly and important encounters in New York, the two didn’t really have the same sort of relationship as May did with Tillich. Nonetheless Adler’s ideas formed a compelling basis for his exploration of Freud, Jung, and Rank. 

But May told me that in the end he found other first generation analysts and later American neo-Freudians like Harry Stack Sullivan and Erich Fromm more powerful than Adler in their sense of complexity of the human condition and intellectual reach.

AD: You note (p.54) that May for "remained all his life wedded to obsessive self-scrutiny." That certainly comes through in your biography down to the last years of his life. What lay behind such an obsession?

I was about to say, “that’s a question for his analyst,” but let me give you two answers. First of all, I think his sense of spiritual devotion, which as it developed was truly a relationship with Tillich’s “God beyond God,” one which a therapist might call, insufficiently, OCD, made him investigate and judge his every action. This compulsion was historically not unusual among what Max Weber called “religious virtuosi,” and May was certainly of that breed. 

But I think more important was that he had the genius to build a theory of therapy based in many ways on his somewhat perhaps narcissistic but very productive contemplation of self. In short, these ongoing themes that provoked incessant self-questioning were in fact the well from which he drew much of his best work.

 AD: Part of May's project, you write (p.114), was "marrying the insights of psychoanalysis with the eternal quests of religion in a manner meaningful to the modern reader." Given how popular his books were, it seems he was successful in this endeavor in one way, but I'm wondering in another way about the kind of reception his books received in the professional psychoanalytic community. Did you come across reviews of and reactions to his works by psychoanalysts, and if so can you give us an idea of what they were?

RA: From almost the beginning, he saw as his mission in life the spiritual counseling of individuals, whether in the first instance through religion and later through psychotherapy, but perhaps most of all by educating an interested public through his writings. This was true when he first started publishing books that implicitly or explicitly saw a crucial interaction between the spiritual and the therapeutic (The Art of Counseling of 1939 and The Springs of Creative Living from 1940), the latter being a main selection of the Religious Book Club. It remained true even after he shed the theological trappings of Protestantism for a spiritualized existentialism.

Much of the answer to your question about his impact on therapists and reviews of his books is as much the ever-changing nature of psychology, psychiatry, and psychoanalysis as it does with the specific contents of one May book or another.  

AD: In early 1940 or 1941, you write (p.135), May began an analysis with Erich Fromm. I've been re-reading Fromm for the last two years and amazed at how well some of his insights stand up three quarters of a century after his English-speaking debut. Tell us a bit about the influence of Fromm on May that you see.

Another very interesting question.

I think there was some influence, though some of the most important ideas about the world and culture were transformed in May’s work from neo-Marxist thought to existential thinking, for instance living in a culture where not so much through the transformation of society but rather the resistance of self an authentic sense of the world might emerge. 

Nonetheless, there can be no question that Fromm influenced May, especially in those early years of analysis before the post-tuberculosis restart of the analysis. And certainly, by reading Fromm’s Escape from Freedom, he got a new and materialist view of an idea that he was already familiar with from reading the late Victorians and conversing with Tillich: the notion that both faith and community had been in decay for some time and that these trends had deleterious effects on the ability of individuals to “be” themselves. In that general sense, May joined with Fromm and others of the postwar era—David Riesman, William H. Whyte, John Kenneth Galbraith, and others—each in their own way critiquing the conformity, consumerist values, and general weakening of individual autonomy.

AD: I sometimes wonder if the existentialist movement in theology and psychology alike has been largely left behind, but then you trace out the burgeoning relationship between an older Rollo May and a then-young and upcoming Irvin Yalom, who is still with us after an astonishingly prolific career. Tell us a bit about that influence of May on Yalom.

RA: As Irvin Yalom has said many times, it was his reading of May’s Existence (a collection of essays from European therapists) introducing an existential framework to psychoanalysis and psychotherapy that inspired him to follow a psychiatric and analytic path. Later, when they got to know each other, I believe each helped the other in imagining the possibilities of existential psychology. However, there were differences. Yalom was a doctor, taught at a prestigious university medical school, pioneered group psychotherapy, was a self-declared atheist, and was a successful novelist. Rollo May was many things but none of those. In short, while they came together on existentialism, their careers and commitments were strikingly different.

AD: May's relationship to Christianity waxed and waned over the decades--from being a pastor and preacher early on to falling away it seems and then to returning to attending church later in life as an Episcopalian (p.331). Where, in the end, do you see May's life in relationship to Christianity?

RA: I think it is fair to say that past the early 1950s, at which point the formal church was no longer part of his life, he nonetheless lived a life imbued with the values he gained within the Protestant church culture and retained an abstract but real sense of what he called “infinitude.” His attendance at the Episcopal church in Tiburon in the 1980s had more  

AD: For those new to May and wondering where to begin, do you have, say, your top three favorites of his writings? What would you recommend beginning with for those who want to discover May today?

RA: My top three for getting to know May’s work would be Man’s Search for Himself (1953), Love and Will (1969), and The Courage to Create (1975), which is short, fits creativity into a vision of society, and as usual is clearly and compellingly written. And I would also suggest reading May’s introductory chapters in Existence (1958), an edited introduction to the possibilities of merging psychotherapy with existential thought. These are marvelous explanations of the power of existentialism. I might add that since the book’s publication, I have received any number of emails, some quite lengthy attesting to the influence May’s ideas had on their lives, and the three I recommended were ones that most often came up in our exchanges.

AD: Having finished this biography, what are you at work on now--new works in the pipeline?

I am still catching my breath but have thought about a short book based upon some lectures I have given recently about the practice of spiritual life in America, both in and out of formal denominations and traditional ritual practice. One element I wish to explore is the impact of religious and cultural pluralism on individual and group spiritual practice.

AD: Sum up your hopes for the book, and who especially should read it.

RA: Most of all, I hope to restore Rollo May’s place in the history of public intellectual life and, indeed, allowing readers to grasp the significance of his work to contemporary society and thought and inspire to engage with his ideas. As a biographer, I have also tried to write as “intimate” a biography as the sources allowed in order to provide readers with an account of May’s life that conjoins the public and private, as well as the unconscious and conscious—that is, brings an understanding that the origins of significant public lives lie in unique and often less than ideal sojourns. 

As for a readership, my hope is that psychologists open to a broader view of their profession as well as all who in one way or another were affected by May’s writings would profit from it. Yet, I also hope that those too young to know of Rollo May first-hand but who are in need of a broader and deeper sense of life somehow find the book and seek out May’s own attempts to offer roads to a richer life.

Sex Addiction and Supervision: Vamik Volkan's New Book

Last summer I was delighted to be able to learn the internationally renowned psychoanalytic scholar and psychiatrist Vamik Volkan. You can read that interview here. 

He e-mailed me yesterday to say he has a new book out: Sexual Addiction: Psychoanalytic Concepts and the Art of Supervision (Phoenix Publishing, 2021). 

About this book the publisher tells us this:

Vamık D. Volkan recounts the story of Judy, a woman attempting to solve her early life deprivations through non-chemical addiction. He provides an understanding of the psychology behind such an addiction and also illustrates pertinent therapeutic concepts and issues which arose in Judy’s case. These include built-in transference, twinning, interpretation, dreams, hoarding, acting out, and therapeutic play. By paying attention to such things, it is possible to gain a greater understanding of the internal worlds of patients with preoedipal deprivations, conflicts, and fixations.

For this case, Dr Volkan undertook the role of supervisor to an analyst in training. The topics of the psychoanalytic supervisor–supervisee relationship and the supervisor’s emotional reactions toward the patient, whom the supervisor never meets, are rather ignored in the psychoanalytic literature. This book gives an open and frank overview of the relationship, reporting not only what was said but also what lay behind the words.

Written in Dr Volkan’s characteristically accessible style, this book will be enjoyed equally by those under supervision as those providing it, and provides an excellent overview of work with addiction.

The publisher also provides the table of contents and introduction to the book here. 

Why Are We Squeamish in Reading (Samizdat) Stories about Long-Term Therapy?

To open this book, Reflections on Long-Term Relational Psychotherapy and Psychoanalysis, is to experience, however briefly, a sense of picking up some samizdat literature of the Soviet period. That may be an exaggeration, and in saying that, I mean no disrespect to those who lived through The Great Terror of Soviet communism. I have read Conquest's book and some of the memoirs and biographies of others who lived through that period and do not wish to diminish any of it by shallow analogies. 

Nevertheless, the power of collective pressure, and even more collective disdain, even in "free" and democratic societies, is no small thing. Sustained to a high enough degree and for long enough time, such pressure and disdain can make otherwise innocent people feel highly suspect and force them to engage in splitting and cloaking, which one would not expect psychotherapists to do if they are trying to heal patients of those same phenomena! Nevertheless, here in the United States the pressure against, and disdain for, long-term psychotherapy has been widespread for a quarter-century and more now, requiring clinicians who believe in and practice long-term therapies to downplay or deny their involvement, discussing the same only with trusted colleagues under a cloak of secrecy to prevent the prying hands of "managed" health care apparatchiks from hauling them before some star chamber for "ethical" violations and/or "fraud."  

As someone whose life was profoundly changed, and for the good, by long-term psychoanalysis in my native Canada (where American pressures at time-reduction of therapy are only slightly less advanced) I do not think my "bias" on this question is any great secret. I fully believe that in some (not all!) cases, some patients may well require long-term treatment. 

At the same time, however, as someone whose intellectual formation in psychoanalytic thought has debts above all to Winnicott, Nina Coltart, and Adam Phillips, I am not--thanks to them--an ardent and unyielding ideologue about analytic therapy or its length. One thing I take from them in particular, and the British Independend/Middle school as a whole, is their pragmatism and avoidance of hidebound ideologies and practices, including about psychoanalysis itself (which Phillips well addresses in almost all of his works, but perhaps especially his recent book The Cure for Psychoanalysis). Stated positively, I believe people should find whatever theory and modality works for them, and pursue therapy at whatever length they need--short or long matters not to me if it aids in their flourishing and healing, which should remain the sole criteria for adjudging length. 

In that light, then, and without fear of any contradiction, I have written sincerely and appreciatively about short-term therapy here. I have seen patients in my own practice who came with with otherwise good health and very highly functioning lives who needed assistance in one particular area and when some success had been achieved in that area, wanted to discontinue therapy, which I fully supported. It is, after all, their life and as someone who is also deeply indebted to Erich Fromm, I believe that therapy should aim at maximizing their freedom, above all--as Fromm said--from authoritarian figures, which some therapists certainly can be!  

I have had, so far, two supervisors who had very opposing views on long-term therapy, and I respected, and respect, both of them and their arguments. The first, a licensed clinical social worker of longstanding, noted that perhaps if therapy is running on for years at a time then one needs to set two goals: to increase social skills and thereby to increase the likelihood of finding friends. As someone who has worked long-term in community mental health, he was rightly very wary of anyone engaging in services for too long and thus depriving someone who might desperately need them from accessing the same. 

My second supervisor, a long-time clinical psychologist, has talked about his experience of long-term therapy in terms that authors in this book do also: as something that may sometimes be indicated by the patient's manifest needs and in the patient's interest, and perhaps even requested by the patient him/herself. 

The editor, Susan A. Lord, makes those arguments herself, and other contributors do too. Lord gets right down to business in opening her book Reflections on Long-Term Relational Psychotherapy and Psychoanalysis with a frank acknowledgement of the discomfort many experience in even talking about the topic of long-term psychotherapy. How strange and sad that we are made to feel like quasi-criminals!

But before that she gives us a startling epigraph, revealing a fact about two people whose books I have admired, but whose relationship I did not know of: the late neurologist Dr. Oliver Sacks was in a half-century-long psychoanalysis with Dr Leonard Shengold which ended only with Sacks' death in 2015 (Shengold died in 2020. He is perhaps best known for his searing book Soul Murder: The Effects of Childhood Abuse and Deprivation). Sacks wrote about his analysis in part in his memoir, On the Move: A Life. No doubt this revelation of a 50-year analysis has caused all kinds of recoiling in readers. 

Admittedly, that is perhaps a world-record and not a normative standard that anyone else should necessarily imitate. So what do the authors and editors of this book mean by "long-term" therapy?

Most of them adhere to what seems to be something of a semi-accepted standard of any treatment that goes beyond six years. But many of the contributors talk of patients they saw for 15, 20, 25, and in one case 30 years. 

To admit to such length is at once to raise a whole series of serious questions, and the various authors in this highly valuable collection do an excellent job at that. One must ask, inter alia, such things of oneself and one's patient as:

• what does an ending look like?
• why do we require an ending? Do we, in fact, require one?
• does having an ending facilitate therapy or inhibit it?
• does having a time limit enable growth or inhibit it?
• how long is long-term?
• how much/long is "enough"?
• why does talking about long-term therapy, and admitting to conducting it, seem like a "shameful secret"(p.xiv)?

In her introduction, Lord suggests--as other contributors do--that "we should leave the decisions about length of treatment to our clients." 

The second chapter, by Patricia DeYoung, continues the exercise of raising excellent questions and challenging assumptions. She begins by flatly and rightly insisting that "sometimes brief work is exactly what's needed"  and therefore, for such patients, one can safely conclude long-term therapy is not needed.

What about other patients, however? What about those with major long-standing developmental trauma? For them, she says, long-term therapy is justified and should be seen as such. She then spends most of the rest of her chapter on a 15-year (and counting) treatment with a young man whose life had totally collapsed (into what some might consider near-psychosis, though DeYoung avoids all such language because her patient found diagnostic terms profoundly demeaning and unhelpful). 

Jean Kotcher, in her chapter, offers some helpful reflections on what therapists need to be able to conduct long-term therapies, noting that not all therapists are cut out for such work. Drawing on a definition from Norman Doidge et al that defines long-term work as averaging six years in North America, she notes her own experience is considerably longer: 15 years in some cases she discusses, including with patients who were massively abused as children. To work over the long haul requires, Kotcher says, that "long-term therapists have patience and self-esteem that does not rely upon a timely 'cure,'...comfort with uncertainty..., and an ability to commit to and be energized by long, mutually caring professional relationships, sometimes for decades" (p.32). 

She further notes that sometimes in long-term therapy not much appears to be happening because in fact not much is happening directly or consciously. Instead, there are stretches where gains are being quietly and undemonstratively consolidated and integrated. The temper of such therapies is, she later says, "relaxed" and allows patients the ability to engage in "unfreezing themselves from destructive and unsatisfying patterns and relationships, past and present, to arrive as more fully evolved people who are supple and more capable of living fuller lives" (35). 

William Meyer, a just-retired social worker, has two chapters in this book. It was, in fact, in search of his writings that I was led to Reflections on Long-Term Relational Psychotherapy and Psychoanalysis in the first place. Both of these chapters are very helpful. He starts off chapter 4 by noting something that might be obvious and for that reason overlooked: "the similarities between the role and functions of a good therapist and a good parent" (37). A parent is a parent for the long-haul. There is usually no "termination" in that relationship, raising the question: why must there be one in therapy at least for some people?

There are, he notes, some people for whom brief therapy is indicated, and he reviews some of the standard criteria here: a relational capacity, psychological mindedness, motivation, and evidence of adaptational ability. This is not an exhaustive list, but if your patient is lacking one or more of these, considerable caution is in order before recommending brief therapy. 

Much of the rest of the chapter is given to talking about cases, and in one of these he notes that for a sometimes-suicidal patient who went through bouts of despair he had to show her that "I will carry the hope until she feels stronger" (45). 

He ends by returning again to Winnicott and the latter's observation that "we can actually alter the patient's past" so that the therapist who now provides a holding and maternal environment can in fact contribute to the patient's growth even if it arrives later in life than for those who had good maternal environments. 

In his next chapter, he raises an absolute humdinger of a question: "If an individual was on a psychotropic medicine that provided symptom relief, would anyone suggest that the person stop taking it?" This question becomes all the more acute when, "for many patients, the therapeutic relationship is the best love relationship they have ever experienced" (54). If that is so (and in my case it was--at least prior to getting married), then who are we to prescribe artificial limits to that in advance? Is it not utterly perverse (in that way only advanced capitalism can justify) to say that you can have a life-long relationship to a pill for its therapeutic alleviation of symptoms, but not to another human being?

Yes, but....I can hear you splutter. But what about abuses? What if the therapist is extending treatment for unhealthy reasons of his own pathology? What if the therapist is dragging things on to line his own pocket? These are all crucially important questions and if such things happen then (as Superintendent Hastings might say) the professional associations and legal authorities should throw the book, and bookshelf, at the perpetrators. But surely we should not let these abstract and rare problems inhibit therapeutic practice unduly? Why allow the bogeyman of a lazy or fraudulent therapist inhibit the rest of us? For a profession that likes to self-soothe by endless repetition of the mantra of "evidence-based," where is the evidence for massive and widespread fraud committed by corrupt therapists dragging on treatments for decades without justification or results? 

Carol Ganzer's chapter, "Mourning the Melancholy Object: Giving Voice to Traumatic Experience" is also very substantial. Parts of it put me in mind of the recent book of Madelon Sprengnether, Mourning Freud. Ganzer notes that much of therapeutic work has to "deal with ghosts from the past" and that such ghosts often represent the "melancholy object" which (in a definition borrowed from Stephen Frosh) is "one that is never fully acknowledged and consequently can never be properly mourned." Such objects form a "present absence."

Ganzer's chapter is useful in illuminating the clinical phenomena of enactment and impasse. About the former she says that she can detect one beginning or happening when "I find myself behaving differently from my usual patterns with patients, or I am surprised and caught off guard in some way" (p.66). The latter she says (here drawing on the work of J.M. Davies) may be linked to incomplete mourning: "an impasse in the treatment is linked to an impasse in mourning in the analyst" (70), a point she then illustrates with a case study of one of her patients. 

Natalie Peacock-Corral has an interestingly titled chapter "It Takes a Long Time to Grow Young." In it she talks about how learning psychoanalytic theory on sadomasochistic dynamics helped her understand the self-destructive drive and practices of one of her long-term patients. She recounts her experience of a long-term therapy with a man in his 30s, and how this showed her what Winnicott was on about when he wrote of the therapist/parent needing to be able to tolerate the rage of the patient/child without retaliation. It took this patient 12 years of treatment before he could properly mourn his mother, and in the meantime Peacock-Corral learned a further lesson first discussed by Nancy McWilliams (in her superb book Psychoanalytic Psychotherapy: A Practitioner's Guide, about which more another day): that the patient needs the therapist to be a worthy opponent. 

Perhaps the central insight of her chapter is one she derives, as a relational psychoanalyst, from Winnicott: there is no such thing as a patient. (DWW had phrased it as "there's no such thing as a baby.") In other words, as she continues, "there is the patient and the therapist." Just so.

Speaking of babies, this author recounts what her two pregnancies, and a miscarriage, provoked in her long-term patient Robert. The latter experience especially allowed him to appreciate her in a vulnerable state and so be helpful and even somewhat of a healing presence. In doing so, he was playing the role that Harold Searles described in his very memorable and insightful 1975 paper which I have referred to before: "The Patient as Therapist to his Analyst."

Skipping over several chapters in the interest of keeping this review to somewhat manageable length, let me, in concluding, turn to the final chapter by Anthony Bass, "The Longest Goodbyes: Analysis Everlasting." He begins by noting how often and how long patients have conversations in their mind with their therapists during vacations, separation, and even after the death of the therapist, noting that "an analyst's voice is often a lifelong companion." (To his credit he notes that this is not always salutary for not all analysts may have been a helpful and healing presence.)

In this chapter, we see Bass fully inhabit the so-called two-person psychology that developed after Freud and is especially prominent among relational analysts/therapists (the terms are used interchangeably throughout this book). For Bass, "the learning curve for an analyst often continues for a lifetime." This should be at least a partial rebuke to the slanderous prejudice which assumes long-term analytic (or other) therapy involves no effort by the analyst beyond lining his own pocket. You are always learning, always being challenged, because no patient is ever the same during treatment; nor are any two patients alike. Equally, however, no therapist is ever the same in treatment with one patient, or across treatments with multiple patients. As he puts it, "in any analysis worth its salt, both participants change as a function of their encounter with one another." 

Moreover, the process of arriving at change (and the agreed-upon landmarks of what change might look like) is never the same, nor even necessarily stable and constant inside one treatment. Here Bass charmingly used a reference to that voice that most of us have heard at least once in the last two decades of driving: the voice of our GPS when we miss the turn (whether by design or accident): recalculating. In therapy, he says, the route and destination are always recalculating.

In the end, then, this very rich book has brought out into the open an unnecessarily and unhelpfully hidden discussion about the fact that late capitalism's fetish for brevity and efficiency is, in therapy at least, highly unwelcome and often highly deleterious. Does all therapy have to be long? Does it all have to be short? Therapists and patients alike should have the freedom to decide. The answer is always going to be: it depends on the patient's needs. All other considerations should be otiose. 

How May We Say that Psychoanalytic Therapy Changes Us?

I freely admit that I've struggled for twenty years to read Lacan with any profit--nearly the same period as I've sought to discern the effects of my own psychoanalysis, which ran for seven years four times a week on the couch. So I am glad, finally, to have been exposed to enough of his writings to find some insightful and useful ideas therein for understanding my own experience as an analysand. 

At the same time, though, I am aware of violating my own practice of always seeking to read primary literature rather than secondary sources, which I have done in this case in the form of Luis Izcovich's recent book The Marks of a Psychoanalysis, trans. E. Faye and S. Schwartz (Karnac, 2017). Izcovich is a psychiatrist, psychoanalyst, and academic teaching and practicing in Paris, where he is a founding member of the School of Psychoanalysis of the Forums of the Lacanian Field. He has written several other books, most of which have not been translated into English. He quotes Lacan lavishly, especially in the latter half of the book, which was far and away the more valuable part to me. 

Part of the accessibility of this book, for me, was that it does not confine itself only to Lacanian thought. Chapter 10 takes me into deeply familiar territory: England, where Izcovich reviews the work of Winnicott and Guntrip. The latter was especially interested in the question at the heart of this book: how much change can anyone expect to experience after having been analyzed? 

Guntrip was first analyzed by the unjustly neglected Scottish analyst W.R.D. Fairbairn (about whom John Sutherland wrote an interesting if incomplete book, Fairbairn's Journey into the Interior) toward the end of the latter's life. Fairbairn--to the extent he is known at all today--is invariably introduced as a solitary Scottish analyst practicing in isolation in Edinburgh where he kept out of the Controversial Discussions and turmoil in the Klein-Freud feud around the English psychoanalytic scene down in London in the 1940s. Fairbarin, even in relative obscurity, remains, to my mind, important for his early and still valuable work on the schizoid personality type which others--Guntrip most notably--have expanded upon considerably. 

Guntrip felt there was still more work to be done, and so embarked upon a second analysis with Winnicott. He would recount details of both analyses later in writing, showing that he received different gifts from each analyst, but that Winnicott was able to take him farther than Fairbairn, but neither could go as far as Guntrip hoped and wanted. 

If neither analyst was able to effect the comprehensive cure that Guntrip seems to have wanted, he would nonetheless be led to ask a crucial question (which is also Izcovich's question): "How complete a result does psychoanalytic therapy achieve?" 

In one of his last essays, "Analysis Terminable and Interminable" (1937), Freud answered this question in a pessimistic way. Here Freud recognizes that almost all analyses will be incomplete in some way for diverse reasons. In some cases it may be that the analysis was broken off too soon; but in in others an analysis may have been successful, allowing for the patient to have a long period of health and freedom which may then be unexpectedly replaced by a return of old habits, or fresh suffering, requiring new therapeutic attention. Sometimes the analysis did all that it could, and new trauma, which nobody could anticipate, emerges, requiring new therapy. This is also true in a well analyzed analyst's life, leading Freud here to give his famous--and welcome--counsel that "every analyst should periodically--at intervals of five years or so--submit himself to analysis once more, without feeling ashamed of taking this step." 

Izcovich goes beyond Guntrip to ask additional questions: What are the marks of a successful and completed analysis? Can we see them clearly? 

When he finally and fully turns to these questions, Izcovich offers an attractively straightforward answer, at least for me: "without doubt the most salient (marquant) indicator of analytic progress is a very clear change in the intellectual inhibition that preceded the analysis" (121). This, he notes later on, does not have to be immediate and is not always calculable. 

A little later Izcovich writes in what seems to me reminiscent not only of Winnicott, but even more of Adam Phillips (whom he does not cite) when Izcovich notes that "one aspect of psychoanalysis is anti-identity" (135). As Dodi Goldman (inter alia) has mentioned, one of the most attractive aspects of Winnicott was his thwarting of ideology and identity in their essentialist guises, his refusal to be dogmatic about these and other matters. 

That, it seems to me, is an especially rare and important gift today--to be freed of the need to have have questions of "identity" solved in a clear and unambiguous way. At the same time, however, such freedom comes at a cost, which was well captured in Auden's haunting panegyric poem for Freud where he notes that "To be free/is often to be lonely." 

The answer to these questions--about the ends and marks of psychoanalysis--is not automatic, and Izcovich shows that Lacan would want us to remind us that the "crucial question concerns what use is made of the effects of an analysis" (213). It should not be assumed, he continues, that one effect is for the analysand to become an analyst "but rather it is what analysis changes in the way someone lives his life" (215). Such changes, however, do not result in having everything resolved sensibly and in understanding everything. Rather there is "discontinuity" at the end of the analytic journey, which leaves one--here Izcovich and Lacan quote Melanie Klein--with a renewed capacity for "solitude" (which is well treated in the contemporary English psychiatrist Anthony Storr's book Solitude: A Return to the Self.)   

In the end, then, Izcovich says that for Lacan "therapeutic analysis should clear the way, via a freedom in relation to the symptom, and, as a consequence, open up the most direct path in life to the realization of one's desire" (239) insofar as this can be known and accepted (for some people do not want what they desire, or do not want to desire at all!). In some cases, one's desire, after an analysis, has been re-directed: "libidinal redistribution implies the withdrawal of libido from certain partners in life in order that it be invested in new ones" (243). 

Izcovich's book did not offer all the answers I may have expected when I first picked it up, but it was and is a useful reminder (especially when joined to the chorus of others whom I love, particularly Nina Coltart but also Michael Eigen) that analysis begins and ends in mystery.