A Note on Harold Searles on Counter-Transference

Having, as you will see here, paid my debts to Harold Searles for his fascinating and often useful work on schizophrenia (and before that his essay on "The Patient as Therapist to His Analyst"), I must now register a complaint that his book Countertransference and Related Subjects: Selected Papers (International Universities Press, 1979), ix+625pp. is misleading from the outset. That is, the book is badly named: only on p.373 do we get first discussion of counter-transference, and it is not developed in any useful detail but remains superficial. The rest of the book virtually ignores any serious discussion of countertransference and is instead an assorted collection of articles, most having to do with schizophrenia. It should therefore have appeared under the title Collected Papers on Schizophrenia Vol. II, as a complement to the other volume bearing that title. 

Having been an academic editor for twenty years now for presses and journals in two languages and three countries, I am perhaps more critical, and less forgiving, than some. I find it serves nobody well when publishers allow authors to throw everything into a book without any attempt even so much as to organize the chapters coherently. Those chapters then ramble on with excessive detail and clinical illustrations that run for so many pages as to lose their point very quickly. In short, this book should have been at least 25% shorter than it is. (The editor who gave me my first editorial job in 2002 said "We pay you for one thing only: to be ruthless!" There is always room to cut--sensibly and intelligently, without blindly hacking away--and myriad opportunities to put things more compactly and cogently.) 

That said, there are little nuggets here and there one must dig out, as here:

Finding Your Own Psychotic Elements:

I liked early on in the book when Searles noes that at the end of a successful treatment of schizophrenia or psychosis, the patient has achieved individuation and ego integration to whatever possible degree, but, Searles says, the psychotherapist has also gained something: he is much closer to, and on much easier terms with, his own psychotic elements, and, in future, will not have to travel so far or so hard to experience them in the next case that comes along. 

This is a point he reiterates at the very end of the book (pp. 596ff.) with brief reference to Harry Stack Sullivan, noting that if the psychotherapist has reflected philosophically on the fact that the differences between 'sanity' and 'insanity' are not so great he will, in Sullivan's famous words, be able comfortably to see and accept that "we are all much more simply human than otherwise" and thus the psychotic person is not some strange 'other' we must race to rescue and 'fix.' 

What Might Psychosis Have to Teach Us?

It still seems sadly common to deride psychotic disorders as a descent into utterly meaningless gibberish and irrational gestures ('word salad' etc.) but I simply cannot believe that to be the case all the time. And so with Searles, in this book as in his other one, I think he is onto something significant when he claims that "Schizophrenia is, in a sense, the shadow cast by the emotional deficiencies of our culture" (26). 

Even more strongly, Searles speaks of his schizophrenic patient thus: "because he, perforce--not by choice--has been living on the sidelines of humanity he is in a position to tell us some important things which we have been too immersed in 'normal' living to see" (p.26). This accords very much with what patients have felt and described to me, too--like they are coming back to report on things nobody wants to hear but which they regard (and I agree) as being vitally important to think about by way of acknowledging the suffering and isolation at the heart of the human condition, and the oft-unfulfilled longing for communion and connection. 

The Rewards: 

I was heartened to read that Searles reports feeling "unclean" with guilt, and "perverse" in his fascination with his patient's delusions and hallucinations--until he allowed himself to see them as high art, as products of a highly creative mind. I was also impressed (albeit uneasily) the first time delusions and hallucinations were described to me in very careful and exacting detail, feeling like I was watching a painter very deliberately decide on which brush, colour, and location on the canvas for each stroke and detail.

Having overcome his guilt, in the end Searles sees "one of the endlessly rewarding, exciting aspects of this work" to be found precisely in the unpredictability and singularity of each individual. I fully agree! 

A Caution Against Cures:

Searles, however, is at pains in his lengthy chapter on "The Dedicated Physician" not to go about putting pressure on patients to achieve the sense of satisfaction the psychotherapist needs in watching patients get better. As he elsewhere noted, and others have as well, pressure to be 'cured' can in fact be highly suspect and unhelpful--and may arise from omnipotent and sometimes sadistic elements in the psychotherapist's mind. Searles notes how often the overly zealous and over-eager therapist infantilizes the patient by his insistence on a cure, by his omnipotent desire to help which robs the patient of his autonomy. Sometimes you do this to avoid having a competitor or even superior in the patient, whose health or strength is suddenly greater than yours. 

Regardless of your motive, he says you must not imprison the patient with your desire to see him cured. In this he joins with Nina Coltart, Adam Phillips, and others in swearing off the idea of 'cure,' and I am glad to learn from them on this score, as I also have from Searles, albeit not as much as one might expect in a book of 625 pages!