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Psychoanalysis and Homosexuality

This short new book, Psychoanalysis and Homosexuality: A Contemporary Introduction (Routledge, 2023, vii+164pp.) by two British clinicians, Leezah Hertzmann and Juliet Newbigin, is something of a useful handbook of (select) sources. It would be helpful to have on hand to refute those who still wish to criticize Freud and associate to him what are demonstrably later and far less felicitous attitudes towards homosexuality, which he never held. Such (often tendentious) criticism is rather tiresome and has long been known to be baseless by those of us who have actually read, and still regularly re-read, Freud (as I have done since 1990), either in German or in the authorized translation, or both. 

Hertzmann and Newbigin's book reads, in part, rather like a graduate student's lit review as part of a thesis requirement. The authors have provided decent lashings of (select) primary source material (always in translation, of course) farced not with scholarly analysis but rather with commentary of their own, which has its place. The style is admirably and immediately accessible and clear.

My hesitation with this book is threefold: first, it is never clear how they chose to pay attention to some figures and not others. It is never good to leave your readers guessing about your selection criteria. To my amazement, the radical views of Sandor Ferenczi (so much so that Freud himself, very "liberal" in his day on this question, was made uncomfortable by them) on homosexuality show up nowhere in this book.  It would have been good, at the very least, to have a look into Sandor Ferenczi: Reconsidering Active Intervention by Martin Stanton. Other important figures from that first generation--which, as a whole, was far more "liberationist" than their reactionary heirs in postwar America--are also overlooked. Why?

Second, the book attends in no significant way to significant historiographical issues in the composition and context of the texts they choose to include, and in those they exclude. I teach my history of psychology class every fall, and attending to how and why that history is written, and by whom--who is in, who is out, who does the choosing, and what are the subterranean currents to this choosing and composing we need to listen for with our third ear--is at least as important as any question of what was written. 

From this follows my third concern: the book pays insufficient attention to sociopolitical factors, especially in the United States in the postwar (=Cold War) period, where many of the developments we can now rightly deplore in psychoanalysis took root with a vengeance. Though these authors indicate a nodding familiarity with Dagmar Herzog's book Cold War Freud, they have not sufficiently integrated her arguments into this little book (or those of other scholars who are relevant here, including Todd McGowan and Paul Roazen)

The problem--as Freud foresaw as far back as 1909--was that on questions of sexuality in general, America was a puritannical and hostile nation that could not handle his ideas. And this was confirmed after his death in 1939 and the end of the war in 1945 when American attitudes (many of them politically driven) towards many things argued by Freud were disastrously distorted or abandoned, including such things as the restriction of analysis to physicians (which he strongly denounced in The Question of Lay Analysis) and the rise of psychoanalysis as an ideology (the best recent book here is Adam Phillips, The Cure for Psychoanalysis) with orthodox beliefs and practices rigorously policed and enforced by training institutes that often existed in a state of excommunication from each other) rather than a method of treatment. Those institutes, of course, came to exclude homosexual candidates from training. 

Now, it is rightly objected--as I have objected in the past as both editor and reviewer--that one must not unfairly criticize authors for not having written the book the reviewer thinks they should have while overlooking the book they did in fact write. That would be a valid objection here if--again--we were given any sort of rationale for how this book was written, or what the purposes of composing this highly selective, almost idiosyncratic text were. It is certainly not a systematic or comprehensive history, but that does not deny its value and virtues, and the place it does fill as a very brief introduction to the topic. Scholars wanting a more thorough, searching, critical, historiographically sophisticated text will have to produce one themselves or wait for others to do so. 

Having offered such concerns, let me now end with some examples of the book's virtues. 

The third chapter does, in some ways, attend to postwar figures sometimes overlooked, including Sandor Rado who, with some of the Kleinians and others like Edmund Bergler, seem to have played significant roles in shaping views on homosexuality and trying to obtain a role in its "treatment." This chapter--drawing on Herzog--also notes (as more recent authors such as Andrea Celenza and Galit Atlas have done) that psychoanalysis as a whole became far less willing to consider the role of the erotic, in all its forms, and far more suspicious of it and intolerant of its ambivalences and ambiguities. 

The final chapter of the book is the richest, and here the authors turn again to the problem of the exclusion and suspicion of sexuality across the board in clinical work, noting--as others such as Celenza, Atlas, Maroda, and Gabbard have done--that most training programs deal insufficiently or not at all with questions of erotic transference and counter-transference, but that such questions are even more defended against when "the patient's sexual or gender orientation is different from that of the therapist" (p.133). Thus, they argue, one of the challenges going forward is to more fully recognize non-heterosexual forms of desire and how they show up in, and have an impact upon, treatment. 

Optimal Responsiveness: A Short Note on Howard Bacal's Book

I begin with a confession: So much of what many authors in this collection, and above all the rather self-impressed and heavy-handed editor himself (who not only writes an introduction to the book, but also superfluous and sometimes condescending introductions to every chapter, including the two chapters he himself wrote) are enthralled with (viz., the concept of optimal responsiveness) seems very commonplace to me now. To avoid such impatience on my part, I had constantly to remind myself while reading Optimal Responsiveness: How Therapists Heal Their Patients, ed. Howard Bacal (Jason Aronson, 1998) that a quarter-century is a very long time in psychotherapeutic history, and that in 1998 when the book was published (and in years earlier in that decade as these chapters were being written) the things we take for granted today--being on this side of the rise of two-person, interpersonal, relational, and self-psychology changes in our theorizing at the hands of people like Thomas Ogden especially--were, in fact, rather novel. 

But I firmly believe books have to be read in their original context as well as our own, and so I can see how valuable many of these chapters may have been 25 years ago. And, as I shall briefly show, some of them remain very valuable today.

For me, the largest overall value comes from how much of self-psychology, including Kohut's writings themselves, this book very skillfully manages to make clear. In doing so, it helps me finally find valuable material in him after struggling for close to a decade to read him, including a stint in 2018-19 when I was on a fellowship at his very own Chicago Psychoanalytic Institute, some of whose analysts on faculty also admitted (sotto voce) they could hardly understand his leaden and jargon-riddled Teutonic prose.

The book's virtues extend beyond making Kohut generally clearer into showing some key parts of his thought that are of direct clinical use to me in one of my hardest cases. I always remain grateful to authors who give practicing clinicians ways of reconceptualizing a case and adjusting their techniques for trying out in that ongoing feedback loop that Jonathan Shedler memorably talks about. 

Bacal's opening chapters lay out the idea of "optimal responsiveness" which seems to have begun as an explicit challenge to very early ideas of "optimal frustration" of various drives. Two of the chapters do an excellent job laying out the genesis and historical development of this latter concept from Freud who seems to have been reacting not just to patients but also his rather more careless colleagues, not least Jung and Ferenczi who instead of frustrating or denying patients' desires for more intimate contact, indulged those to sometimes disastrous effect. 

Bacal argues that "optimal" does not mean perfect, but means instead means "most favorable natural conditions for growth" and thus can include all kinds of responses by the therapist in the moment. Thus if the patient needs you to be mirroring or affirming, you do it; if withholding is indicated, you do that; if something needs to be directly challenged rather than "contained" then you do that. In some ways, as I noted above, this idea of such flexibility is more commonplace today than it seems to have been in the 1990s, when Bacal wrote that "optimal responsiveness of the analyst is determined by the position of the patient on the developmental line of self-selfobject relations, and on his position on the developmental line of internalization of, and capacity for, empathy" (p.32). 

Overall several authors in the book usefully reminded me that in some cases with serious developmental deficits, there are in essence holes in the internal self-structure and until and unless these are repaired, or at least attended to in the best (optimal!) way, little progress will be made, especially if the idea of progress is heavily insight-dependent. Thus Kenneth Newman's chapter (drawing on Winnicott's famous essay "The Use of an Object") reminds us that some patients cannot use the therapist adequately when they have such deficits (I immediately thought here of obesessive-compulsive personality disorders, about which I wrote at some length here, and Shedler brillantly discusses here). 

I joined this up with a much later chapter by Lynne Jacobs who offers a helpful caution that some "patients need to forcefully blot out the subjectivity of analysts in order to ensure that there is room for their own" (p.200). A little later she says that sometimes with some patients (and I again think of OCPD patients here) the therapist's independent existence needs to be "sturdy enough to be left in the background for long periods of time, to be refound at a later point unharmed and available for engagement" (p.201). 

In other words, to use a famous passage she does not quote here, therapists themselves need to remember that it can be a "joy to be hidden" and is not necessarily a disaster not to be found (for a while!).