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. 

Creating an Analytic Mind

Some discussion on Twitter this week with Jonathan Shedler and others about what we hope patients will be left with after therapy is over put me in mind two books I often find myself returning to. (Shedler deals handily and powerfully with the old and tiresome slanders that psychoanalytic/dynamic therapy are somehow less effective and less "evidence-based" than the CBT methods seemingly so beloved by governments and insurance companies today. See the invaluable articles at his website above, but also see this new book which I am looking forward to reading.)

The first is by Adam Phillips, who, like Shedler, is always worth reading. I have read all but one of Phillips' books, and would be hard-pressed to rank them, but if I had to, then On Kissing, Tickling, and Being Bored: Psychoanalytic Essays on the Unexamined Life would probably be in my top three, if only for its essay "Psychoanalysis and Idolatry," which I drew on in my own recent book on the sex abuse crisis in the Catholic Church. 

Anyway, Phillips has a lovely little aphorism in this book: "The cure can begin only after the treatment has ended." One can certainly debate that, but I have found it very true in my own life. As Luis Izcovich has recently argued, psychoanalysis leaves lasting "marks" in certain often distinguishable ways--a point stated even more dramatically by François Roustang almost forty years ago now. 

The second book that came back to mind this week is by Fred Busch. I read it several years ago, but it pays re-reading. He argues very much in favour of the idea that psychoanalysis and analytic therapy should leave the person with a re-structured mind as a permanent and positive after-effect: Creating a Psychoanalytic Mind: A Psychoanalytic Method and Theory (Routledge, 2013). 

Busch writes in a low-key manner with a refreshing lack of ideological rigidity, jargon, or hubris. He interpolates passages from well-known literary works with short case-studies from his own practice to illustrate what he means. This is a rewarding book that pays re-reading. 

As he recounts in the introduction to this book, Busch is something of a pioneer in psychoanalytic technique and training, being one of the first clinical psychologists to be admitted in the 1970s to psychoanalytic training at an American institute. (This restriction has never made any sense to me. I grew in Canada, underwent analysis there, and planned to finish a doctorate in the humanities and then embark on a training analysis at the Institute in Montreal. I was able to do this because unlike American institutes, those in Canada, the UK, and parts of Europe and elsewhere, generally have had no problem following Freud's recommendations in The Question of Lay Analysis.) 

As he looks over the course of an analysis, Busch understands it to consist of three phases:

1) The first phase is when the patient comes to be familiar with his own inhibitions and restrictions that keep him from living: until the patient can wonder about his lack of wondering, wondering is not possible. This phase, later in the book, is called one of self-observation. 

2) The middle phase of an analysis is the beginning of a "psychoanalytic mind," that is, learning to observe one's own mind and its sequence of free associations. Such a psychoanalytic mind is necessary if the analysis is to bear long-term sustainable fruits in one's life. It is necessary, that is, if the patient is to be freed from the "slavery of repetition compulsion" and instead freed to "think about thinking." Later in the book Busch calls this phase one of self-reflection. (In my experience this ability to "think about thinking" has remained a constant and constantly valuable gift bequeathed by analysis.) 

3) The terminal phase of an analysis consists of a deeper psychoanalytic mind more completely free from deceptions in understanding one's associations with greater veracity. Here the analysand can "play, muse, reflect, and interpret her own associations." This phase Busch later calls self-inquiry. 

Classically, it was thought by some that the main goal of an analysis was insight into the contents of the unconscious.  But for Bush, "the process of knowing is as important as what is known." Here Busch pioneers a different goal for analysis, giving greater emphasis to the patient gaining an understanding of how his mind works and how it affects him. Busch suggests the freedom of a psychoanalytic mind, with a process of knowing in addition to what is known, may be of greater long-term benefit.

This, it seems to me, is a very noble goal for a clinician to work towards: not merely to leave a patient with certain tips or techniques that may come in handy in some future struggle, but to help in the creation of a mind that can now think much differently. And one thing that newly recreated mind will likely have--dare we say should have?--is an awareness of its ongoing need for the help of others. Here I would return to Freud in noting that the creation, and nourishing, of such a mind is never going to be complete, but will require perhaps ongoing or perhaps periodic work. As he says in his "Analysis Terminable and Interminable": "Every analyst ought periodically himself to submit to analysis, at intervals of, say, five years, without any feeling of shame in so doing. This is as much as to say that not only the patient's analysis but that of the analyst himself is a task which is never finished." 

In conclusion, I would simply note that Busch has a new book coming out in November which I am looking forward to reading. The publisher tells us this about it: 

In this first-of-kind book, senior psychoanalysts from around the world offer personal reflections on their own training, what it was like to become a psychoanalyst, and what they would like most to convey to the candidate of today.

With forty-five personal letters to candidates, this edited collection helps analysts in training and those recently entering the profession to reflect upon what it means to be a psychoanalytic candidate and enter the profession. Letters tackle the anxieties, ambiguities, complications, and pleasures faced in these tasks. From these reflections, the book serves as a guide through this highly personal, complex and meaningful experience and helps readers consider the many different meanings of being a candidate in a Psychanalytic Institute.

Perfect for candidates and psychoanalytic educators, this book inspires analysts at all levels to think, once again, about this impossible but fascinating profession and to consider their own psychoanalytic development.