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. 

The Mind Object: On the Problem of Precocity in Children

One of the most interesting essays I came across this fall was from D.W. Winnicott in 1949, "Mind and its Relation to the Psyche-Soma." That became the focus of a very rich discussion with my students this past week, drawing on both their own experience but also that of their work in schools and clinics with autistic and abused children. Such children often seem to exhibit what Winnicott recognized as a precocity used as a defense mechanism and a form of adaptation that had certain benefits at the time, but which can later in life be found to be the source of problems. In its more extreme forms, it may even give rise to schizoid tendencies. Precocity, then, is often sign of trauma and a form of self-repair when regular forms of care and repair, from healthy objects in the child's world, are missing or are themselves destructive. This is commonly seen in the phenomenon of having to become parents to (or in lieu of) one's parents. 

I came across Winnicott's essay when it was cited by the great Adam Phillips in his newest book, The Cure for Psychoanalysis (2019), which, strangely, seems to have appeared in print for about two days in as many copies and then disappeared again. I don't know why that would be. I had to order a copy from a Canadian bookseller which I heartily recommend. They are apparently the largest bookseller in North America devoted to titles in mental health. 

The latest Phillips book, which I am reading (but saving as a treat for my Christmas break), in turn put me on to another volume, hard to find, of which I was also ignorant: E.G. Corrigan and P-E. Gordon, eds., The Mind Object: Precocity and Pathology of Self-Sufficiency (New Jersey/London: Jason Aronson, 1995). It is a goldmine of essays by some of my favourite people, including Phillips as well as Nina Coltart, Christopher Bollas, and Michael Eigen. Herewith some thoughts on several of the chapters.

The book begins with a clinical vignette of a patient quite self-consciously alienated from his own body, leading the editors to note that such experiences inspired the book: "Can a person relate to his mind as an object...idealize it, fear it, hate it? Can a person live out a life striving to attain the elusive power of his mind's perfection?" This leads to the first mention of the Winnicott essay noted above, which first highlighted for clinicians the danger of early trauma resulting in a turning away from the body's needs in order to prize the mind and its functioning above all else. Thus split, the mind dominates both psyche and body. 

Winnicott's work was first amplified by his sometime analysand and collaborator (and highly controversial fellow analyst) Masud Khan, who spoke of a "rigid premature structuring of internalized primary objects." From them both we get the concept of the mind "having a life of its own."

After further clinical vignettes of high-achieving adults in therapy as well as children, the editors note that one key characteristic they all have in common is "startlingly high verbal IQs" but much lower scores on other measures, including performance. They also often lack spontaneity and expressiveness, but at the same time are often dependent and controlling to a high degree. They never "surrender to any relationship and thus leave the other feeling useless" (p.3). This reminds me of something Christopher Bollas said in his fascinating first book, The Shadow of the Object: Psychoanalysis of the Unthought Known, of a certain type of analysand (typically schizoid) who makes very little use of his analyst. For to do so would be to admit dependence on another, and this is the very thing not allowed: "Striving to disavow reliance on others, they have empowered the mind as the locus of self-holding and self-care" (3-4). 

The editors note that while the bulk of these insights is indebted to object-relations theory, there are some early insights in Freud and especially Ferenczi, whose pioneering work in trauma led him to recognize that early trauma can sometimes result in an artificially advanced maturity in a person.

But back to Winnicott, for it was his insight into the failures of maternal adaptation and nurture that set the stage for seeing how the baby's mind can itself become a soothing object making up for maternal lack, though often only at the price of ego splitting, dissociation of affect, and intellectual primacy. All mothers occasionally fail to meet, either promptly or adequately enough, the needs of their children, but it those children who suffer from this cumulatively that experience enduring trauma.

The idea of cumulative trauma is Khan's. Also of interest from him is the idea of identification in an unhealthily diffuse fashion, so that "the human being can be everybody and is a nobody." One over-identifies with others in face of a lack of real object relating.

Other coping mechanisms may enter to help the child, but the mind as object dominates them all, allowing one to feel in control and even to feel a sense of triumph at seeing things others cannot see. This often outlives childhood. As the editors remind us rather grimly, "precocity is a disorder of adaptation much valued in our culture" (16).

How does one treat such patients if they present for therapy? It is not easy--Bollas recognized this more than thirty years ago, and others in this volume are also aware that, as the editors say, "the therapist [is] in the paradoxical position of offering help to someone who essentially needs to disclaim help" (17). They may nevertheless go on to be brilliant patients, always agreeing, readily entering into insights....until they suddenly and swiftly bring the treatment to an end when they have attained not healing but "repaired self-sufficiency" (17). 

These are the patients who claim never to mind vacations or missed sessions, who can zero in on analyst-analysand dynamics with great speed and acuity but who in the end do all this in service of a need to be in defensive and omniscient control. One sees this in the counter-transference when the therapist often feels both dumb and useless. The use of silence with such patients can often be unnerving, leading them to greater heights of self-interpretation, self-criticism, or obsessive repetition. 

Instead, what seems to work is for a therapist to be the kind of person to "risk not knowing, who can bear uncertainty, who can fumble and recover, who can be wrong, and be comfortable with difference" (19). Also the therapeutic environment and relationship are important here in the sense that they may eventually allow the patient to relax the grip of mind-control and discover two fully embodied people in the room who can play together. 

Peter Shabad and Stanley Selinger in their chapter late in the book return to the question of therapeutic technique by noting that sometimes certain "radical" questions of accepted technique, and departure from them, may be enjoined upon the work with such precocious patients. E.g., it may be more important to work with a kind of "reflection in action," looking at the moment-by-moment here-and-now of the therapy (which Yalom makes much of) rather than bringing in carefully planned interpretations from a distance, especially if doing so reinforces the patient's problems. As these authors put it, referencing Winnicott, "the patient will not let his false self defenses down until the analyst has first done the same" (226). 

I pass over Coltart's chapter as it is covered in her book Slouching Towards Bethlehem, about which more another time. 

Michael Eigen's chapter is especially interesting insofar as he makes connections between precocity and mystical experience, as when he says: "mystical experience can be used to further or short-circuit personality growth," but often does both (122). Perhaps more mundanely and less threateningly, one can speak not just of mystical experiences as playing this unhelpful role, but advanced initiation into any sort of religious community. They may, as Eigen recognizes at the end, "save an individual...[but] also thwart her" (132). 

Harold Boris' chapter, "Of Two Minds: The Mind's Relation with Itself" contains some succinct statements of the desires of the precocious mind. It begins by trying to "protect a breaking heart or a flagging will" and continues to manifest itself in, inter alia, the fear of: "junk, claptrap, cants, dissimulation, and above all, lies" (185). Such minds very much want to protect themselves and do so through such defenses as impeccable logic and reason by which they see through apparitions and mirages that bedevil lesser minds. For such minds, "nothing...is more precious than candor" (185).

Adam Phillips' chapter concludes the collection by appropriately returning to Winnicott's essay noted at the outset. Phillips notes that "in the absence of relatively reliable environmental provision the mind becomes a kind of enraged bureaucrat" (235) and that he notes in Winnicott language hinting at "political insurrection." In a healthy situation, the mind listens to and works with the body and its objects; but in an unhealthy precocity, "there is a military coup and a dictator is installed called a mind object, at once bureaucrat and terrorist....at its most extreme there can be no unconscious because everything has already been accounted for" (236). 

Phillips by returning to the challenge of working with such patients in therapy, noting as others have the real knife-edge dangers that exist for by focusing on the mind in analytic therapy especially is one not actually reinforcing the very source of the problem? In the end Phillips turns to Ferenczi's famous saying that the patient is not cured by free-associating: he is cured when he can free-associate.

Finally, Phillips returns to a suggestion that will show up regularly in many of his books written after this chapter from 1995: the importance of learning to forget, or as he ends this chapter, the importance of a "mind on vacation."