The Volkans on Schizophrenia

Nearly a decade ago, I began exploring the underlying psychodynamics of ISIS propaganda, and the wider historiography of the Crusades. In the course of that research, I think it was the historian and psychoanalyst Charles Strozier (in his book  The Fundamentalist Mindset: Psychological Perspectives on Religion, Violence, and History) who first introduced me to the works of Vamik Volkan and his pioneering and pivotal concepts of "chosen trauma" and "chosen glory." 

I went on to read several of Dr Volkan's books, including Bloodlines: From Ethnic Pride To Ethnic Terrorism. These and others of his corpus have been very helpful to me in several articles and lectures, and now in a book I have coming out later this year on the dynamics of Russian-Ukrainian historical and religious conflicts. 

More recently, as readers may recall, I interviewed him about his Large Group Psychology which was published by Phoenix in 2020. (By all means order the books through Phoenix directly where you will often get a discount.)

All this is to say that when I learned last year that Phoenix was publishing a new book he co-wrote with his son Dr Kevin Volkan, and that the book was on schizophrenia, about which I have been reading extensively since last fall, I was very excited and determined that I must read it, as I have now done, and also determined to interview the authors, as they have also now graciously consented to doing. 

Before turning to their thoughts, let me further entice you to order their new book Schizophrenia: Science, Psychoanalysis, and Culture by pointing out just two of its paramount virtues (and leaving you to discover the rest for yourselves): first, there is a consistent and wholly welcome modesty throughout the book. It is sometimes put about by lazy and uninteresting people (who are usually engaged in projective identification) that those of us who operate psychodynamically are hide-bound rigid ideologues rejecting all other forms of psychotherapy, from drugs to CBT to whatever this week's acronym du jour is. But, as you will presently read, while both Volkans (père et fils) are clearly steeped in psychoanalytic thought and approaches, they do not brandish any of that as a means of denigrating or dismissing pharmacotherapies and CBT. Time and again throughout the book one encounters--if you will--the "subjunctive mood" on many occasions. Their language is modest and quite sincerely so: regularly one reads that some people may be helped by some of the treatments examined here, but that no treatment is appropriate for everyone. There is no totalizing language here buttressing sweeping claims!

This is all embedded in a book whose first half looks at contemporary neurological and aetiological research into schizophrenia and acknowledges the use of psychotropics as being helpful, whether as stand-alones or as adjuncts to other therapies. It also examines CBT approaches and recommends some of those where appropriately indicated.

Second, and related to this first virtue, is the extensive attention paid--in the final quarter of the book--to cultural questions about the history, diagnosis, manifestation, and treatment of schizophrenia outside a middle-class American context in the early 21st-century. This too marks the book out as distinct in my (so far limited) experience in the field. 

With that in mind, let us turn to our two very distinguished authors and hear from them. 

AD: Tell us about your backgrounds

Kevin Volkan, EdD, PhD, MPH (KV) is a founding faculty member and Professor of Psychology at California State University Channel Islands. He also currently serves on the Graduate Medical Education faculty for the Community Memorial Hospital System in Ventura, CA, and as an adjunct faculty member for California Lutheran University’s clinical psychology doctorate program. 

Vamık D. Volkan, MD (VDV) is the author, co-author, editor, or co-editor of over fifty psychoanalytic and psychopolitical books. He is an Emeritus Professor of Psychiatry at the University of Virginia, Charlottesville and an Emeritus Training and Supervising Analyst at the Washington Psychoanalytic Institute, Washington, DC. In 1987, Dr Volkan established the Center for the Study of Mind and Human Interaction (CSMHI) at the School of Medicine, University of Virginia. He is the President Emeritus of the International Dialogue Initiative (IDI), which he established in 2007. 

As we say in the foreword of the book, we come from different but overlapping backgrounds. We give a more comprehensive overview of our backgrounds there.

AD: What led you to write this book on schizophrenia now?

VDV: Many individuals with this condition do not get enough or necessary treatment. Many are out there wandering around. It is important to bring attention to this mental/societal condition.

KV: Where I live in Southern California, we have an enormous homelessness problem. This is also true in many other parts of the country. Driving through downtown Los Angeles, it’s hard to believe that this is America. Conservative estimates are that around a third of the homeless population have severe mental illnesses – usually schizophrenia. 

So, although this disorder is a big problem, there has been little progress on how it is understood and treated over the last 50-100 years. The scientific understanding of the biological roots of schizophrenia has made great strides, but this has not yet translated into better treatment and care for people suffering from schizophrenia. 

But there are several new treatment possibilities on the horizon. Some of these new treatment methods include various types of psychotherapies. While psychoanalytic-derived treatments have been around for a while, these have not often been applied to psychotic individuals, especially in the United States. People like my dad have been working with those who suffer from schizophrenia in an in-depth way. He has learned a lot about schizophrenia and has important insights into how psychotherapy can be used to treat it. Our book is an attempt to communicate this insight as well as to document the state of schizophrenia research and treatment as it stands today.

AD: What is it like co-writing a book, especially as father and son?

VDV: One of the best things that ever happened for me. I felt very proud of my son, a great academician.

KV: Working on this book with my dad has been a wonderful experience. I was a bit nervous at first since he is such a luminary in the field. But the writing process went very well and was a chance for us to get to know each other and become closer.

AD: You note (p.19ff.) that cannabis use has been linked in a number of studies going back over a decade to increased rates of and risk for schizophrenia. Tell us a bit about some of those findings and your views on them. Given the increasing popularity and legalization of cannabis in North America, do clinicians need to be extra vigilant in screening for use? Are we as a society proceeding too fast in tolerating or even encouraging recreational use of cannabis?

KV: There are many studies that link the development of schizophrenia and cannabis use. The causal direction of the relationship is not entirely clear. For instance, do people who have a predilection to developing schizophrenia self-medicate with cannabis in a prodromal phase or do they use cannabis which then triggers the onset of psychosis? The latest research suggests that the latter is more likely especially among adolescents. Early age of cannabis use, and frequency of use seem to be predictive of significant risk for developing schizophrenia among vulnerable young people. 

Cannabis has not, as far as I know, been legalized anywhere for adolescents. Will legalization cause in increase in adolescent cannabis use? Maybe, maybe not. We are in the middle of a ‘natural experiment’. Will legalization cause a spike in first episode schizophrenia? A study by Vignault et al. in 2021 in Canada found that cannabis use among adolescents did increase when cannabis was legalized but did not seem to cause an increase in diagnoses of psychotic disorders (interestingly, there was a modest increase in personality disorder diagnoses). So, I think the jury is still out about the relationship of cannabis legalization to schizophrenia.

What I advise my undergraduate students and as well what I tell my clinical psychology graduate students to tell their patients is the following:

• Early cannabis use is bad. Children and adolescents should not use cannabis period, especially given the increased strength of the drug. 

• For people in their 20s there is some risk from cannabis use, especially if they are chronic users of strong cannabis. If there is no family history of psychoses and the use is occasional, the risk of developing schizophrenia is not zero, but is low.

• For people with a first-degree relative diagnosed with schizophrenia or another psychotic-adjacent illness they should not use cannabis at all. This is especially true for kids and young adults. 

• People who are diagnosed with schizophrenia or a psychosis adjacent illness should not use cannabis.

• Adults in their 30s -50s who do not have schizophrenia or something similar and who do not have first-degree psychotic relatives are not likely develop schizophrenia because of cannabis use.

• Adults older may find some cognitive benefit from cannabis use, again provided they do not have a schizophrenia or similar diagnosis.

These recommendations are speculative and subject to change when better research becomes available. (See Vignault, C., Massé, A., Gouron, D., Quintin, J., Asli, K. D., & Semaan, W. [2021]. The potential impact of recreational cannabis legalization on the prevalence of cannabis use disorder and psychotic disorders: A retrospective observational study. The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie, 66, 1069–1076.)

AD: You mention (p.76) that Searles (whom I wrote about here) suggested clinicians treating schizophrenia need to pay attention to the counter-transference. But this theme is not much developed in the rest of the book. Would you want to elaborate some thoughts on that here?

VDV: The psychology of analysts and therapists undertaking intense work with people with schizophrenia needs consideration; for example, their ability “to regress in the service of the other” is crucial. The necessity of tolerance and therapeutic use of countertransference in treating patients with schizophrenia demands that the therapist meet the patient in his or her regressed state and, in a sense, validate it without intruding into the therapeutic space. The patient must feel that he or she is not alone in a strange place. This conduct helps change the patient’s regression from chaotic to therapeutic. Because of their own psychological make-up, certain analysts or therapists may be better equipped than others to use their personal responses to the patient’s primitive activities. Training is important, but most psychoanalytic institutes do not provide the necessary training.

AD: Your 13th chapter on object relations theory was one that I resonate deeply with. There, and in several other places in the book, you speak of schizophrenia patients as "object hungry." Would you elaborate a little bit on that concept for our readers?

VDV: The patient with schizophrenia is hungry for libidinal experiences, but this hunger is never satisfied. An attempt is made to collect "good" images in order to libidinalize the infantile and adult psychotic selves, but the patient also collects "bad" objects under the influence of repetition-compulsion, and certainly in the patients’ experience what is “eaten” as good might easily turn out to be bad.

Utilizing its available ego functions, the infantile psychotic self, like the early computer game character Packman, is doomed to “eat up” anything in front of it, without finding any food that is nourishing. The infantile psychotic self’s main ego function is internalization. 

But it also evacuates constantly what has been “eaten.” Therefore, its other main ego function is externalization. Here I am using the terms internalization and externalization to separate these functions from more sophisticated introjection and projection mechanisms in which there is some fit between what is projected and the target and between what is introjected and the reality of the object before it is taken in. Such fits do not exist in externalizations and internalizations. At times even these primitive ego mechanisms are not functional. The infantile psychotic self simply fuses with objects, only to separate from them.

AD: The number of chapters devoted to cross-cultural understandings of schizophrenia was itself hugely impressive, going far beyond what I've found in numerous other recent works. Why was it important for you to include this material?

KV: While the prevalence rates of schizophrenia are similar around the world, the ways in which it is related to specific cultures varies a lot. The relationship between schizophrenia and how specific cultures deal with the disorder can provide many insights into understanding, preventing, and possibly treating schizophrenia. 

These chapters also point out that there may be different kinds of schizophrenia with some versions having a more ‘physiological’ etiology (qi gong psychosis for example) with other versions deriving more from societal conditions (for instance Saora psychosis). The idea that people in the developing world are less likely to have subsequent psychotic breaks after their first episode has been floating around. This may be related to not being treated with antipsychotic medication on first presentation or may reflect something in the culture which provides some resilience. 

Additionally, there is a lot of research about the increased risk for schizophrenia among immigrants. Switching cultures may undermine cultural resilience in several ways. I am especially interested in cultural variation in early object relations as something that possibly can prevent schizophrenia from developing in people who have a propensity for the disorder.

AD: You note (pp.116-17) that it may be important for psychotherapists treating schizophrenia to have a more fully developed "potential for regression in the service of their patients." Would you elaborate a little bit on this? I'm wondering if it is similar to Harold Searles saying that therapists need to be in touch with their own psychotic elements when trying to treat schizophrenia?

VDV: When I was growing up on the island of Cyprus my paternal grandfather used a plow pulled by animals that thrashed the wheat. “Regression” was not a scary thing for me.

KV: I think we answered a lot of this question in the response to question 6 above. In essence regression allows us to walk with the patient in their experience without our countertransference getting in the way of this. One of my teachers calls this the ability to maintain dual consciousness – a regression into the chaotic unconscious of the patient while simultaneously maintaining a rational egoic consciousness that guides the therapeutic interaction. In my opinion, this requires a certain degree of talent that probably has to do with one’s early experiences. 

I can add that I have been involved with and studied several Asian religious and philosophical systems which include meditation as part of their practice. Most meditation techniques include some form of regression. Because of this experience I have not found working with people who suffer from schizophrenia especially difficult. I agree with my dad that training is important and training specifically to do psychotherapy (not behavioral or case management) with those suffering from schizophrenia doesn’t happen much. In a sense I was fortunate to begin my career working with people suffering from schizophrenia (I wrote a blog piece on this.) I also think that working with people who suffer from personality disorders like borderline personality disorder, etc., where the patient can experience temporary psychotic states, is also helpful in learning to treat schizophrenia. 

AD: I really found your concept of the "doughnut personality" (pp.86-89) insightful. Tell us a bit more about that.

VDV: I will focus on the patients’ descriptions of their changed personality soon after the loss of their existing personality. These patients, at least for a short time, describe a new personality, which I named a “doughnut personality.” My doughnut analogy refers to patients’ experience of an exaggeratedly fearsome or exaggeratedly idealized outer layer, which is the dough of the doughnut, and a middle part that is either perceived as empty or filled with unpalatable “bad” jelly. The patients experience the outer layer as a "monster" or the opposite, an "angel" (or some similar term) according to the degree this component is saturated with the derivatives of aggression or libido.

Several of my patients going into schizophrenia described the two components of a changed personality by comparing them to a doughnut. After a while, the outer component of the dough changes; a sense of extra omnipotence (megalomania) infiltrates the dough. For example, patients now declare that they are Jesus or another prophet, the greatest musician or the best terrorist. This corresponds to classical observations on the development of “world construction fantasies.” But here I am describing a new construction in these patients’ perceived sense of their internal world. When omnipotence settles, their references to the "bad seed" or "emptiness" seem to lessen a great deal or disappear altogether.

AD: Sum up your hopes for the book, and who especially would benefit from reading it.

KV: I’ll just repeat what I said in my blog piece: The book can serve as a textbook for graduate clinical psychology students, psychiatry residents, as well as students in counseling, clinical social work students, psychiatric nurse practitioners, and other mental health graduate programs. The book is also written for the lay reader who seeks to understand more about schizophrenia, as well as the theory and process of psychoanalysis and psychoanalytic-based therapies. 

AD: Having finished this book, Schizophrenia: Science, Psychoanalysis, and Culture, what do you both have in the pipeline next?

KV: I have been working on a book about demonic possession. This will be a predominately psychoanalytic exploration that will be an expansion of a paper I published recently. I am also working on a paper looking at the latest social cognition research on schizophrenia and its implication for psychoanalysis and psychoanalytic psychotherapies with people suffering from schizophrenia. My dad and I have talked about working on a book on psychoanalytic therapy that is based on work he has done in China, which would be a fun project.

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. 

On Play and Enjoyment and Laughter in Psychotherapy

  As Arthur Leonoff commented in his necrology for Dr Louise Carignan, who was my psychoanalyst for seven years, she had a very memorable and infectious laugh. I don't remember what provoked it on one particular afternoon while I was lying on her couch, but the memory of that laugh has stayed with me more than twenty years later. It helped me realize that psychoanalysis and psychotherapy were not solely about solemnly entering into deep, dark waters of trauma, but should allow for occasions of laughter and enjoyment. 

This is a theme I first found in the great Nina Coltart, about whom I wrote here at some length, reflecting my longstanding gratitude to her. Her book Slouching Towards Bethlehem was what inspired me to seek out Dr Carignan in the first place, and in that book she stoutly and rightly insists that patient and therapist should be able to find humour in situations and therefore to laugh together.

More recently, I have been hugely indebted to Adam Phillips, including his recent book The Cure for Psychoanalysis. It is in that book (about which more another time) that he reminds me of what Winnicott (whose biography Phillips wrote more than thirty years ago now) said about the role of playing and enjoying in psychotherapy. 

Though I wrote earlier this year a few jottings on D.W. Winnicott on the fiftieth anniversary of his death, I had not then quite managed to finish Playing and Reality, which I now have thanks to Phillips drawing on it in his recent book, where he says that "what appeals to me about Winnicott is his wish to enjoy the patient's company." Just so. 

Reading DWW is always such a wonderful experience. You never have to worry about being bamboozled by theory or assaulted by polemics, or confused by turgid and abstruse sentences. I really do have the feeling, through Phillips' portrait and others I have read over the years, that you could indeed see DWW making and enjoying a cup of tea with his patients. This still comes through even today in his writing, many of whose basic insights seem to age really well. (I have recently found some of his writings in Through Paediatrics to Psychoanalysis on the possible meaning of adolescent stealing helpful to thinking through a very difficult case I am involved with clinically.) 

In Playing and Reality, DWW stoutly opens his third chapter by insisting: "Psychotherapy has to do with two people playing together." He goes on to say that if the patient is incapable of playing, then this must be the primary clinical task: to help them get to the point where they can play. In other words, modifying a famous Freudian saying, I would say "Where inhibition was, there shall playing be!" Or--if you will indulge me one more--modifying an equally famous saying of Ferenczi, the patient is not cured by playing but is cured when s/he can play (and do so, presumably, on his or her own). 

Later in the chapter, DWW says that health can be defined by the extent to which one is capable of playing, and that such playing "is itself a therapy." But in a clinical setting, there is a particular type of playing: "the playing has to be spontaneous and not compliant or acquiescent if psychotherapy is to be done." It cannot be coerced, in other words, but creative (a word DWW makes much of throughout this book) and always free. 

This, of course, requires certain things from the therapist, and here DWW is again equally direct: "If the therapist cannot play, then he is not suitable for the work." Therapists can also wreck the play of therapy, DWW warns, if they behave like experts who understand all the possible configurations of a game and act from this position of presumed omniscience instead of being at one with the patient in not knowing in advance how the game will play out. 

This, we know from several sources, is very much how DWW was with his patients, not just because he reports this to us, and his wife also noted this in a moving and important essay she wrote after his death, but also from some of his analysands including, perhaps most famously, Marion Milner, who charmingly recounts of DWW that was "on excellent terms with his primary process"! 

It is of course common today for therapists to have websites on which they advertise their philosophy of treatment, location, fees, etc. But in all my perusing of these, I have never once come across anybody who says that "Psychotherapy has to do with two people playing together." Imagine having that on a banner atop your website, or framed on your waiting room wall! 

Nor have I seen any self-descriptions by therapists today that they are on excellent terms with their primary process! Their websites sometimes groan under the weight of degrees and credentials, yes, and additional certification and training in whatever the acronym du jour is--certainly. But to advertise oneself as being on excellent terms with one's primary process?

If we cannot be playful and find the work enjoyable, and laugh at ourselves and with our patients, then it seems hardly likely that we will be able to keep at it for long or to do it very well. Thank God we have the witness of Donald Winnicott even fifty years after his death to save us from such ponderousness and to remind us of playing and enjoying not just outside our consulting rooms but within them. 

Adam Phillips and Leo Bersani on Intimacies

Some day I might write that very long review essay about Adam Phillips, almost all of whose books I have read and re-read.

One that had hitherto escaped my attention is a slender volume co-authored with Leo Bersani in 2008: Intimacies. Herewith just a few thoughts from it.

The book is characterized by an anti-historical approach which is surprising to find in psychoanalysis. By that I mean they begin by asking whether or not "psychoanalysis has misled us into believing, in its quest for normative life stories, that knowledge of oneself is conducive to intimacy" (vii).

More strongly still, the authors assert that "There are other satisfactions than the satisfactions of personal history" (3). This is not to say that history is irrelevant or can--or should be--escaped. But it is to take up again a theme developed across many of Phillips' books: the danger of imprisonment in the past, in the stories of our past which presume to determine who we are, what we are and are not allowed to think about ourselves.  

This is a danger which can in fact drive some people to analysis and therapy, but even there sometimes certain stories get reinforced if, e.g., one is especially wedded to a diagnostic history. It requires careful clinical discernment to know when to set aside diagnostic history and labels because they end up doing more harm than good, forcing people to believe something that may not work to their total good.

This becomes clear towards the end of the book when the authors note that "as a clinical practice, psychoanalysis is committed to the unsettling of the individual's hard-won (i.e., defensive) self-knowledge" (93). 

Another theme common in much of Phillips' writings--but here expressed in a more explicitly Lacanian vein--is the fear we have of being too much for ourselves. In this book, both Bersani and Phillips recognize "the fear of jouissance, despite and because of the longing for it,...is not to be underestimated" (97). 

Finally, perhaps the most interesting question raised by and in the book is this: must we understand ourselves in order to be happy? The authors do not quite put it this way, but instead note the assumption of most standard analytic therapy is that "whatever is strange about myself I must make familiar; recognition must replace bewilderment" (99). This they take to be the gist of Freud's famous (and famously mistranslated) "where id was, there shall ego be." 

But why? One of the things Phillips has helped me to see over the years is that a certain degree of self-forgetfulness is very much to be welcomed. Put in concrete terms, I have realized--never more so than during this pandemic--that one way to even temporarily lift one's mood is to go do something concrete for someone else, forgetting about your own struggles for a time. Make soup for someone in a shelter, or help shovel the driveway of your elderly neighbor. Such seemingly "banal" things can in their own way be therapeutic. 

Vamik Volkan Discussing His New Book

As I indicated earlier in the week, Vamik Volkan is a clinician and scholar from whom I have learned much. He has a new book out, Large Group Psychology, just published by Phoenix Books, whose website everyone interested in psychotherapy, psychoanalysis, and much else should keep a close eye on. Rare is the week that does not see Phoenix publishing something, or advertising books soon to be published, all of which look fascinating. 

I sent Dr Volkan some questions about his book. Here are his thoughts:

AD: Tell us a bit about your background

VV: I was born in 1932 to Turkish Cypriot parents on the Mediterranean island of Cyprus when it was a British Colony. The first humans on the island arrived about ten thousand years before the birth of Christ. As the centuries went by, invaders and traders multiplied. In my childhood I was exposed to people with different large-group identities: Cypriot Greeks, Cypriot Turks and, in much smaller numbers, Armenians, Maronites, people who considered themselves as descendants of Phoenicians and, of course, the British – all living side by side. Only much later I begin to wonder what history means for people with different large-group identities.

In early 1957 I came to the United States armed with my medical degree from the Ankara University’s Medical School in Turkey and only 15 dollars in my pocket, but I had a job at a hospital in Chicago. I became an American citizen a few years later. My departure to the United States was part of the phenomenon known as the ‘brain drain.’ The United States lacked medical doctors at this time and therefore attracted doctors from around the world. I had my psychiatric and psychoanalytic training in the USA.

In 1977, Egyptian president Anwar Sadat visited the Knesset and famously referred to a psychological “wall” between the Israelis and the Arabs—a wall that, he stated, accounted for 70 percent of the problems between them. In response, the American Psychiatric Association’s Committee on Psychiatry and Foreign Affairs, of which I was a member, brought influential Arabs and Israelis together for unofficial dialogues for six years to find out if this “wall” could be made permeable. This is how I started my decades-long work in unofficial diplomacy.

I met and had opportunity to spend time with many political and community leaders (For example, Jimmy Carter, Mikhail Gorbachev, Yasser Arafat, the Emir family in Kuwait, North Cyprus President Raif Denktaş, Turkish President Abdullah Gül, Estonia President Arnold Rüütel and Archbishop Desmond Tutu). This also helped me to study leaders-followers interactions and national, ethnic, religious and political large-groups’ psychology. As an academician, generally speaking, I stayed away from the news media. However, I believe that deeper knowledge about what lies behind what we see, hear and learn daily is useful for the public

AD: What led to the writing of Large Group Psychology: Racism, Societal Division, Narcissistic Leaders, and Who We are Now?

VV: I have been living in Charlottesville, Virginia since 1964. Following the deadly 2017 white supremacist rally in my city numerous fatal attacks on churches, synagogue and mosques occurred worldwide. In many countries, people are asking the metaphorical question “Who are we now?” and coming up with seemingly opposite answers. I could no longer ignore the urge to write a new book about large-group problems.

During my decades-long activities in the international arena I have learned that behind observable factors like politics, economics and law, the central psychological factor in starting and keeping alive large-group conflicts is the protection and maintenance of large-group identity. During my work I heard the subjective experiences of such large-group identities being expressed in terms such as “We are Palestinians,” “We are Lithuanian Jews,” “We are Russians living in Estonia,” “We are Polish,” “We are Communists,” “We are Sunni Muslims.”

AD: I visited Cyprus in October 1993 for an international ecumenical conference in Limassol devoted, in part, to overcoming division and conflict between Christians. As a young, naive kid from Canada I was almost entirely ignorant of the conflict until we were given a guided tour of Nicosia, getting as close to the DMZ/Buffer Zone as we were allowed. I've never forgotten the shock of seeing that, like a huge open scar right across the city streets. That division and its conflict are very personal for you, as you tell us in your moving first chapter. Is that conflict part of your own working through of the "rescue fantasy" (p.1) you speak of as motivating some therapists and clinicians?

VV: My arrival in America in 1957 coincided with the Cypriot Greeks’ struggle against British rule in order to unite Cyprus with Greece. The Greek Cypriots began to oppress Turkish Cypriots and an ethnic conflict was inflamed. I experienced a terrible stabbing pain six months after taking up residence in America. My father sent me a newspaper clipping with very grave tidings. My roommate, Erol, from the days when we lived in clapped-out lodgings in Turkey while attending the same medical school had returned to Cyprus to tend to his ailing mother. He was the nearest thing to a brother that I have had. A Greek terrorist shot him seven times, killing him, in a pharmacy where he was buying medication for his mother.

He was murdered in order to terrorize the ethnic group to which he belonged. After receiving the news of his death, I felt numb. I did not cry. I was in Chicago, in a foreign environment in which I was close to no one, so I did not share the news of my former roommate’s murder with any other person. Much later I would become aware how the murder of my roommate played a role in my involvement for finding ways for a more peaceful world.

Relationship between Cypriot Greeks and Cypriot Turks changed greatly since your visit to the island in 1993.  Border crossing points are now available. Due to COVID-19 there are the necessary cautions for border crossings.

AD: Your discussion of group psychology is, as of course you note at the outset, indebted to Freud and his book Group Psychology and the Analysis of the Ego.
One of the key points you repeat in your book is that group psychology exists "in its own right." Tell us a bit more what you mean by that and why it's important to be clear about this.

VV: Sigmund Freud and his followers (in the clinical setting) described what belonging to a large ethnic, national or religious group means for an individual and how an individual unconsciously perceives his or her large group as a symbol of a mother or father figure.

My work is very different. As a psychoanalyst I have studied the shared psychological processes within a large group and relationships between opposing large groups. Large-group psychology in its own right means making formulations about the conscious and unconscious shared past and present historical/psychological experiences that exist within a large group. Making such formulations enlarges our understanding of the emergence of present-day societal-political-religious events, and leader-follower relationships. 

Doing this allows us to look at the interactions between opposing large groups in depth. This is similar to a psychoanalyst making formulations about his or her analysands’ developmental histories associated with various conscious and unconscious fantasies in order to understand what motivates certain behavior patterns, symptoms and habitual interpersonal relationships.

AD: Two other key phrases recur in your book, reflecting some of your earlier work: "Complicated mourning" and "survivor guilt." From everything I'm hearing in this pandemic, there seems to be a lot of both being experienced by people today. Tell us a bit about those and how you understand them.

VV: I wrote about my roommate Erol’s murder above. Since I did not have family members or friends in Chicago at that time, I had no one to share my feelings and thoughts about my loss. My mourning process was complicated. 

Also, I was not aware of my “survivor guilt.” While I was safe in the US my family members in Cyprus were living under very difficult conditions and my former roommate was dead. Decades later I realized how I handled my “complicated mourning” and “survival guilt.” My first academic research was on these topics. I wrote papers and books on these subjects. My book (with Elizabeth Zinti), Life After Loss has been translated into several languages.

In the present book, the reactions to loss are seen in the  Addendum, which describes 16 analysands’ initial responses to the pandemic. These patients returned, consciously and unconsciously, to their childhood losses and re-experienced anxieties and old defense mechanisms and fantasies linked to such losses. Moreover, when I gave a seminar for 8,000 Chinese mental health workers on trauma due to COVID-19 pandemic on April 3, 2020 I encouraged them to study the psychology of mourning.

AD: You note (p.29) that an individual who has difficulty in mourning can often pass that on to succeeding generations, resulting in the transgenerational transmission of trauma. Is that also a dynamic we see at work in groups, indeed whole countries? Could it be said that some of the rage and grief today over police brutality and racism are at least partly due to America's never really having grieved the legacy of slavery and attempted to heal from it?

There are variations of transgenerational transmissions and all of them depend on the permeability of the psychological boundary between children and their mothers or other important caretakers. It is not only anxiety that travels from the mother or other primary caretaker to a developing child through the permeable boundary. Other psychological “messages” are also  given to the child.

Important adult persons may push their specific self- and object-images into the developing self-representation of the child. In other words, the “other” uses the child, mostly unconsciously, as a reservoir for certain self- and object-images that belong to that adult.

The experiences that created these mental images in the adult are not “accessible” to the child, but instead are deposited or pushed into the child, but without the experiential/contextual framework that created them.
In the psychoanalytic literature there are many papers and books that examine the psychology of the transgenerational consequences of the Holocaust for the children of the survivors as well as the perpetrators.

The rage and grief today over police brutality and racism are mostly due to America's never really having mourned the legacy of slavery. Mourning is a slow process related to remembering and relating to lost persons and things and, if everything goes Ok, saying “good bye” to such lost objects. What we see in the streets can be considered as an expression of shared mourning. I hope that it will take a positive course.

AD: In that vein, can we see your notion of a "linking object" as helpful in trying to understand some of the battles over statues, including over the removal of the Robert E. Lee statue in Charlottesville in 2017, which you say in your introduction was part of the motive for writing this book?

I described linking objects and linking phenomena in 1972. A linking object is an item chosen by an adult mourner that unconsciously represents a meeting ground for the mental image of the lost person or thing and the corresponding image of the mourner.   

Not every keepsake is a linking object; the item is a linking object if the mourner makes it “magical” and uses it as a “tool” for postponing the work of mourning. For example: after his father’s death, a young man picks up his father’s broken watch and hides it in a desk drawer.  For the young man, this broken watch becomes “magical.”  He becomes preoccupied with repairing the watch, but he never gets it repaired.

Some statues and monuments are shared linking objects. They connect many people to their ancestors’ losses or glories often without hurting or humiliating other large groups. But in the US some such shared linking objects humiliate another group (African Americans).

We are now more openly becoming aware that the beginning of American greatness was accompanied with the history of slavery. This reality now is hitting us openly. We need good leadership and open discussions to come up with ideas about what to do with some statues and monuments.

AD: Over the years, since discovering your work, I've found your concepts of "chosen trauma/glory" and "time collapse" enormously valuable. In this new book you introduce a concept I've not come across before in your work: "Entitlement ideology." Would you give us a sense of that and perhaps a current example?

Entitlement ideologies refer to a shared sense of entitlement to recover what was lost in reality and fantasy during the ancestors’ collective trauma. They deny difficulties and losses that had occurred during it, and imagine their large group as if it is composed of persons belonging to a superior species. Holding on to an entitlement ideology primarily reflects a complication in large group mourning, an attempt both to deny losses as well as a wish to recover them, a narcissistic reorganization accompanied by “bad” prejudice for the other.

The white supremacists openly verbalize their (fantasied and delusional) entitlement ideology, to have an America populated only by  white people from selected locations.

Some entitlement ideologies are known by specific names in the literature. What Italians call “irredentism” (related to Italia Irredenta), what Greeks call  “Megali Idea” (Great Idea) (an irredentist concept that expressed the goal of reviving the Byzantine Empire), what Turks call “Pan-Turanism” (bringing all the Turkic people together from Anatolia and Central Asia), what Serbs call “Christoslavism,” and what extreme religious Islamists of today call “the return of an Islamic Empire” are examples of entitlement ideologies.

We should remember the horrible consequences of the inflammation of the Serbian entitlement ideology (to have a greater Serbia) under Slobodan Milošević and be aware and careful about the inflammation of American white supremacists’ entitlement ideology.

AD: On pp.54-55 you speak of the "formal and informal systems of 'checks and balances' in a well-functioning democracy [that] prevent a leader's personality...from exerting undue influence over government and the governed." It seems ever more widely accepted by clinicians and observers today that such a system in this country is under the greatest and most severe strain ever. Is that an assessment you would share?

Yes.


AD: You refer to some of those clinicians (p.98) before, in ch.9, talking about "persons with exaggerated narcissism." Here you draw on the works of Kohut, Kernberg, and Jacobson. Tell us a bit more about this phenomenon of extreme or exaggerated narcissism. Is this a helpful way of understanding Donald Trump?

In my book I describe Charlottesville Psychoanalytic Study Group’s years-long study of persons with exaggerated narcissism.  An in-depth description of such individuals’ behavior patterns, need to be number one, language peculiarities, inability to have empathy and other characteristics help us to see observable personality characteristics of Donald Trump.


AD: Sum up your hopes for Large Group Psychology, and who especially would benefit from reading it:

VV: First, today we see a preoccupation with Donald Trump’s tweets, verbalizations, and behavior patterns. In the book the reader will learn about narcissistic personality organization, why it evolves and how it can lead to destructive or reparative societal processes. Such knowledge will help the reader to have a better understanding of Donald Trump and his influence on his followers.

Second, there are severe societal/political divisions in the USA. The reader will read why there is a need to have allies and enemies in human nature.

Third, racism, ethnic prejudice, removing or not removing some statues are discussed. In the book I describe the experience and views of an immigrant to the USA in late 1950s on these issues.

Fourth this book illustrates the need to have an in depth psychological/historical understanding of large groups and the meaning and the power of large group identity in order to find new solutions for political/societal problems.

Fifth, I wrote this book before the COVID-19 pandemic started to illustrate shared psychological processes of the Trump-era America and the world. The corona virus pandemic made me to realize that deeper knowledge of such psychological processes is sought by the reader. At the present time the personality of political leaders, racism, societal/political divisions and political propaganda preoccupy public interest. 

Sixth and finally, this book is written without my hiding behind technical psychoanalytic terms. It is easily readable.

AD: Having finished this book, do you have other projects on the go at the moment--other books in the works?

VV: I just finished writing another book. Soon I will send my manuscript to my publisher.  This one is on non-chemical addictions. I describe how some individuals remember their childhood traumas and their own “solutions” with compulsive actions. I hope that this book will also help the reader to have a deeper understanding of some political leaders’ repeating actions.

The Fascist in All of Us

When, in the mid 1990s, Ontario's socialist government, for which I proudly voted just after having turned 18 the year of their election, was replaced by the "Common Sense Revolution" of Mike Harris's neo-con Tories, I and a lot of my grad-school friends rather lazily derided the new government as a bunch of "fascists." 

That term seems to be acquiring even greater prominence now in the US, and not without reason. But its frequent usage can still be an occasion of looseness and imprecision of expression it seems, making it easier to dismiss as vague and vitriolic. 

What does it mean to say someone or some movement is or inclines towards a fascist state of mind? Are there more precise criteria, even "diagnostic" criteria, to aid our discernment? Indeed there are, thanks to the essay "The Fascist State of Mind" by the scholar and psychoanalyst Christopher Bollas, who trained in America, practiced professionally for most of his life in England, and now seems to be back in these United States. He is a very prolific author, and I have read almost all of his books, beginning with his first (and, I think, still his best) book, The Shadow of the Object: Psychoanalysis of the Unthought Known from 1987. 

In his 1992 book Being a Character, Bollas bluntly, disconcertingly, but quite rightly insists that given the right circumstances, “there is a Fascist in each of us.” That is perhaps his most important point to keep in mind. It will not, of course, endear him to anybody, but then psychoanalysts at their best rarely do. In making such a universalist claim, Bollas is at one with Freud as well as others, including those of the Jungian tradition who remind us of our own "shadow side"; and the Kleinians, who have so helpfully revealed the universal propensity for "projective identification."

But back to Bollas. He gives us eight concrete criteria by which a fascist state of mind develops, and to just this extent I find him very helpful in bringing greater precision to the discussion. It is amazing (dare we say uncanny?) how much these characteristics, outlined by Bollas almost thirty years ago now, describe the long-standing actions of the current occupant of the White House whose tenure, we pray, will soon be over. 

In the early stages of fascism, Bollas says, there arise certain psychic processes which, he argues, if left unchecked are the foundation of what he calls "intellectual genocide" which is usually a precursor to actual genocide (here Bollas draws on the invaluable work of such as Robert Jay Lifton and Raphael Lemkin). Examples of Donald Trump doing all of these are so numerous and widespread as to require no demonstration here--but then we can find examples of many of these in other places, as well, including our own habits and practices. 

Distortion: This, Bollas says, involves distorting and slandering one's opponents, making them less recognizably human. 

Decontextualization: This is done not just to an argument or a claim, but most worryingly to a person, who is removed from the context in which they normally reside and "isolated for purposes of persecution." 

Denigration: The two foregoing processes combine here to produce scorn and belittlement, further dehumanizing the subject. 

Caricature: The assigning of "undesirable qualities" from a person to an entire group. 

Character Assassination: This is an attempt to remove the person from the scene entirely by rendering their views completely odious and therefore unmentionable. (Cf., in today's argot, "cancelling" or "cancel culture.") 

Change of Name: The bestowal of nicknames, usually derogatory (and often racially, ethnically, or religiously constructed or affiliated), as a further means of belittling a person or of assigning his or her characteristics to an entire group. Cf., again, Melanie Klein on projective identification. 

Categorization as Aggregation: (Strikingly, when I first read this, I thought it said "Categorization as Aggression," which is not inapt at all!) For Bollas, this is a crucial moment in which the dehumanization is nearly complete. Here a person is no longer a recognizable individual at all, but assigned to a hated mass or group or abstract category whose name has been changed, history distorted and decontextualized, and in general been demonized. (Bollas doesn't say this, but it seems to me one prominent example of this would be "Godless Jew," which term Freud adopted rather proudly as a self-description in part, it seems, to defang those who had already attempted to categorize him thus.) 

Absence of Reference: Finally, and in addition to the foregoing, the person or group's unique history, contributions, and characteristics are "disappeared." We refer to them no longer; we pretend they do not exist in unique, singular, recognizable form. If they are discussed at all, it is in the disguised, distorted, dehumanized fashion noted above.

Bollas notes at each stage that, individually, these eight characteristics can be found, sometimes singly and sometimes severally, in virtually any and every debate in virtually any and every human group or encounter. He recognizes that each and all of the foregoing "is ordinary" in many ways. That is not to rob the term of any precision or applicability so much as it is to make us realize, as we noted at the outset, that fascism is not something that only "those people" do, but potentially and frequently something we can all engage in. In recognizing that, Bollas is not seeking to downplay its seriousness, but instead to encourage us to recognize that resisting the descent into a fascist mindset does not require heroic or dramatically self-sacrificing gestures in fraught and singular circumstances: "since it is ordinary, we can do something about it in the simple Freudian way of talking about it in the here and now and therefore partly divesting the act of its potential by addressing it." 

So let us continue to discuss fascism if only to remain perpetually on our guard against outbreaks of it in ourselves and others.