The Still Small Voice

Psychoanalytic Reflections on Guilt and Conscience

Donald L. Carveth

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367101756
• eBook ISBN: 9780429922336
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Whereas Freud himself viewed conscience as one of the functions of the superego, in The Still Small Voice: Psychoanalytic Reflections on Guilt and Conscience, the author argues that superego and conscience are distinct mental functions and that, therefore, a fourth mental structure, the conscience, needs to be added to the psychoanalytic structural theory of the mind. He claims that while both conscience and superego originate in the so-called pre-oedipal phase of infant and child development they are comprised of contrasting and often conflicting identifications. The primary object, still most often the mother, is inevitably experienced as, on the one hand, nurturing and soothing and, on the other, as frustrating and persecuting. Conscience is formed in identification with the nurturer; the superego in identification with the aggressor. There is a principle of reciprocity at work in the human psyche: for love received one seeks to return love; for hate, hate (the talion law).

CHAPTER ONE
The moral ambiguity of psychoanalysis

For decades what Freud (1933a) himself regarded as “the preferred field of work for psychoanalysis”, namely “The problems which the unconscious sense of guilt has opened up, its connections with morality, education, crime and delinquency …” (p. 61), has been neglected in favour of a preoccupation with narcissism, shame, self, relatedness and, most recently, the neurological foundations of mind. But recently issues concerning the superego, guilt, and conscience appear to be returning from repression. No doubt this “comeback” amounts to a reflection in psychoanalysis of a shift in the wider culture: the “culture of narcissism” (Lasch, 1979) got us into hot water. What three decades ago Rangell (1980) described in The Mind of Watergate as the “syndrome of the compromise of integrity” led eventually to the 2008 crisis of “casino capitalism”. It is time we began rethinking the psychoanalytic theory of morality.

As early as my doctoral research (Carveth, 1977) I was struggling with what I saw as the grossly inadequate psychoanalytic position with respect to moral questions. In this connection, I remember being struck by Abram Kardiner’s (1977, pp. 107–109) account, in My Analysis with Freud: Reminiscences, of one of his first clinical encounters after qualifying as a psychoanalyst and hanging out his shingle. A man presented with a work inhibition that he sought to have cured by analysis. It turned out he was a hit man, a professional killer, who was suddenly and inexplicably having trouble performing his job. After a few sessions in which both patient and analyst recognised the mutual threat they constituted to one another, the man did not return, leaving Kardiner wondering whether or not he had “cured” him.

Kardiner’s case raises a range of significant issues that psychoanalysts, with few exceptions, have sought to evade. The patient came with a psychological problem, an inhibition of function. In the traditional view, the psychoanalyst, like the physician, abstains from moral judgement and employs his expertise in the service of relief of the patient’s “inhibitions, symptoms and anxiety” (Freud, 1926d). So in a case like this, does the analyst get on with the job and help the patient overcome his neurotic inhibition against killing? If not, why not? If the analyst declines to help in this instance, is he or she now, like the patient, suffering neurotic inhibition? Is the analyst suffering from an unresolved moralistic countertransference? Does he or she require more analysis, especially of his or her superego? Or could it be that the idea of psychoanalysis as a scientific, technical, ethically neutral or “value-free” enterprise amounts to a cover story disguising the fact that, in reality, despite its avowed commitment to honesty and to putting everything into words, psychoanalysis practises an ethic it simply refuses to preach?

Half a century before the invention of psychoanalysis, in The Concept of Anxiety (1844), The Sickness unto Death (1849), and other works, Søren Kierkegaard advanced a view of emotional disturbance in which issues of morality and guilt are central. As Barrett (1958) explains, for Kierkegaard:

The condition we call a sickness in certain people is, at its centre, a form of sinfulness. We are in the habit nowadays of labelling morally deficient people as sick, mentally sick, or neurotic. … But the closer we get to any neurotic the more we are assailed by the sheer human perverseness, the wilfulness, of his attitude. If he is a friend, we can up to a point deal with him as an object who does not function well, but only up to a point; beyond that if a personal relationship exists between us we have to deal with him as a subject, and as such we must find him morally perverse or wilfully disagreeable; and we have to make these moral judgments to his face if the friendship is to retain its human content, and not disappear into a purely clinical relation. At the centre of the sickness of the psyche is a sickness of the spirit. Contemporary psychoanalysis will have eventually to reckon with this Kierkegaardian point of view. (p. 170; my emphasis)

Though Freud himself possessed “the mind of a moralist” (Rieff, 1959)— to Pfister he wrote that “[O]n the whole I have not found much of the ‘good’ in people” and that “Most of them are in my experience riff-raff” (letter cited by E. Jones, 1961, p. 445), while to Putnam he commented on “the unworthiness of human beings, even of analysts” (letter cited by Jones, 1961, p. 433)—in marked contrast to Kierkegaard, he sought to “de-moralise” therapeutic discourse. The founder of psychoanalysis did not believe that immorality is at the root of neurosis, or that its cure renders people morally improved. “Why”, he asks, “should analysed people be altogether better than others? Analysis makes for unity, but not necessarily for goodness” (letter to Putnam cited by Jones, 1961, p. 433). The patient was to be viewed not as a morally troubled soul in need of redemption, but as a victim of an “illness”, albeit one caused less by biological factors than by conflicting unconscious psychological forces and mechanisms in need of readjustment through becoming conscious.

In psychiatry de-moralisation has been more consistent than in psychoanalysis; patients have been viewed as victims of illnesses rather than moral agents implicated in their own suffering. The psychoanalytic position on this question has been ambiguous. On one hand, in keeping with Freud’s psychic determinism, patients have at times been depicted as pawns of unconscious forces and the compulsion to repeat, though ego psychology (Hartmann, 1939) attempted to resist such reductionism. On the other hand, psychoanalysis reveals the degree to which patients are the unconscious agents of their suffering. Whereas Freud (1916–17) attributed much of the resistance to psychoanalysis to the challenge it constitutes to the notion of free will (“But human megalomania will have suffered its third and most wounding blow from the psychological research of the present time which seeks to prove to the ego that it is not even master in its own house, but must content itself with scanty information of what is going on unconsciously in its mind” (p. 284)), Schafer (1976) drew attention to a complementary truth: that the resistance to psychoanalysis has as much or more to do with its widening, rather than shrinking, the range of human responsibility, its revelation that “People … are far more creators and stand much closer to their gods than they can bear to recognise” (p. 153). Schafer asks:

What, after all, did Freud show in the Studies on Hysteria … but that a neurotic symptom is something a person does rather than has or has inflicted on him or her? It is a frightening truth that people make their own mental symptoms. It is an unwelcome insight that if neurosis is a disease at all, it is not like any other disease. It is an arrangement or a creation, an expression of many of an individual’s most basic categories of understanding and vital interests. … Consequently, the widespread rejection of psychoanalysis may be understood as a species of disclaimed action. It is a way of asserting: “Do not tell us how much we do and how much more we could do. Allow us our illusions of ignorance, passivity, and helplessness. We dare not acknowledge that we are masters in our own house”. (pp. 153–154)

Despite rejection of free will in favour of strict determinism in psychoanalytic metapsychology, the clinical psychology of psychoanalysis reveals patients as the unconscious agents and creators of their emotional “illnesses”, however much they may also be victims of the circumstances to which such “illnesses” are a response. In pointing this out, Schafer was in no way seeking to replace a one-sided determinism with an equally one-sided voluntarism, but simply drawing our attention to the fact that we tend to err in two directions: at times excessively claiming responsibility and, at other times, excessively disclaiming it. Like Sartre (1943, 1960), he recognised that human beings are both subjects and objects.

While never denying the reality of emotional or psychological disturbance and suffering, nor the validity of psychoanalysis as therapy, the claim that someone is “mentally ill”, like the claim that an economy is “sick”, could for the psychoanalyst Thomas Szasz (1961) never be more than a metaphor. Where so-called “mental illness” can be shown to have an organic or neurochemical cause, then it is physical not mental illness. The latter term is reserved for conditions psychiatry wants to believe are illnesses but cannot prove to be so in any literal sense. It may look like “illness” in certain respects, but it is not illness unless its physiological, biological, anatomical, neurological, or neurochemical causes are discovered, in which case it is physical not mental illness. In Szasz’s view, and in mine, psychoanalysts are metaphorical “doctors” treating metaphorical “sicknesses” of the soul. If I continue to refer to my analy-sands as “patients” it is not because I consider them to be suffering from a literal illness, but because the term “patient” shares with the term “passion” the common Latin root patiens, from the verb pati, meaning “to suffer”. Patients are sufferers. Those of us who seek to work with them therapeutically share a commitment, if not a “calling”, that transcends the professional or business element and cash nexus conveyed, to my ear at least, by the term “client”.

While psychoanalysis has been ambiguous with respect to the question of the causation of emotional disturbance and the degree to which patients are the victims or the agents of their suffering or both, it has, at least manifestly, shared the psychiatric attitude towards treatment, viewing it as a technical rather than a moral enterprise. The goal of psychoanalytic therapy was to render unconscious forces conscious and to thereby enhance the patient’s freedom to choose, but the resulting choice, for good or ill, was the patient’s business, not the analyst’s. In other words, the goal was to make people freer and saner, not necessarily better. (I leave it to the ambitious philosopher to attempt to reconcile the psychoanalytic commitment to expanding patients’ freedom with Freudian psychic determinism.) Rieff (1959) describes the psychoanalytic “counter-ideal of health” as follows:

The chaotic id and the “rigid” superego are the areas of psychic vulnerability; the ego, having flexibility and craft, is Freud’s category of resolution. Where conscience, or an ideal, has divided personality against itself in constraints of its own devising, the therapeutic task is to help the ego move from mere defensiveness on to the offensive in an effort to achieve a new integrity. But this integration of self is no harbinger of goodness. It is possible to become more sound of mind and yet less good—in fact, worse. To be a complete man, self-united and controlled, states that counter-ideal of health in the name of which the old constraining ideals of devotion and self-sacrifice are rejected. (pp. 64–65)

One reason for the hostility towards psychoanalysis on the part of certain religious traditions is that they took seriously the, in my view false, claims that psychoanalytic therapy is not about helping people to be good, but only to become more rational and sane, and that “it is possible to become more sound of mind and yet less good—in fact, worse.”

Let it be clear that I am in no way arguing that therapists should moralise with their patients or seek to indoctrinate or convert them in one way or another. On this point I am a traditionalist. Except in extreme circumstances where the patient constitutes a danger to himself or others, it is the analyst’s responsibility to abstain from acting-out his or her countertransference in such ways, independent of whether such countertransference derives from the analyst’s superego, or from what I distinguish as his or her conscience. But what I do claim is that it is not possible for a person to become sane (“of sound mind; not mad” (O.E.D.)) without at the same time becoming morally improved. This is because a person’s immorality is always known to and disapproved by conscience, and sometimes also punished by the superego (even where the superego is the instigator of the immorality, a not uncommon situation as I will argue). When it is unconscious, bad conscience cannot promote positive change and reparation. In this circumstance the unconscious superego seizes the opportunity to inflict punishment, generating emotional disturbance, however obscure its manifestations and effects may be.

Although analysts may be reluctant to admit it, no patient is genuinely helped by psychoanalysis who does not in the process become morally improved, for it is necessary to become morally improved in order to overcome neuroses, character and personality disorders, and the suffering they entail. The churches misunderstood psychoanalysis because psychoanalysis misunderstood, or at least misrepresented, itself. The exceptional circumstances mentioned above, where the patient constitutes a danger to himself or others, are circumstances that force the analyst to “come out of the closet” as it were and acknowledge and act upon the moral values that undergird the entire therapeutic enterprise, but that are normally hidden behind a mask of moral neutrality, unless and until the patient forces our hand. The fact that there may be good, pragmatic, clinical reasons for wearing such a mask, at least for a time, should not be allowed to blind us to the fact that it is a mask. In “the sci-entistic self-misunderstanding of metapsychology”, Habermas (1971, Chapter Eleven) discusses Freud’s misrecognition of psychoanalysis as a natural science rather than an interpretive, hermeneutic enterprise (I personally believe like other human or social sciences it contains elements of both). A related element of this self-misunderstanding is the failure of psychoanalysis to grasp, or at least acknowledge, the inherently moral dimension of its practice. The Kleinians have come far closer than the Freudians to recognising this, but even they have been reluctant to make it explicit.

Freud (1933a) argued that psychoanalysis has no other Weltanschauung than that of science itself and is only interested in “submission to the truth and rejection of illusions” (p. 182). While acknowledging that in practical life the making of ultimate value judgements is unavoidable, these are left to the liberty and responsibility of the individual. In this view, psychoanalysis is committed only to a penultimate “ethic of honesty” (Rieff, 1959, ch. 9), restricting itself to helping analysands to transcend self-deception. But the idea that psychoanalysis has no ethic other than that of honesty is not honest. At best it is an illusion, hopefully without a future. For, like it or not, “Where id was there ego shall be” (Freud, 1933a, p. 79) is a moral imperative requiring far more than replacing illusion with truth: it enjoins us to transcend impulsive action and, instead, develop ego strength, prudence, discretion, and rational self-mastery. Developing ego where id was “is a work of culture—not unlike the draining of the Zuider Zee” (p. 80); sublimation of primitive drive is encouraged. But overcoming our illusions, developing self-control, sublimating our drives—this is still not enough. In addition, we must transcend narcissism in favour of object love, we must bind Thanatos with Eros, and we must overcome the harsh, primitive superego that is a “pure culture of the death instinct” (Freud, 1923b, p. 52) if we are to avoid self-destruction. In these and other ways the Freudian ethic far exceeds the demand for self-knowledge. While others fail to practise what they preach, psychoanalysts refuse to preach what they practise.

Four decades have now passed since Karl Menninger (1973) asked Whatever Became of Sin? In so doing he drew attention to a de-moralising trend in psychiatry and psychoanalysis mirroring that of the wider culture. Increasingly, it seems, we have come to reject Cassius’s conviction that “the fault … lies not in our stars, but in ourselves” (Julius Caesar, 1.2) in favour of that proto-narcissist Lear’s protestation that we are “more sinned against than sinning” (King Lear, 3.2). Such demoralisation, such guilt evasion, is only to be expected in the culture of narcissism. If, as the old saying has it, the superego is soluble in alcohol, then in narcissism it seems it may be liquidated altogether. But this is merely an appearance, for when the anaesthetic wears off the superego takes its sadistic revenge—it may even have cunningly instigated the whole process precisely to be able to do so. As Britton (2003) points out, the narcissistic disorders are grounded in evasion of what Bion (1959, p. 313) called the ego-destructive superego; but in my view they also entail flight from conscience conceived as a fourth structure of the mind distinct from id, ego, and superego. Narcissistic preoccupation with our grandiosity or inferior6ity, or each in turn in cyclothymic or bipolar oscillation, is characteristic of the paranoid-schizoid position (Klein, 1946) where splitting (idealisation/devaluation) reigns. But self-obsession, of either form, precludes genuine concern for the other. While viewing the self as all-good obviously prevents any admission of wrongdoing, a sweeping judgement of the self as all-bad entails an obvious distortion that removes any realistic focus upon the particular sins of which we may be guilty.

Might it have been easier to bear guilt back in the days when the Judaeo-Christian doctrine of the Fall of Man, of our intrinsic moral imperfection, was widely accepted, or when the need for capitalist accumulation made self-restraint a virtue, than in late capitalist consumer societies promoting oral-narcissistic regression and instinctual release rather than repression? Today the idea of moral imperfection as an intrinsic feature of being human—“For all have sinned, and come short of the glory of God” (Romans 3:23 KJV)—is widely rejected (viz., the letter to the editor cited in Chapter Two from a woman who was not a sinner). It is worth noting that moral imperfection precludes being perfectly bad as much as it precludes being perfectly good. I expect it has always been difficult to consciously bear guilt and not evade it by attacking either the self or others. When our narcissism renders conscious moral suffering (depressive or reparative guilt) intolerable, the superego exacts its pound of flesh either through unconsciously constructed forms of self-torment (persecutory guilt and shame) or by scapegoating others onto whom one’s guilt is projected. That is, when reconciliation with conscience is refused, the ego-destructive superego has a field day, however unconsciously. I will argue that the only viable escape from the clutches of the superego is reconciliation with conscience.

Prior to the 1960s, psychoanalysts viewed superego analysis as central to the analytic process, for it was widely agreed that the dynamics of guilt and self-punishment play a crucial role in both psychopathology and cure. Some analysts never lost sight of such fundamental Freudian and Kleinian insights, implicitly agreeing with Rangell’s (1974, 1976, 1980, 1997) view that, in addition to the ego-id conflicts resulting in neurosis, there are the ubiquitous ego-superego conflicts that frequently result in what Rangell called the “syndrome of the compromise of integrity” and that I think of as “the psychopathy of everyday life”. But I think it is fair to say that many of the newer psychoanalytic theories that came to prominence in the 1970s and 1980s (“coincidentally” with the emergence of the culture of narcissism and the rise of neo-liberalism or market fundamentalism)—the types of object-relational theory and relational psychoanalysis that draw on those parts of Winnicott’s (1960a, 1962) multifarious thinking that stress “ego-relatedness” and on Kohut’s (1977) “self psychology” that is so congruent with this— tended to downplay intrapsychic conflict among superego, ego, and id in favour of an emphasis upon trauma, deprivation, abuse, and neglect by caretakers, that is, the ways in which we are more injured than injurious.

By the late 1950s, Sandler (1960) had already noticed that in the indexing of cases at the Hampstead clinic there was a “tendency to veer away from the conceptualisation of material in superego terms”; he was wondering why “therapists have preferred to sort their clinical material in terms of object relationships, ego activities, and the transference, rather than in terms of the participation of the superego” (p. 129). Two decades later, Arlow (1982) observed that “[S]uperego function has been shunted...

Table of contents

• Cover Page
• Half Title
• Note about the cover image
• Title Page
• Copyright Page
• Dedication
• Contents
• ABOUT THE AUTHOR
• ACKNOWLEDGEMENTS
• FOREWORD
• PREFACE
• CHAPTER ONE The moral ambiguity of psychoanalysis
• PART I: CLINICAL REALM
• PART II: CULTURAL REALM
• SUMMARY
• REFERENCES
• INDEX