Psychoanalysis and the Birth of the Self

A Radical Interdisciplinary Approach

Mark Leffert

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138588462
• eBook ISBN: 9780429960406
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book draws psychoanalysis out of unsubstantiated, hermeneutic speculation and into the science and philosophy of the Self. Mark Leffert offers a survey of where we as human beings come from, going back into prehistory and our development as individuals. Psychoanalysis and the Birth of the Self is written to provide psychoanalysts with interdisciplinary information drawn from fields that they may have had little access to.

Leffert undertakes a novel integration of topics not frequently discussed together, resulting in a radical critique of the theorization of psychoanalysis. The book begins by setting the story with a short analysis of the history of psychoanalysis. A new science has been founded on the recognition of the impossibility of separating evolution from development; it is called Evo-Devo. Applied to the human condition, it integrates development with palaeoanthropology and forms the basis for exploring such topics as the neurophilosophy of consciousness, the birth of the Self, and its neurodevelopment. It includes epigenetics in the conversation. Leffert then takes a radical turn, integrating the biological Evo-Devo of the Self with the study of its Existence that is, Existentialism and Phenomenology. The integration of these two threads, Evo-Devo and Existentialism offers a powerful and unique tool for exploring the Self. The author offers an innovative way of understanding an individual that pulls together their biology, their development, and the way they choose to exist in the world. It steps outside of the traditional ways of clinically understanding an individual not by abandoning them but rather by powerfully supplementing them.

Psychoanalysis and the Birth of the Self offers a novel, interdisciplinary braiding of disparate strands of knowledge that will be of interest to psychoanalysts as well as those in the disciplines of neuroscience, existentialism and phenomenology, and anthropology.

1

PSYCHOANALYSIS’S YESTERDAYS, TODAYS, AND TOMORROWS

A brief history of being with patients

Introduction

Over its long history, Psychoanalysis has changed, in some ways hardly at all and in others so as to make of it a thing beyond the recognition of the early analysts. This is both good and bad; there is yet much more to be done. In this admittedly presumptuous chapter, I’m going to look at where we started from, where we’ve gotten to over the past century, and where we might be going in the next quarter century or so. Many, but not all of the events I will be talking about are well-known to all of us, but I will be talking about them in novel and perhaps disturbing ways. (Sadly, we have become known for rejecting ideas we find disturbing, and I ask only that you suspend belief and tolerate, for the moment, the accompanying uncertainty.) I write about all of these in the plural, since a number of different psychoanalyses (and I do not mean just metapsychologically different) have always been practiced, are being practiced in the present, and there are two possible outcomes for our profession going forward into the future. Although we should retain hope, some of the possibilities are ominous, intensifying the trivialization of our profession in the eyes of the wider world, a process that began to appear over recent decades, had we but the wit to apprehend it.

It should be obvious that a comprehensive account of a history such as I am proposing would be incomplete in a multiple volume work. What I want to offer here is a selective, warts-and-all narrative of the history of being with patients. Narratives contain knowledge that is actually power-knowledge (Foucault, 1980). Not including something in a narrative, for example, all too easily becomes an exercise in the power of exclusion. A deservedly obscure illustration of this can be found in Fruition of an Idea: Fifty Years of Psychoanalysis in New York (Wangh, 1962), which offers a history of the activities of the New York Psychoanalytic Society and the New York Psychoanalytic Institute as if it was the whole of psychoanalysis in New York and that no other psychoanalytic ideas even existed. I have tried as best I can to avoid this power trap in the choices I have made concerning what I would talk about (and, by exclusion, what I have chosen not to talk about), but such efforts can, at best, only be partially successful.

Trying to offer a definitive history of clinical practice at once faces a number of problems. Such a report is, inevitably, subjective. No one, not even a like-minded individual, would offer a similar, let alone identical, account. I offer this unashamedly for what it is: a claim to be knowledgeable about the subject and speak of it from a perspective honed over the past half-century, without making any claims of any sort of unique or special standing. Another source of the subjectivity is the relative dearth of hard data on these subjects. Surveys have been mostly limited to practice metrics and degree of analyst or therapist satisfaction. Participant self-selection tends to limit survey results to a description of the behavior and feelings of a subset of like-minded individuals. There is a small but significant literature (Hill, 2010; Leuzinger-Bohleber, Stuhrast, Rüger, & Beutel, 2003; Leuzinger-Bohleber & Target, 2001; Schechter, 2014; Tessman, 2003) about how patients feel about their analysts and the results of their analyses. We can also fall back on a series of subjective assessments gleaned from listening to how analysts talk in seminars and conferences, what they write, and what we hear from supervisees and patients about what they do and hear. A final source of inevitable subjectivity is the unknowable gaps between what clinicians think they do, say they do, what they actually do, and how aware they are of any of these (I’ve seen enough, Leffert, 2016, to confirm that this is a real issue).

The history of psychoanalysis is not a smoothly linear sequence of events, which makes the telling of it that much more difficult. As a card-carrying Postmodern,¹ I (Leffert, 2010) think of history in Derrida’s terms (1978) as a group of individual threads, interreferentially braided into a sheaf of différence. Some threads, like the Relational thread, make their appearance and then continue while others, like the Existential thread, can come and go. Despite the efforts of many metapsychologists to the contrary, all of these threads must inevitably influence each other.

Most of us already know the salient facts of psychoanalytic history (although “younger” analysts may be forgiven for some uncertainty about some of the less recent yesterdays). Unfortunately, all too few of us think of what psychoanalysis will be like tomorrow, beyond asserting the comfortable platitudes that it is alive and well, etc., and has a bright future. I have been recasting our historical narratives (Leffert, 2010, 2013) for some time and will do so yet again in this chapter. I will use phenomenological² tools to do so here, following Husserl’s (1937/1970, 1913/1983) admonition, which became a kind of phenomenological battle cry, to Return to the Things Themselves. (The Things here are two people in a room, talking to each other mostly about the life problems of one of them.) So, with these caveats firmly in place, let us proceed.

Allow me to turn, for a moment, to metaphor. It is in the form of a story I want to tell you. One can presume that, in the 19th century, there were many firms successfully engaged in the making of buggy whips. With the advent of the automobile in the 20th century, the need, and hence the demand, for buggy whips fell. As this happened, the less efficient of these firms and the ones producing an inferior product began to go out of business. Finally, perhaps by 1925 or so, only one firm remained. It admittedly created a superb buggy whip (or at least it thought that it did) for an ever-shrinking market. Maybe it still survives, maybe not, but what is clear is that the world is now interested in gas pedals.

So how does this metaphor translate to the fate of psychoanalysis, poised to move forward as it is, in the early 21st century? A friend recently told me of an analysis she had had with a largely silent analyst 30 years ago. The analyst did begin to speak, and rather vociferously I might add, when my friend told her of an exciting job opportunity in another city. The analyst was aghast and expressed outrage that my friend would even consider moving before “completing” her analysis. Fortunately, she was able to not just consider it but to do it and has sought, as needed, psychotherapy over the intervening years. Her tone in telling me this was somewhat accusatory, and she asked me to justify the analyst’s behavior as if it were my own; I told her that I could not. What makes this an even more difficult situation to discuss is that I must admit that, if confronted with it when I was a practicing analyst in the later 1970s, I would have responded in much the same way as my friend’s analyst (hopefully without the outrage). Her present-day perceptions of psychoanalysis highlight a secular problem facing us all; it is not a subject for finger pointing (I could not say the same if the treatment itself had occurred in the present).

I have noticed another disturbing trend in the choices made by our colleagues. Over the years, I have come upon perhaps a half-dozen instances in which analysts who have had a couple of analyses (or more) feel in need of further help and seek out not another analyst, but an experienced social worker whom they usually see weekly, or occasionally biweekly, with great satisfaction. When psychoanalysts, who are presumably the savviest of analytic consumers, vote with their feet, we are in very serious trouble as a profession. These two illustrations would seem to exemplify the problems we have going forward. But there is more.

As a profession, we have not made our peace with psychotropic medication, becoming comfortably fixated on its abuses rather than its therapeutic benefits. Although we have been tackling the very thorny problem of therapists and analysts who have sex with their patients for three decades, we have largely done so on a case-by-case basis and are only beginning to get beyond that to address the wider social and cultural issues plaguing psychoanalytic groups of which it is but one example. We no longer even have a definition of psychoanalysis or its frequency that satisfies the 30,000 members of our profession (of which the American Psychoanalytic Association [APsaA] only boasts 3000) who have had training in psychoanalysis. (Laplanche and Pontalis had already acknowledged this problem in 1973.)

A further series of problems exists around the metapsychologies, a term that I use to refer to the differing theoretical orientations by which members of our profession tend to identify themselves, taking some overarching concept, or the name of some founding psychoanalytic mother or father as self-signifiers. (Such theoretical ultra-orthodoxy tends to be less of a problem for psychoanalytic psychotherapists who have not trained/been indoctrinated at psychoanalytic institutes.) These theoretical differences have been pursued with increasing civility in recent years; sometimes, they are even able to coexist in the same institute. But this doesn’t solve the problem. There is often little or no evidence for the theoretical positions taken by these groups, and repeated studies (Leuzinger-Bohleber et al., 2003; Leuzinger-Bohleber & Target, 2001; Tessman, 2003, to mention but a few) have demonstrated that the theoretical orientation of the analyst has nothing to do with clinical results or what is valued by the patient (in psychotherapy and psychoanalysis, the customer is usually right). What patients seem to value above all else in their therapists is understanding and a caring attitude. The problem we face today is that, while many analysts are aware of these findings, more or less all try to elide the issue and avoid considering its clinical and educational implications.

In dividing our history into what are, after all, identity categories, we ignore the fact that some issues persist over the course of more than one period. In these cases, I have had to make a somewhat arbitrary assignment, expecting the reader to understand the carryovers. Bearing this in mind, let’s begin with the first of our inquiries: Psychoanalysis Past.

Psychoanalysis as it was

The history of the “facts” of yesterdays of psychoanalysts is well-known to contemporary psychoanalysts and psychotherapists and does not bear repeating here. An excellent summary of these “facts” of the theory is to be found in Sandler, Holder, Dare, and Dreher’s (1997) Freud’s Models of the Mind: An Introduction. We, however, are after bigger game.

A phenomenological inquiry into the birth of psychoanalysis

In pursuing this inquiry into the things themselves (Husserl, 1937/1970, 1913/1983) of psychoanalysis, I am going to go about it phenomenologically. What that means here is that we must always begin with an inquiry into what can be observed directly in the therapeutic situation, as opposed to what can be theorized or hypothesized about what’s going on and its theoretical (as opposed to existential) meaning. Husserl relied on direct observation, and if something could not be observed directly then he placed it in brackets, or epoché, saying in effect let’s go on through to the thing and then come back to explore the bracketed material. If these ideas are unfamiliar, they will not make total sense, but will become clear the first time they are employed.³ The narratives I’m constructing in this way will look very different than the customary history of psychoanalysis all of us are used to.

In the late 19th century, Sigmund Freud was a hardworking young neurologist struggling to raise a family.⁴ During this period he made his greatest discovery (not any of the metapsychologies that appear in the Standard Edition). What he discovered, if we look at the memoirs of patients who saw him, was that regularly and frequently scheduled appointments in which patient and [psychoanalyst]⁵ engaged in a caring discourse focused on the patient’s life, problems and unhappinesses usually⁶ resulted in the patient feeling better or at least being able to feel at home (heimisch) in her life. These salutary effects often persisted. What went along with this in that far-off time was [the affect-trauma frame of reference (Rapaport, 1958/1967; Sandler et al., 1997)]. If we honestly consider the contents of this particular epoché, given what we have come to know about psychic trauma and post-traumatic stress disorder today, we must conclude that they are meaningless.

Going forward into the teens of the new century and beyond, the theoretical situation became so complex that it is best to replace it with a new epoché, [metapsychology].^7,8 This is the first period of multiple schisms appearing within psychoanalysis; [metapsychology] would never be singular again. For those of us trained in Freudian institutes, this did not appear the case. As Christ cleansed the Temple by expelling the merchants and moneychangers, so Freud, first in his inner circle, and then among their spiritual descendants, labeled these heretics (Bergmann, 1993) apostates and erased them from institutional consciousness. For the Freudian psychoanalyst, [metapsychol...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright page
• Table of Contents
• Acknowledgments
• Introduction
• 1 Psychoanalysis’s yesterdays, todays, and tomorrows: a brief history of being with patients
• 2 The neurophilosophy of consciousness
• 3 Psychoanalytic theories of development and the new science of Evo-Devo
• 4 The origins of the Self and its consciousness: the Evo-Devo of human being
• 5 Being and nothingness or to be or not to be
• 6 Common ground
• Index