Knowing, Not-Knowing and Sort-of-Knowing

Psychoanalysis and the Experience of Uncertainty

Jean Petrucelli

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781855756571
• eBook ISBN: 9780429915451
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

A contemporary, wide-ranging exploration of one of the most provocative topics currently under psychoanalytic investigation: the relationship of dissociation to varieties of knowing and unknowing. The twenty-eight essays collected here invite readers to reflect upon the ways the mind is structured around and through knowing, not-knowing, and sort-of-knowing or uncertainty. The authors explore the ramifications of being up against the limits of what they can know as through their clinical practice, and theoretical considerations, they simultaneously attempt to open up psychic and physical experience. How, they ask, do we tolerate ambiguity and blind spots as we try to know? And how do we make all of this useful to our patients and ourselves? The authors approach these and similar epistemological questions through an impressively wide variety of clinical dilemmas (e.g., the impact of new technologies upon the analytic dyad) and theoretical specialties (e.g., neurobiology).

Part I
Stalking the Elusive Mutative Experience

CHAPTER ONE
The enigma of the transference

Edgar A. Levenson, M.D.

Psychoanalysis from its inception has been biased towards theory, metapsychology, presumably the font of the mutative therapeutic action. Far less emphasis has been put on the phenomenology of therapeutic action; that is, on how people change. This valorization of metapsychology is increasingly coming under scrutiny, however, as the erstwhile sharp-edged doctrinaire distinctions between positions blur and attention shifts to an emergent neuropsychological paradigm; at this stage of knowledge really more a metaphor than a genuine model (Pulver 2003). In other words, now that it is less clear that we are right and that you are wrong, we are all beginning to wonder what it is we are doing when we do what we all know how to do.

Metapsychology, for all its claim to ontological truth, always reflects the current culture, the social context in which we are all imbedded, but of which we are largely unaware. As Gregory Bateson said, the point of the probe is always in the heart of the explorer (Bateson 1979: 87). The current emphasis on the vicissitudes of early mothering, especially as described in attachment theory, reflects a cultural change, from the patriarchal, Oedipal-oriented (conflict and envy) world in which I both grew up and became an analyst, to a matriarchal, nurturing one in which mothering (early) and empathy is privileged. One also notes, not inconsequentially, that the demographics of psychoanalysis have shifted from largely male and medical to female and psychological along with a radical shift in the economics. Believe it or not, when I entered the field in the early fifties, psychoanalysis was the second highest paid medical specialty and we had waiting lists! Clearly this made for a therapeutic milieu that tolerated more frustration and tempted therapist less to overaggressive interventions.

But does anyone entirely believe that if secure attachment takes place, all subsequent troubles are weathered: Oedipal, family, sibling, peer group, societal, mid-life and old age? Whatever happened to the father? It would appear that although we are ostensibly ecumenically intended, agreeing to disagree amicably, psychoanalysis is still split into what Cooper called a “growing plurality of orthodoxies”, adamant, entrenched, and highly politicized (Cooper 2008: 235). Yet, surely everyone from Freudian to relationist is on to something, has grasped some aspect of our proverbial elephant, the nature of mind.

Once the “Ghost in the Machine”, mind, and its correlate, consciousness, has become of cardinal interest (Levenson 2001). We are now in the Age of the Mind. The nature of consciousness is hotly debated in a virtually medievalist sectarianism amongst the mentalists, the functionalists, the materialists, and the mysterians (Damasio 1994). Suffice it to say that the debate centres on whether consciousness is merely an epiphenomenon of the brain—an inevitable outcome of organic complexity—or, whether it is of another essence altogether.¹ Consciousness, as Damasio says, is “the last great mystery and may lead us to change our view of the universe we inhabit” (Damasio 1994: 21).

I would suggest that our current focus should be, not so much on competing metapsychologies and their interpretive sets, as on how mind works; how experience is processed and integrated. As Jonathan Miller put it, “we are the unwitting beneficiaries of a mind that is, in a sense, only partially our own” (Miller 1995: 64). We must understand the phenomenology of change, how people comprehend their being in the world, and how the analyst’s presence and interactions foster flexibility and growth.

Regardless of theoretical doctrines, all analysts are struck by two oddly autonomous parameters of observation: first, the flow of consciousness as it is evidenced in the patient’s narrative—the unconscious associations, the “red line” of coherence that runs through the ramblings of a session—and second, the transference enactment, the way analyst and patient behave with each other in the course of the inquiry. Clearly, both the interpersonal and the intra-psychic co-exist: the relationship between the intersubjective world and the still mysterious internal processes of change must be synthesized. Integrating these two strikingly incompatible aspects of the analytic process has been, for me, consistently the most puzzlingly and yet rewarding aspect of the therapeutic endeavor.

The patient’s flow of consciousness, the intra-psychic, is the classic sine qua non of the analytic process—not necessarily limited to free-association, since the same order is equally evident in a detailed inquiry. As Bollas put it:

[there is an] understandable and inevitable tension between the goal of free association and the wishes of the analyst to understand the material: as free association unbinds meaning—in what Laplanche terms and celebrates as the “anti-hermeneutics” of psychoanalysis—while interpretation creates and binds meaning. No sooner are such understandings established than the workings of the unconscious, evident through free association, break the interpretation into particles of meaning, which constitute a “use of the Object”, hopefully celebrated by the analyst’s unconscious working along similar lines even as such use disperses his interpretive creations. (Bollas 1999: 70)

The second striking manifestation is, of course, the relationship between the patient and the therapist, the uncanny way the two play or enact, or re-enact, the very patterns that are under inquiry This is of course the storied transference, these days considerably loosened from Freud’s original constraints, but still clearly central to the process.

I want to proceed to two clinical excerpts. The first illustrates the coherence of the patient’s unconscious flow of associations, which seem, at least at first view, to be independent of the therapist’s participation. It very much reflects Masud Khan’s aphorism that we are the servants of the patient’s process. The second example, also a dream, illustrates less the flow of unconscious associations than the intricate interweaving of content and transference enactments.

This first patient, a thirty-year-old man, has a dream about three weeks into therapy. He is “with another guy”. Perhaps they are reviewing his portfolio. That’s all. That’s the dream. Who is the guy? He doesn’t know. He is thinking of working for a friend of his mother’s brother—his famous uncle Max, the family patriarch, who is wealthy and powerful and helps them all with their problems, financial or personal. Oh yes, there are snakes floating around overhead. Also something like hieroglyphics, bits of information. Any other associations? Other ideas? None. Suddenly he remembers that the dream takes place in his parent’s garage, at their country house. What about the house? His parents own an isolated country house. He often visits there without them. He must enter the house through the garage, which is always left unlocked. He must first reach over a shelf in the dark to find the light switch. Then he must reach over deeper into the dusty, cobwebbed space to find the house key. Then he must take the key around to the front of the house and open the main door. Otherwise, he could enter through the garage, go down the stairs from the garage to the cellar—a very spooky place that he has always avoided—and then he can go up the back stairs into the house. He never ever goes into the cellar. The garage is scary enough since it is never locked. Every time he opens the door, he expects to be attacked by “a bum or bear or something”.

Why doesn’t he just have another key to the front door? Why not leave another key hidden near the front door? It’s not clear; he never thought about it. Does his father go through all this when he uses his house? Where were the bits of hieroglyphics? The associations begin to proliferate: to the movie, Indiana Jones and the Temple of Doom. It seems that entering the garage is like the movie—always hidden rooms, monsters, having to reach through icky bugs and snakes—Indiana Jones’ Achilles heel, his phobia. What about snakes? Constrictors … not vipers … constriction … squeezed. He doesn’t have a snake phobia, but he hates spiders!

Hieroglyphics come back into play. He was always interested in archaeology, thought it would be a wonderful thing to do. It is his grandfather and father’s interest. Grandfather would spend weeks meticulously repairing antique vases, from his homeland. His father also loved antiquities. When my patient was a child, his grandfather would play with him, breaking a vase, burying the pieces and having him find them, dig them up and reconstitute the item.

This profuse flow of associations to a very brief dream, some totally spontaneous, other a consequence of my detailed inquiry, seem to come from some entirely autonomous source. They are, to put it technically, metonymic not metaphoric; that is, they are private associations.² Only the patient knows their relevance, as compared to metaphor, which is in the common domain, a story. Certainly the therapist has no idea where it was headed, although he did ask detailed questions that focused the odd omissions.

One certainly could infer a transferential subtext. The patriarchal Uncle Max who helps everyone, the fascinating game of inquiry and reconstitution (Freud, after all, considered psychoanalysis an archaeological process), the coded messages; all point to a view of transference and of the therapy. Is it a game to make the patriarch happy? Does it really engage him? The questions proliferate, but for the moment I want simply to show how this dream has a blatant associative aspect and a much more implied and less self-evident transferential dimension.

The second dream is far more elaborate, richly metaphoric, and chock full of blatantly obvious transferential implications. Indications of an associative flow are sparse. For this fifty-year-old woman, it is her first dream in vivid colour and occurs one year into therapy. She is at a conference where she meets Osama Bin Laden. He is her height, hazel eyes; something seems to be wrong with his right shoulder. He asks whether she hates him. She explains that she is Jewish and pro-Israel. She’s telling him “straight”. He’s listening, looking her straight in the eye. Then Bin Laden wants to kiss her. He chews food and then passes it to her lips; like a mother bird or wild dog (note the polarities of nurturance—a bird or a carnivore). This, he explains, is “an old Indian custom”. He has a virus, she is thinking of getting him medicine (she doesn’t seem concerned about catching some disease from being fed by him).

In contrast to the first dream, her associations are minimal: namely that her mother visited India twice (without her father). I point out to her the stunningly obvious—that I am her height, have hazel eyes and when she started in therapy with me a year earlier I’d just had shoulder surgery; my right arm (same side as in the dream) was in a sling for many weeks (the right side in both cases). This dream is a veritable palimpsest of unconscious process: first, the content, her apparent unawareness of perfectly obvious themes; her presenting me with the themes so that I can pre-chew them and force-feed them back to her—which, of course, I proceed to do by explaining the dream to her. Does she need to be told that her feelings about Osama are ambivalent? That he represents the therapist? All he lacks is a name tag!

She has wonderful dreams—at least at that stage of the therapy— that make me feel very clever and insightful and I usually fall for “interpreting” them to her. If they are so obvious why doesn’t she see them? How can someone so smart be so dumb? It is a prime example of R.D. Laing’s dictum about mystification: the patient learns not to know what the patient knows she knows but is not supposed to know (Laing 1967). In this dream, although there are many rich threads of inquiry into her history, the interactive replay of those themes with the therapist is most instantly obvious.

These two dreams illustrate the polarities in the dialectic between the intra-psychic process of unconscious flow and the interpersonal process of transference enactment. How do competing psychoanalytic groups deal with these two apparently dissonant aspects of the process? Why don’t analysts simply use both parameters of therapy flexibly, moving freely between them? As the clinical cases suggest, each seems so striking that one is tempted to think, “Ah. So that’s how it works!’ And, as I shall elaborate, psychoanalytic groups do seem to privilege one or the other as a means of institutional definition.

It all used to be much simpler. In the Good Old Days, you either were or were not an analyst: this, of course, was decided by the powers that be. The White Institute was not. Simple as that. It was a pragmatic application of Popper’s (1959) principle of falsifiability—you can’t say what a thing is if you can’t say what it isn’t. Psychoanalysts defined themselves by declaring who wasn’t. The struggle for status, prestige, patients and candidates invokes a polarization: them/us. The minute you are convinced you are right and that your system is the only Truth—you’ve established a religion. Current ecumenism allows for multiple versions of psychoanalysis, some of which admittedly may strain the definition of the process. But at least we now talk to each other.

In 1983, Greenberg and Mitchell published their seminal Object Relations in Psychoanalytic Theory (Greenberg and Mitchell 1983). By subsuming virtually every psychoanalytic position under the rubric of “relational” (including the Kleinians, Kohutians, Interpersonalists, Winnicottians, and so on), they politically outflanked and isolated the Freudians; essentially pressuring them to participate in an ecumenical movement that may have had as much to do with pragmatics as any genuine substantive synthesis. Ironically, the Interpersonal position—the original apostates—may currently be closer to contemporary Freudians than to our other presumably “relational” cohorts.

At about the same time, Merton Gill presciently identified the problem in a paper read at the William Alanson White Institute (Gill 1983). Gill, who has been perhaps the most conciliatory of the Freudian analysts on the committee that in 1942 expel...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• ACKNOWLEDGEMENTS
• ABOUT THE EDITOR
• CONTRIBUTORS
• INTRODUCTION
• PART I: STALKING THE ELUSIVE MUTATIVE EXPERIENCE
• PART II: THE KEYNOTE ADDRESSES
• PART III: DISSOCIATION—CLINICAL, DIAGNOSTIC, AND CONCEPTUAL PERSPECTIVES ... FROM MURDER THROUGH ABUSE TO MASOCHISM
• PART IV: WHEN EXPERIENCE HAS A MIND OF ITS OWN
• PART V: HOW DO WE KNOW AND HOW DOES IT CHANGE? THE ROLE OF IMPLICIT AND EXPLICIT MIND/BRAIN/BODY PROCESSES
• PART VI: HOW BODIES ARE THEORIZED, EXHIBITED AND STRUGGLED WITH AND AGAINST: GENDER, EMBODIMENT, AND THE ANALYST'S PHYSICAL SELF
• PART VII: I KNOW SOMETHING ABOUT YOU: WORKING WITH EXTRA-ANALYTIC KNOWLEDGE IN THE ANALYTIC DYAD IN THE TWENTY-FIRST CENTURY
• PART VIII: OMISSIONS OF JOY
• INDEX