Death and Fallibility in the Psychoanalytic Encounter

Mortal Gifts

Ellen Pinsky

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138928688
• eBook ISBN:
  9781317400028
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Death and Fallibility in the Psychoanalytic Encounter considers psychoanalysis from a fresh perspective: the therapist's mortality—in at least two senses of the word. That the therapist can die, and is also fallible, can be seen as necessary or even defining components of the therapeutic process. At every moment, the analyst's vulnerability and human limitations underlie the work, something rarely openly acknowledged.

Freud's central insights continue to guide the range of all talking therapies, but they do so somewhat in the manner of a smudged ancestral map. That blur, or degree of confusion, invites new ways of reading. Ellen Pinsky reexamines fundamental principles underlying by-now-dusty terms such as "neutrality," "abstinence," "working through," and the peculiar expression "termination." Pinsky reconsiders—in some measure, hopes to restore—the most essential, humane, and useful components of the original psychoanalytic perspective, guided by the most productive threads in the discipline's still-evolving theory. Freud's most important contribution was arguably to discover (or invent) the psychoanalytic situation itself. This book reflects on central questions pertaining to that extraordinary discovery: What is the psychoanalytic situation? How does it work (and fail to work)? Why does it work?

This book aims to articulate what is fundamental and what we can't do without—the psychoanalytic essence—while neither idealizing Freud nor devaluing his achievement. Historically, Freud has been misread, distorted, maligned or, at times, even dismissed. Pinsky reappraises his significance with respect to psychoanalytic writers who have extended, and amended, his thinking. Of particular interest are those psychoanalytic thinkers who, like Freud, are not only original thinkers but also great writers—including D. W. Winnicott and Hans Loewald.

Covering a broad range of psychoanalytic paradigms, Death and Fallibility in the Psychoanalytic Encounter will bring a fresh understanding of the nature, benefits and pitfalls of psychoanalysis. It will appeal to psychoanalysts and psychoanalytic psychotherapists and provide superb background and inspiration for anyone working across the entire range of talking therapies.

Chapter 1

Physic Himself Must Fade¹

On love, on grief, on every human thing,

Time sprinkles Lethe’s water with his wing.

—Walter Savage Landor

Limited as a human being, limitless in the patient’s casting of him, the analyst is a magnetic presence almost without explicit dimension: a shadow figure, known yet not known, who exists largely for the patient’s invention. As if that weren’t odd enough, this therapeutic relationship, unlike many other deep relationships, emphasizes ending as a register of its success. Therapeutic intimacy intends from the outset to end, just as each hour ends, foreshadowing that finality.

Composed of discrete time-limited segments, this special form of discovery and intimacy has for its goal a restorative separation, the analyst becoming, in Loewald’s terms, a “presence in absence” (1978: 180), the relationship internalized over time. A magnet for reawakened desires, fears, hopes, and hatreds, the analyst, a mortal reservoir, performs his (or her) function by surviving, within a construct, each of the patient’s idiosyncratic uses of him. He isn’t supposed to die—though the relationship, in its peculiar jargon, is supposed to “terminate.”

Freud’s newly invented professional figure is an ordinary person serving an artificial or “as-if” role in a fiduciary engagement. Can a chimera die? When the fairy Puck says, “What fools these mortals be,” the Shakespeare character’s “mortal” seems to indicate human folly as well as vulnerability. The folly, the vulnerability, and the certainty of death apply to all humans, including doctors and their arts of medicine. In the words of Shakespeare’s contemporary Thomas Nashe:

Rich men, trust not in wealth,

Gold cannot buy you health;

Physic himself must fade;

All things to end are made,

The plague full swift goes by;

I am sick, I must die—

Lord, have mercy on us

(from “In Time of Plague”)

To these two profoundly traditional notions about the human condition—that man is a fool and he also dies—we can contrast Donald Winnicott’s well-known aphorism, “The analyst survives.” Puck, a kind of god, speaks words written by one mortal and performed by another. The play, like the immortal Puck, lives, though William Shakespeare is dead. A similar intersection of the ordinary and the uncanny, the actual and the simulated, is at the very heart of the therapeutic relationship, with its flaws and benefits: a gift that is mortal in its origin as well as its nature.

A therapist’s humanness is of course no more extricable from his or her professional functioning than is the human idiosyncrasy of any parent or teacher (or any role of guardianship) separable from their acquired skills. Rather, that humanness is the foundation upon which the work rests. But unlike the mores of child care, evolved and shifting over centuries, and unlike the teacher’s humanness embedded in the culture of pedagogy, the odd activity of the analyst is a twentieth-century invention. An artifice, psychotherapy functions by offering a safe, delimited illusion, like a play. The vehicle of attraction derives its energy from a human being, someone fallible as well as vulnerable in that benign fostered illusion. Freud’s stratagem starts with love:

The process of cure is accomplished in a relapse into love, if we combine all the many components of sexual instinct under the term “love”; and such a relapse is indispensable, for the symptoms on account of which the treatment has been undertaken are nothing other than precipitates of earlier struggles connected with repression or the return of the repressed, and they can only be resolved and washed away by a fresh high tide of the same passions.

(1907: 90)

What kind of love is this “fresh high tide of the same passions”? Freud (1916–1917) describes the development of transference: “By this we mean a transference of feelings on to the person of the physician, because we do not believe that the situation in the treatment can account for the origin of such feelings” (442). Freud (1910) is quite clear from the start about the universality of this “transference,” a phenomenon that “arises spontaneously in all human relationships, just as it does between the patient and the physician” (51).

But unlike other relationships, the analytic doctor in the consulting room puts that phenomenon, purposefully intensified by the structured situation, to a particular use:

In every psycho-analytic treatment … the strange phenomenon that is known as “transference” makes its appearance. The patient, that is to say, directs toward the physician a degree of affectionate feeling (mingled, often enough, with hostility) which is based on no real relation between them and which … can only be traced back to old wishful phantasies of the patient’s which have become unconscious. Thus the part of the patient’s emotional life which he can no longer recall to memory is re-experienced by him in his relation to the physician; and it is only this re-experiencing in the “transference” that convinces him of the existence and power of these unconscious sexual impulses.

(Freud 1910: 51)

Making an analogy to chemistry, Freud captures the heat of this transference process fueled by memory and desire, as well as the doctor’s role in the “reaction”—an implicit potential combustion:

[The patient’s] symptoms, to take an analogy from chemistry, are precipitates of earlier experiences in the sphere of love (in the widest sense of the word), and it is only in the raised temperature of his experience of the transference that they can be resolved and reduced to other psychical products. In this reaction the physician … plays the part of a catalytic ferment, which temporarily attracts to itself the affects liberated in the process.

(Freud 1910: 51, emphasis added)

It’s easy enough to see the danger in this artificial realm of “raised temperature,” a stage purposely tilted to court “fresh high tides” of intense feeling—the past brought to life in the present—with the analyst in the role of love object but also in the position of guardianship and responsibility: desired, and protective. These are the same “highly explosive forces” to which Freud refers in his great essay “Observations on Transference-Love” (1915), describing the circumstance whereby the patient quite naturally—“as any other mortal woman might” (1915a: 159)—falls in love with the doctor. And Freud here poses a fundamental, imperative question: “But how is the analyst to behave in order not to come to grief over this situation?” (163).

That is: what is the analyst to do in response to this “falling in love in the transference” (Freud 1915a: 162), the result, precisely, of a calculated invitation—arguably (in some technical sense) a seduction? The idea of “transference” thus provides, brilliantly, both possibility of cure, in real life, and a necessary safety for the doctor: a protective distance on that special stage. Vehicle, safety, and danger—transference is all in one, the mortal analyst playing the part of a “catalytic ferment.”

Although Freud’s narrow focus here is the danger of sexual exploitation, his question—How is the analyst to behave?—has implications for the entire relationship between patient and doctor. Freud’s (1915a) formulation, necessary but fateful, places the analyst’s conduct in the oddest of categories: “The course the analyst must pursue,” he writes, “is one for which there is no model in real life” (166). According to this remarkable prescription, the analyst, in managing the transferential relationship, must behave in no known manner, according to no known code. This exceptional affective element may be likened to a potion (as I call it in Chapter 2), a magical concoction with both medicinal and poisonous potential. The doctor must not follow his (or her) merely mortal nature by giving in to the heated situation: “The treatment must be carried out in abstinence,” the analyst neither gratifying nor suppressing “the patient’s craving for love” but instead treating it “as something unreal” (Freud 1915a: 166).

Abstinence, then, is a fundamental principle of treatment: reliably neither seductive nor seduced, the analyst abstains, his appetites withheld, his expression of feelings in check.

If, as Freud says, transference is a universal phenomenon, then all human relationships, however “real,” are also in part imagined—imbued with feelings associated with early love objects. However, the treatment relationship itself, Freud emphasizes, is unique: it has no model. But can this really be true? Does the analytic doctor—unlike the mother, the father, the lover, the friend, the teacher, the plumber, the mail carrier—resist every other form of social behavior, every inclination of ordinary human nature, restricting himself (or herself) exclusively to analyzing the forces stirred in the transference?

Perhaps Freud means that for none of these other objects of transference is the position as fully stylized (or perhaps also as attractive, magnetic, even addictive): a stringency limiting reciprocal action and seductive behavior—the analyst’s abstinence—along with a non-judgmental receptiveness to everything the patient expresses—the analyst’s benevolent neutrality. The analyst neither criticizes nor approves, supplies neither “yes” nor “no.” Instead, he interprets, putting words to the patient’s wishes whose object he is. In this way the analyst takes a meta-position: the analytic “as-if,” the stance based on abstinence and neutrality.

None of this is to say that the patient’s “craving for love” isn’t real; nor does it mean that the analyst is unresponsive, quite the contrary: human nature assumes response to another’s longing. But the analytic doctor doesn’t act on that response as he or she might in ordinary life. In becoming the object of the patient’s desire, the analyst is required to suspend his or her own nature, in a balance that recognizes both human response and fellow feeling (how else to understand the patient but through fellow feeling?) but at the same time prohibits enacting them. This is an extraordinary demand on an ordinary person. Both people abstain from direct sexual activity, but the patient’s task—to give free expression to his or her cravings—is very different from the analyst’s task. The analyst suspends his appetites, though not empathic understanding, and instead the doctor analyzes: a tactic, and an attitude, only intensifying the patient’s longing.

We may see implicit here the fundamental paradox of abstinence as alluring: the principle of abstinence protects but, by design, also heats the treatment crucible, thus conflating the ethical and the technical. No idea is more central to the analytic project than this one. In 1950, building on Freud’s propositions in Papers on Technique, Ida Macalpine (1950) writes that the analyst’s moral integrity “becomes a safeguard for the patient to proceed with analysis: it is a technical device and not a moral precept” (527). The analyst’s moral integrity, in this tough-minded view, is a necessary condition in two senses. On the one hand, treatment is possible only with moral integrity as a given condition; in this meaning, it is a mechanism, or device, an additional feature of the bounded frame, like the time limit or the fee the patient pays. On the other hand, moral integrity is a human condition or state of being; in this meaning, it is an ideal human attribute achievable only partially by an always-particular, always-striving, always-imperfect person: that is, a mortal being.

I believe Freud (1915a) means something similar when he advises that the analyst let it be seen that “he is proof against every temptation” (166), though of course he may feel temptation, along with the full range of emotion, as is part of one’s humanness. The trustworthiness of the non-perfect being—the analyst’s trustworthiness—is something attained, and in that sense (again) it is a mortal gift. This gift is always being tested, necessarily so. The analyst strives to hold an uncomfortable, contradictory position, the role for which there is no model: the analyst is “an actor inside and outside of a passionate, but nevertheless merely virtual, drama” (Friedman 2006: 704).

Characterizing the intensity of the treatment situation, Richard Almond (2011) writes that “the psychoanalytic relationship has a charismatic quality” (1136). Almond is referring in part to Freud’s (1912a) statement in “The Dynamics of Transference”: “We do not understand why transference is so much more intense with neurotic subjects in analysis” (101). Crediting Chodorow (2010), who invokes the social theorist George Simmel on characteristics pertaining to dyads, Almond writes:

What Simmel, by way of Chodorow, offers as an answer to Freud’s question about intensity is that the private, dyadic setup of analysis in itself creates an emotional hothouse … The intensity of the psychoanalytic relationship … derive[s] from intrinsic characteristics of dyads that are secluded, that meet frequently, and that are not highly scripted.

(2011: 1134)

Another paradox is embedded here: in a situation that is, by its structure, inherently seductive for both people, the analyst must strive, in the interest of Macalpine’s “technical device,” to be non-seductive and unseduced. Or, to put the paradox another way: virtual seduction is necessarily an element in the therapeutic process and must not be the actual outcome.

To resist acting on his or her “ordinary human nature” in the face of the patient’s awakened desire and intensity of pressure, then, is one definition of the analytic doctor’s professional role.

But is the analyst then out of nature, like the immortal bird of Yeats’ “Sailing to Byzantium”? What will the doctor’s manner, and manners, be in this fundamentally paradoxical encounter, a relationship that is intimate yet professional, professional yet barely social? And what manners prevail above and beyond the analyst’s powers or life span? If Freud’s “no model in real life” leaves the analyst without clear definition in the world of ordinary social behavior, do we locate the doctor in “unreal” life, a designation that might suggest an Olympus w...

Table of contents

• Cover-Page
• Half-Title
• Series
• Authors
• Title
• Copyright
• Dedication
• Contents
• Acknowledgements
• Introduction
• 1 Physic Himself Must Fade
• 2 The Potion
• 3 The Olympian Delusion
• 4 The Instrument
• 5 Mirrors and Monsters
• Epilogue
• Reference
• Index