Silent Virtues

Patience, Curiosity, Privacy, Intimacy, Humility, and Dignity

Salman Akhtar

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138332386
• eBook ISBN: 9780429822438
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Silent Virtues addresses six areas of mental functioning namely patience, curiosity, privacy, intimacy, humility, and dignity. Each of the areas is elucidated with the help of clinical, literary, and cultural material. The book introduces a series of novel ideas, including: (i) the distinction between patience as a component of the therapeutic attitude and the exercise of patience as a specific technical intervention; (ii) the description of the five psychopathological syndromes involving curiosity: excessive, deficient, uneven, anachronistic, instinctualized, and false curiosity; (iii) the description of four psychopathological syndromes (failed, florid, fluctuating, and false) involving intimacy; (iv) the discourse on the importance of humility in selecting patients and in deciding upon the longevity of our professional careers; and (v) the description of three forms of dignity (metaphysical, existential, and characterological) and the various ways in which they affect psychoanalytic technique.

Part I

Sensing and searching

Chapter 1

Patience

It takes a long time to develop from a psychically inchoate infant to a coherent adult with identity and agency. The mind has to evolve distinction between self and its objects, renounce omnipotence and magical thinking, learn to bear ambivalence, acquire self- and object-constancy, negotiate travails of the oedipal situation, enter the temporal order of life, master task orientation, learn to play, reconfigure primary internal objects and one’s relationship with them, merge affection and sex together, and develop capacities for intimacy, industry, and generativity. This task-filled journey to assuming adulthood takes over two decades and demands patience from both the traveller and his or her tour guides. Neither growing-up nor child-rearing can be rushed. These processes depend upon pre-programmed epigenetic sequences that unfold from within and facilitating psychosocial inputs that come from the outer world. And, all this takes place at its own merry pace with both progressive and regressive trends competing to take control of the developing ego. No wonder enormous patience is required from both children and parents in order for this sojourn to succeed.

The same is true of psychoanalytic treatment. It is slow and time-consuming. Many years intervene between the beginning and end of this painstaking process and much forbearance is required from both the analyst and the analysand. In fact, patience constitutes a cardinal non-interpretive element of the former’s technique (Stone, 1961) and an essential ingredient of the “fairly reliable character” (Freud, 1905a, p. 263) required of the latter. In light of this, it is unsettling to note that psychoanalytic literature has little to offer on patience. The puzzlement is compounded by the fact that encounter with masochistic caricatures of patience and narcissistic flurries of impatience forms an almost daily feature of the psychoanalyst’s clinical life. Yet there is little to read about such phenomena. It is this lacuna that I intend to fill here. I will examine the quality of patience in its phenomenological nuance, its developmental origins, its cultural variations, and its psychopathological distortions. Then, I will elucidate the technical implications of these ideas and conclude with some synthesizing remarks.

Phenomenological aspects

The root word for ‘patience’ is ‘patient’ which, in turn, is derived from Middle English pacient and Greek pēma. This etymology results in the inclusion of the following phrases in the dictionary definition of ‘patience’: “1: bearing pains or trials calmly or without complaint, 2: manifesting forbearance under provocation or strain, 3: not hasty or impetuous, and, 4: steadfast despite opposition and difficulty” (Mish, 1987, p. 852). Going beyond English to other major languages like Spanish, Chinese, Arabic, and Hindi, one searches for further subtleties in delineating the phenomenon of patience. Spanish, generally a rich source of connotations, describes paciencia in terms that are essentially similar to English. The Chinese word for patience is nai-sin, which underscores the capacity for tolerance as a character trait. Arabic has two related words to cover this phenomenological terrain: sabr and tahammul. The first denotes the capacity to accept adversity with calm and the latter denotes the capacity to carry on with dignity during states of suffering. Moreover, the first Arabic word for patience is etymologically related to words that mean ‘pouring’ or ‘emptying out’, and the second Arabic word for patience to words that are linked to pregnancy. The implication of this is that patience refers to bearing less-than-full psychic states and can, in due course of time, lead to fruitful outcomes. Hindi refers to patience as dheeraj, a word derived from Sanskrit dhri, meaning steadfast, composed, calm, well-behaved, and well-bred. The linkage with ‘good’ behaviour and breeding has the consequence of elevating patience to a higher and desirable standard.

While mostly described as a monolithic phenomenon, upon a closer look, patience turns out to have four components. These components are (i) acceptance of external and internal reality as it exists at a given moment, (ii) absence of resentful feelings and bitterness, (iii) retention of hope that matters would change for the better and, (iv) capacity to wait for favourable times without haste and restlessness. As would be immediately obvious, each of these elements has its own developmental history and each adds its particular hue to the multifaceted phenomenon called ‘patience’. The first element (i.e. acceptance of a given external or internal reality) implies the achievement of ‘depressive position’ (Klein, 1935), i.e. renunciation of the belief in an ‘all-good’ self-object discourse and deepened capacity for reality testing, mourning, gratitude, humility, and reparation. The second element (i.e. retention of hope) implies robust ‘object constancy’ (Hartmann, 1952; Mahler et al., 1975) whereby the overall affective valence of internalized primary object representation is not compromised by need-frustration and by intensified drive activity. The third element (i.e. absence of hostile feelings) is a corollary to the second; absence of full satisfaction is taken to be a transitory and inevitable part of life and not regarded as a deliberate, teasing withholding on the part of the love object. Finally, the fourth element (i.e. capacity to wait) reveals faith in the eventual re-emergence of the good object from the void of separation; echoes of the childhood peek-a-boo game between the mother and child are evident here (see also Kleeman, 1967).

Thus explicated, ‘patience’ appears to be a character trait of maturity. Pop psychology (Sherman, 1987; Ryan, 2013) and spiritually inclined literature (Dalai Lama, 1997; Armstrong, 2009; Easwaran, 2012) uphold it as a great virtue. Even without such idealization, the quality of patience is known to show its benefit and utility in a number of realms. Children’s growing up and parents’ efforts at guiding them through this process requires patience from both parties, as stated above. Learning new skills, regardless of whether it is during childhood (e.g. riding a bicycle, mastering arithmetic) or adult life (e.g. driving a car, learning to play golf), invariably requires patience; one fails repeatedly, lacks dexterity for a long while, and needs to stay the course in order to master the task. Patience is integral to refining and sharpening a talent; the existence of raw talent alone does not take one very far.

Patience is also required for developing genuine intimacy with others and, by implication, for love. It creates and sustains the mental space necessary for listening to others and learning about their lives. Marriage is yet another realm which demands patience, especially in its earlier phases when the two partners are adjusting to the realities of a mutual life (Akhtar and Billinkoff, 2011); they not only have to adapt to each other’s idiosyncrasies but to the important external and internal objects of each other. Building and maintaining a household, raising children, and attending to aging parents also demands patience. The last-mentioned especially requires much tact, and much acceptance of human frailty that is now manifesting through the hitherto invulnerable parental figures.

All this makes sense. Many areas, however, remain unclear. For instance, can patience be focal? In other words, can one be patient in one realm and not in others? Are women more patient than men? If so, why? Can patience be taught? Is perseverance always associated with patience¹ or can the two occur in de-linked forms? Finally, is patience effortless and temperamentally inherent (Lokos, 2012) or the result of an active decision each time a situation comes looking for it (Ryan, 2013)? To answer such questions or, at least, to look for their answers, I turn to the ontogenesis of the phenomena involved here.

Developmental origins

In his paper ‘Formulations on the two principles of mental functioning’, Freud (1911) laid down the groundwork for understanding the childhood origins of patience, even though he did not use the word ‘patience’ per se. Freud declared that until the time internal needs are satisfactorily met – either by external objects or by one’s own hallucinatory creation of gratification – the infant has little need to attend to reality. However, since external supplies are not always forthcoming and since hallucinatory wish-fulfilment fails to bring sustained satisfaction, the infant’s psychical apparatus has to forge links with the external world in the hope of finding gratification. This necessitates moving from the ‘pleasure principle’ (concerned solely with pleasure and unpleasure and operating under the influence of the ‘primary process’ of reflexive discharge) to the ‘reality principle’ (based upon the ego capacities for attention, memory, reflection, and reality testing). Freud went on to state:

Restraint upon motor discharge (upon action), which then became necessary, was provided by means of thinking, which was developed from the presentation of ideas. Thinking was endowed with characteristics which made it possible for the mental apparatus to tolerate an increased tension of stimulus while the process of discharge was postponed.

(p. 221, italics in the original)

Freud acknowledged that the shift from ‘pleasure principle’ to ‘reality principle’ is neither complete (e.g. it leaves scope for day-dreaming) nor rapidly achieved. It occurs gradually and over a long period of time. And, it is more marked in relation to self-preservatory instincts than in relation to sexual instincts. In other words, matters of self-preservation come under the dominance of the reality principle to a greater extent than do the matters pertaining to erotic desire.

In a passage that links these ideas to the underbelly of what we are calling ‘patience’ here, Freud observed that:

the substitution of the reality principle for the pleasure principle implies no deposing of the pleasure principle, but only a safeguarding of it. A momentary pleasure, uncertain in its results, is given up, but only in order to gain along the new path an assured pleasure at a later time.

(p. 223)

However, for such tolerance of delay to become acceptable, the child must receive ample gratifications from his caretakers. Hearing a ‘no’ and bearing its frustrating consequences is only palatable if one hears a ‘yes’ more often. When this economics is reversed, frustration grows and tolerance of delay becomes unbearable. Abraham’s (1924) tracing “impatient importunity, haste, and restlessness” (pp. 404–405) to early oral deprivation speaks to this very point. Bergler (1939), writing fifteen years later, also advocated the same dynamics to underlie characterological hurry though with a novel twist.

All orally super-cathectic people are impelled by a peculiar haste. Apparently these persons are permanently wishing to “get something”. More exact analytic inquiries show, however, that the actions of these regressed people have quite another meaning: they wish chronically to push the persons of the outer world, identified with the phallic mother of pre-oedipal times, into the position of refusal, so that they may then be aggressive, free of a guilty conscience, and enjoy in a masochistic manner.

(p. 14)

Couching his explanations in the drive and ego psychology of his days, Fenichel (1945) noted that “among the oral traits of character are the antithetical qualities of volubility, restlessness, and haste, and the tendency towards obstinate silence” (p. 491). The oral impatience worsened if it was conflated with “urethral-erotic ambition” (p. 492) that later appeared on the developmental scene. Fenichel took the role of ego-weakness into account as well while elaborating upon the anaemia of patience and the resulting incapacity to wait. He stated that:

There are persons whose fear of their uncontrolled id is so intense or has developed so early that they have never had the relaxation and the distance necessary for the development of ego forces to handle it. They are intolerant of tensions and unable to wait. Whenever they have to wait, they experience the waiting itself as a traumatic event. They try to protect themselves against it by any means. In any situation of excitement they look less for gratification than for an end to the intolerable excitement … Persons of this type are always in a hurry, even if there is plenty of time.

(p. 487)

Building upon this early literature, subsequent psychoanalysts and child observational researchers contributed further to the understanding of the developmental antecedents of patience and impatience. Erikson (1950) proposed the concept of ‘basic trust’ which manifests, at first, in the child’s willingness to let the mother out of sight with undue anxiety, anger, or restlessness. Such certitude implies “not only that one has learned to rely on the sameness and continuity of the outer providers but also that one may trust one’s self and the capacity for one’s own organs to cope with urges” (p. 248). Such childhood optimism grows out of frequent experiences of one’s needs being met with satisfaction. Benedek’s (1938) concept of ‘confident expectation’ constitutes an earlier formulation of a roughly similar idea. Both Benedek and Erikson describe a psychic position whereby hope is not lost quickly and faith persists in the environment’s provision of libidinal supplies and in one’s capacity to wait for them.

These notions regarding the early childhood roots of the capacity for patience have been refined by contemporary child observational researchers (e.g. Bowlby, 1969, 1973, 1980; Emde, 1980, 1991; Lichtenberg, 1983; Greenspan, 1989; Schore, 2001). They regard the infant and the caretaker as an evolving interactional system in which each partner is viewed as having separate competencies which affect the other’s behaviour and as initiating and reinforcing the desired behaviour of the other. Internal regulation for the infant, though innately programmed within optimal thresholds of stimulation and/or deprivation, is, in the end, inseparable from the stable regularity of key exchanges with its caretaker. If the innate preparedness of each partner leads them to actively seek gratifying attachment and development-enhancing experiences, then the child becomes capable of affect regulation, stays optimally hedonic (i.e. replete with adequate pleasure), and can tolerate temporary absences of gratification. Although the word ‘patience’ does not appear in this literature, it is clear that the development of self-regulation (as a consequence of secure attachment) implicitly includes the ontogenesis of patience.

Linking such observationally derived notions with Freudian metapsychology, Aisenstein and Moss (2014) note that the infant first progresses from merely needing milk to desiring the breast and then from desiring the breast to waiting for the object-mother. These transitions involve psychic work and to explain the nature of such work, Aisenstein and Moss evoke Freud’s (1924a) concept of ‘primary erotogenic masochism’. This, as we know, refers to the deep-seated human capacity for drawing pleasure from suffering; it emanates from the inward binding of a certain quantum of death instinct by libido. Aisenstein posits this energic amalgam to be the consequence of a particular kind of mother–child interaction.² She declares that:

primary masochism allows the capacity for waiting to be integrated. It is the mother’s psychic work that makes this possible. A “good-enough” mother is one who is able, through her words, to help the baby wait: “Wait, my little one, I’m going to take you in my arms but not right now … you will have your feed soon, just keep calm and wait a bit”. The mother envelopes the infant with words; she gives him word and thing-presentations. She thus helps him to wait, which implies confidence in the object. How is the concept of primary masochism indispensable here? Well, because if the waiting is to be tolerable, it must be “invested masochistically”. The infant has to learn gradually that there is also pleasure in this waiting due to the psychic work that it involves. This investment of the delay is what lies at the basis of desire: I think about and imagine the pleasure to come. I am inclined to say that the structure of desire is masochistic in essence, for it is inconceivable without the renunciation of immediate satisfaction and the investment of waiting. Someone who is in love and is going to see the object of their desire in a week, or in a month, is able to wait because they have learned to find pleasure in psychic work and fantasy scenarios that they create of the forthcoming encounter.

(p. 64, italics in the original)

While Aisenstein links the development of patience with primary masochism, her intent is to describe an essentially normative evolution. There are circumstances, however, where the masochistic element of waiting becomes more pronounced, leading to a stoic turning away from the world that sooner or later warrants clinical attention.

Psychopathology

While idiosyncratic constellations of symptoms (e.g. blissful patience in one realm associated with thorny impatience in another, patience with some individuals in one’s life and not with others, c...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• About the author
• Introduction
• PART I: Sensing and searching
• PART II: Restraining and relating
• PART III: Titrating and transcending
• References
• Index