The Empty Couch

The taboo of ageing and retirement in psychoanalysis

Gabriele Junkers

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135946456
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The Empty Couch is an introduction to the challenges and obstacles inherent in ageing as a psychoanalyst. It addresses the previously neglected issue of ill health, as well as the significance of ageing for psychoanalysts, exploring the analyst's attitude towards getting older, impermanence and sense of time and space.

Covering a wide range of topics Gabriele Junkers brings together expert contributors who discuss the problems of getting physically ill and how to conduct psychoanalysis as an ill therapist. Chapters also address the effects that ageing has on professional stamina, the grief inevitably caused by the losses endured in later life and inquires into the role that institutions (the relevant psychoanalytic institutes or societies) can play in this context.

Setting out to encourage discussion on this vital topic, The Empty Couch brings this neglected area into sharp focus. It will be of interest to psychoanalysts, psychotherapists, counsellors, gerontologists and trainees in the psychoanalytic and psychotherapy worlds.

Part I

GROWING OLDER AS PSYCHOANALYSTS

1

THE AGEING PSYCHOANALYST

Thoughts on preparing for a life without the couch

Gabriele Junkers

There is no escape. We must all face up to the ageing process and accept it for what it is. Ageing is not a psychoanalytic concept; it is a ‘fact of life’ (Money-Kyrle, 1971), an extremely complex process that we attempt to address with our psychoanalytic resources. Bound to the linearity of time and the irreversible effects of time's passage, it permeates all areas of our lives. Without the passage of time, our perceptions and the subjective experience of our affects and emotions would be inconceivable. Only when we begin to reflect on our own experience do we begin to develop a sense of past, present and future. Moreover, a sense of the ageing process requires an active recognition of external realities. We are inevitably and irredeemably exposed to the changes taking place in our bodies and in our social reality.

Moving forward in our life cycle we are confronted with different tasks that are essential for our development (Erikson, 1979). At mid-life stage, these tasks involve recognition and awareness of our own mortality, of death and the existence of destructive impulses within ourselves (Jaques, 1965). Successfully negotiating the many cliffs and obstacles that this stage of life holds in store for us is the prerequisite for true maturity in our later adult lives when we are called upon not only to talk about the inevitability of death, but to recognise and acknowledge it as something that has to do with each and every one of us, personally and individually. There are many losses clamouring to be accepted as such, most insistent of all perhaps those fantasies that have proved to be illusions and have never materialised as we had hoped. And we have to acknowledge our fear of death that Segal (1958) describes as the reason why we may run the risk of losing our psychological equilibrium as age progresses and death comes closer.

The reluctance of many psychoanalysts to engage with their own mortality and the inevitability of death is something profoundly human. Freud has taught us that evading ‘work on the ageing process’ is a way of fending off challenges to our omnipotent thinking and to the illusions that we need to maintain a space that can accommodate our projections into the future.

In society in general, the subject of ageing has developed real momentum in the last 50 years or so. Though years ago analysts such as Eissler (1975) and Grotjahn (1985, 1994) addressed the issue of the ageing psychoanalyst, it is true to say that the number of books and articles devoted to this topic is still very modest (e.g. Quinodoz, 1996; Horner, 2002).

Psycho-somatic individuality is never as diverse as in old age. Individuals age in their own way and in accordance with their own rhythm, which is not at all consistent. Suddenly we find ourselves in a state of upheaval; we have crossed the Rubicon and there is no return. Physical debilitation erodes the illusion that we are ‘the same as ever’. Like everyone else, we psychoanalysts sustain a ‘fantasy of immortality’ within ourselves, which is occasionally reinforced by the covert conviction that our own analysis has made us immune to illness and ageing.

We almost invariably require some stimulus from outside that will prompt us actively to create an internal space in which to engage in an inner dialogue and to deal with our growing awareness of nothingness and death. Yet how powerful is the desire we all have to sidestep this unbearable reality! Many poets, painters and composers have succeeded in pitting their creative powers against the fear and pain caused by the confrontation with age, death and illness, and if a creative artist is forced to leave his work unfinished, he does not leave a suppurating wound, as the psychoanalyst does. André Green (1997) contends that ‘for an artist the preservation of his work is more important than the preservation of his life’ (p. 99). This should definitely not be the case for us psychoanalysts, because in psychoanalysis the creative process takes place between two individuals, the analysand and the psychoanalyst. It is the latter's responsibility to protect his patient against a re-traumatisation and a gaping lesion that are the consequences of an untimely termination of treatment.

Ageing forces us to realise that we can no longer reassure ourselves of our ongoing existence by projecting hopes and aspirations into the future. Also, the resources available to us in putting plans for reparation into practice are increasingly restricted. As death impinges on our field of vision, the pursuit of pleasure loses its allure and no longer contributes to the consolidation of the ego as it once did. At the same time, our imminent end urges us to relinquish the fantasy of an immortal and ideal object as an equivalent for the ‘good breast’. All these hazards assail us in unison, compelling us to adopt a crucially different perspective on our earlier lives, when time did not insist so relentlessly on its finitude (Loch, 1982a, b).

Compared with other professions, the analyst's life-work cycle is out of phase. It has become increasingly normal for analysts to gain their qualifications at the mid-life stage. Accordingly, this period in their lives is outward bound, more determined by the feeling of a fresh start than by intimations of mortality. Even when our children leave home and we become grandparents, we frequently do not have the impression that we have fully scaled the career ladder. As psychoanalysts we live and work sustained by the conviction that what we do can best be done free of the restrictions imposed by clock and calendar. After all, the unconscious has no sense of time. The reality of our own limits, the definition of our lives by chronological time, flies in the face of these notions.

We should of course be glad that there is no one to tell us when our time is up, as is the case in so many other professions. But this is also the reason why relinquishing analytic work requires careful long-term preparation. When do we actively decide not to embark on any new analyses? Our special relationship to our work makes it particularly difficult for us to take the necessary steps. Within the 50 minutes we spend working with our analysands, time is of no concern. We may indeed be so enamoured of this very special dual relationship that we seek to evade its inevitable loss and the work of mourning bound up with it by simply letting things take their course, leaving them to their own devices. The unconscious longing for reparation rooted so deeply in all of us can be such a strong motive to go on working that we miss the ‘right’ moment. Another danger arises from our wish for generativity, our profoundly human desire to put as many young analysts on their professional path as we can. Others again are tormented by feelings of envy at having to leave the field to younger colleagues, resentments Leslie Sohn reminded us of in 2002, himself well over 80 at the time (personal communication). It is awfully difficult to realise that there comes a point when it is too late to father children responsibly. But who am I when I have stopped working as a psychoanalyst?

Freud himself gives us a memorable description of how significant our work can be for our psychological equilibrium. He speaks here from his own experience, having frequently judged a life without work as hardly worth living.

No other technique for the conduct of life attaches the individual so firmly to reality as laying emphasis on work; for his work at least gives him a secure place in a portion of reality, in the human community. The possibility it offers of displacing a large amount of libidinous components, whether narcissistic, aggressive or even erotic, on to professional work and on to the human relations connected with it lends it a value by no means second to what it enjoys as something indispensable to the assertion and justification of existence in society. Professional activity is a source of special satisfaction if it is a freely chosen one – if, that is to say, by means of sublimation, it makes possible the use of existing inclinations, of persisting or constitutionally reinforced instinctual impulses.

(Freud, 1930, S.E. 21, p. 80)

Freud's statement is a very general one. The transition to retirement is a problem in many professions, for surgeons no longer able to operate, for captains of industry who have built up an empire and have difficulty – like Ibsen's Master Builder – leaving their life's work for their sons to continue with. But what if there is no son interested in carrying on in his father's footsteps? With the number of potential ‘heirs’ dwindling rapidly, this is very definitely a problem psychoanalysts are faced with.

For this book I have chosen the couch as a symbol of our analytic work. True, as psychotherapists and supervisors we also have our place in a structured working day progressing from one hour to the next. But the intensity of communion in the analytic process with the opportunity it provides to immerse ourselves in the workings and mysteries of another person's psyche and thus feel both committed and included has a quality that we cannot experience in ‘real’ life outside. We can of course try to substitute the armchair for the empty couch and work with psychotherapy patients or supervisees. But it will never be the same as the couch . . .

Shakespeare's tragedy King Lear is incomparable in the way it describes the painful moment of withdrawal from the world of work that has been so crucial in existential terms. It is an unforgettable demonstration of how difficult it can be to relinquish accustomed roles that have taken on such immense narcissistic significance and how easily such withdrawal can turn into a disaster.

Well stricken in years, Lear has resolved to divide his kingdom among his daughters. He is convinced that their protestations of filial devotion are the right gauge by which to judge who shall be given what. It soon becomes clear that he will accord his love to the daughter who will best serve him as an object for the gratification of his own needs. He desperately yearns to be told how well loved he is so that he can protect himself against feelings of abandonment, exclusion or even annihilation. His youngest daughter Cordelia refuses to be a party to this deception and foils his bid for reassurance: ‘I cannot heave my heart into my mouth: I love Your Majesty according to my bond; nor more, nor less’ (Act 1, Scene 1, lines 91–92). She is disinherited and banished for her pains. Cordelia stands for the truth and the ability to mourn, but she also represents death. And this is precisely, as Freud (1913) emphasises in his interpretation of the drama, what Lear wants to banish from his environs.

The audience witnesses Lear's increasing loss of control over his mental faculties and his lack of concern for the consequences of his actions. Only hesitantly does he recognise that reality is not what he would like it to be. There is a divide between the role he would like to play and the one he has been accorded. He can no longer resort to a sense of true identity: ‘Does any here know me? – Why, this is not Lear! [. . .] Who is it that can tell me who I am?’ (Act 1, Scene 4, lines 226–230).

The eyes of the spectators are drawn to the roles Lear ascribes to his potential adversaries. The drama reveals starkly how he avails himself of the people in his immediate and familiar environment. He considers those to be good and affectionate towards him who collude in his illusory misconception of himself and thus reinforce him in his views. Only Cordelia has the courage to tell the truth. Though she loves him profoundly and sincerely, she is banished because she figures as the representative of the intolerable truth that Lear wishes to turn a blind eye to. He cannot bear to see her go her own way. Nothing can make him accept that the omnipotence that he thought his status as absolute ruler conferred on him has nothing to do with the way things really are. It is sheer self-deception.

The tragedy of this masterpiece is that we as the audience are fully aware of his depression and the desperate steps he is taking to ward off the recognition of pain, distress, mortality, and ultimate death, while he himself is unable to do so. We would dearly like to open his eyes to the true love of Cordelia and the cynical blandishments of his other two daughters. By identifying with the daughter who Lear banishes to spare himself the painful truth, we run the risk of being banished ourselves.

In the following chapters, five psychoanalysts focus on different aspects of this existential assignment that we call ageing. Common to all of them is the attempt to heighten our sensitivity to the tasks implicit in the ageing process, specifically for psychoanalysts.

2

DOES AN ELDERLY PSYCHOANALYST HAVE A ROLE TO FILL?

Danielle Quinodoz

Now that I am an elderly psychoanalyst, what can I share with my younger colleagues that can be of use to them and that is specific to their needs? At this stage in my personal evolution, what role can I fulfil in my psychoanalytic society? I ask these questions because, with the advancement of age, I have come to realise that if an individual accepts to simply be himself, if he inhabits exactly his own space, he brings to the world something original that would otherwise be lacking.

As life expectancy increases, each stage of life also increases

When considering the role that I should fulfil in the last period of my life, I conclude that my research is part of a larger issue: namely, that an increase in life expectancy demands that we redefine not only the role of the elderly in the world, but also that of other age groups as well. Indeed, the increasing number of nonagenarians in Europe has provided the illusion that the lengthening of life has only extended the segment of the population known as the ‘elderly’. Yet, at present, each period of our lives is being prolonged. In particular, if one considers that old age begins at the age when a person experiences physical or psychological difficulties in pursing their professional activities, we can see that, today, old age has a tendency to begin later than before because the period when adults are active has also been extended. Today, the majority of 65-year-olds have nothing ‘old’ about them; they remain very active, except in physically demanding professions. We can observe the same extension of the stages of life with young people: their education continues for a longer period, many continue to live with their parents, women become mothers at a later age, and our active parental, familial and professional lives begin and end later.

Some adults in the prime of life have the tendency to accord value only to those qualities necessary for their hyperactive lives; thus, they tend to see only the failings of older people and not what they can offer. They expect that older people only renounce their previous activities, without themselves creating the necessary benevolent space where the elderly can discover their new role. The elderly can therefore feel rejected for not having any utility. Considering the role of older people in society not only allows us to recognise the activities that they can no longer accomplish, so as to help them give them up, but also to evaluate what specifically they can offer, and thereby to stimulate them to discover their new role and appreciate its value.

In Switzerland, some analysts are concerned about the ageing of our psychoanalytic society, of the advanced age of those who ask to become candidates or members, as well as the high number of ‘elderly’ training analysts. They have not understood that this remodelling corresponds to a large degree to society in general, and that it is a question of finding new markers to rethink the role of the individual in the light of this new situation. Such a reflection asks for all the more creativeness and freedom, as inside this general remodelling each one of us ages in his own way and at his own pace. This attitude, which I observed in Switzerland and in certain other European countries, varies around the world. For example, I have had the opportunity to see for myself the very great respect that Brazilian psychoanal...

Table of contents

• Front Cover
• THE EMPTY COUCH
• Title Page
• Copyright
• Contents
• List of contributors
• Foreword
• Preface
• Prologue
• PART I Growing older as psychoanalysts
• PART II Illness and ending
• PART III Institutional parts of ending
• Epilogue
• Index