Yet at the same time, the contributors to this volume express discomfort with this consensusânot because they disagree that sexual relations with a patient are ethically unacceptable, but because the consensus itself seems to have been formed in a rather superficial way, as a response to crises of public confidence in the closing decades of the twentieth century. We may all agree that sex with patients is âbad,â but has psychoanalysis really dealt with the issue? Does the prohibition reflect genuine self-understanding, or just a blind sense of danger to the profession? Is the consensus credible as a reflection of the ethical state of psychoanalysis?
Part 1: Muriel Dimenâs âLapsus linguaeâ: from Eew! to We!
In voicing their discomfort around these questions, the contributors to this volume have taken inspiration from Muriel Dimenâs remarkable psychoanalytic memoir (Dimen 2011), reprinted as the first part of this book. âLapsus linguaeâ is an unusually personal but also conceptually profound exploration of the experience that we so neatly categorize as âsexual boundary violationâ (SBV). In that essay, Dimen notes the immaturity of our group response to this problem: our tendency to act out the familiar (and familial?) dynamics of shame, such as cover-up and denial, self-exculpating disavowal, and stigmatization of the transgressor, whose moral dirtiness becomes an emblem of our own analytic purity (see also Dimen 2016). She draws our attention to what can only be described as our professional sociopathology, in which the âunpastâ (Scarfone 2006, p. 811) of our psychosexual history as a group endlessly repeats itself. As a profession, we manage the symptoms of this syndrome with ethical codes (thus answering to public morality) and with valiant, though unfortunately isolated, individual efforts to raise awareness (and to help deal with the devastating loss of trust within certain beleaguered analytic communities, e.g., Gabbard & Peltz 2001; Celenza 2007); but we rarely ask ourselves any clear questions about what is behind this symptom of our group life, or why we keep falling into the same neurotic pattern of isolating, externalizing, and denying the significance of the disturbances in our behavior. The standard rationalization is to simultaneously individualize and depersonalize the phenomenon of sexual misconductâto treat it as a statistically inevitable reflection of our population, something to be managed, through education and sanction, but otherwise accepted as a fact of human nature.
Muriel Dimenâs work invites us to think about these and many other issues in a new vertex, inspired by her background in anthropology and contemporary feminist thought. We might call this new vertex the âWe! factor,â echoing her not unrelated study of the âEew! factorâ (Dimen 2005), in which she identified sexual and other forms of countertransference disgust as a problem for the analytic group rather than just the individual clinician. Writing of the Eew! factor, Dimen stated that her interest in âcliniciansâ sexual unease is part of a larger project, individual and collective, of reconsidering sexuality postclassically, beyond but not exclusive of the oedipal, inclusive of narcissism but registering culture tooâ (p. 4). She might very well have said the same about the âWe! factorâ in her work on sexual boundary violations. Just as in psychoanalysis âsex talk is also sexy talk ⊠which may threaten to violate ethicsâ (p. 4), so talking openly about sexual misconduct in the analytic community may be experienced as a kind of violationâan ominous disruption, rarely defined explicitly, spreading with âaffective contagion.â
Dimenâs work can be read as an invitation for âusâ to consider a new kind of âpsychoanalytic we,â not of the âroyalâ or in-group variety, but expressing psychoanalysis as a larger community, including patients. This may sound like an obviously good thing that âweâ can all support, but in practice it would require analysts to make painful changes to our professional identity, our sense of who âweâ are, and how we relate to each other and the interested world. To become a truly ethical community, we would have to acknowledge the Eew! at the heart of our sense of who âweâ are, and put this acceptance into self-critical practice as a group, rather than merely âapplyingâ it to our patients as knowledge already supposedly mastered.
The primal crime
With regard to the question of SBVs, Dimen finds us in a kind of ethical abyss of unresolved transference to our own professionâin the full mode of what Marx called alienation, or what might be described in intrapsychic terms as âinner estrangementâ (Levin 2010). To capture this uncanny, haunted quality of our relationship to ourselves, Dimen resorts to an historically loaded phrase: âthe primal crime of sexual transgression.â It would be a misunderstanding to read a moralistic tone into this choice of words. Her aim is not to indict and excommunicate individual analysts who âtransgressâ but rather to locate the social dynamics of transgression in the origins of the profession itself. In her echo of Freudâs speculative anthropology of the psyche, with its language of primal horde, primal father, and primal scene, Dimen is not trying to generate scandal or moral panic, but to disturb our professionally self-serving assumptions about the otherness of the unethical in our midst. She is suggesting that our analytic rituals are invested in the ancient logic of sacral repetition and expiation. Our general practice remains tied to mythic assumptions that tragically limit the potential for internal communication, negotiation, dialogue, and reparative (as opposed to retributive) justice (Levin in press, a,b).
If analystsâ SBVs represent something âprimal,â as Muriel Dimen suggests, then they cannot be morally and/or ethically extraneous to psychoanalysis, i.e., âunpsychoanalyticâ; they must have been present at the origin, implicit in the formation of the psychoanalytic idea, constitutive of the profession. In effect, Dimen is drawing our attention to an embarrassing inconsistency in our self-understanding. Given that psychoanalysis is a way of thinking that established its origins in the discovery of sexual repression, how could we fail so massively, and for nearly a century, to be curious about our own sexual behavior?
The essays in this volume all in their various ways question the level of certainty implied in the confident language of SBV. The words seem to suggest not only that we have a handle on highly elusive phenomena but, more importantly, that the violation we are referring to is not something we originally intended, is not linked, in some deep and primary way, to what psychoanalysis is really about. The fact that certain instances of SBV are very clearâto paraphrase what the supreme court judge said of pornography, âwe know it when we see itâ (Greenberg 2008, p. 889)âfosters a comforting illusion that these are secondary phenomena, âaberrations,â thus perpetuating the broad pattern of collective dissociation from our traumatic origins as a profession.
The concept of a sexual boundary
Swimming against this current, the thinking in this volume struggles to move behind or underneath the closure of deontological truisms. Muriel Dimenâs metaphor of the primal crime becomes a new point of departure in psychoanalytic ethics, envisaging the possibility that the very idea of psychoanalysis was already a monstrous âtransgressionâ long before the clinically specialized (as opposed to conventional social) construct of a âsexual boundaryâ was invented. From this perspective, indeed, the very concept of boundary seems problematic, an evasion of what is fundamentally difficult in the psychoanalytic enterprise.
A significant problem with the assumption of a sexual boundary is that it tends to privilege a behaviorally concrete definition of the ethical challenges we face. To borrow a phrase from an important French study of SBV (Urtubey 2006), the boundary approach reduces the conundrum of sexuality in the countertransference to the striking image of âlâanalyste qui passe Ă lâacteââthe analyst who crosses over into the realm of action. On the one hand, as we know in psychoanalysis, it is impossible to establish a clear distinction between speech and action, the psychic and the somatic, the internal and the external, or the analyst and the analysand. On the other hand, in the world of actual practice and professional self-regulation, it is not realistic to dispense with behavioral definitions of what constitutes analyst abuse of professional power. We all need a moral superego image of what it is that âwe know when we see it.â Nevertheless, superego morality is not ethics; such images may simply obscure the fact that overtly sexual forms of bad practice often originate in more covert processes that may alternatively express themselves in other, less easily identifiable forms of patient coercion.
The ethical problem is not that we explicitly deny the complexity and ambiguity of our working situation; but rather that we havenât been able to find better ways to talk about them, even amongst ourselves. The ubiquitous literature on countertransference since 1950 amply illustrates this point: it ventures into the territory of what is therapeutically contraindicated (e.g., the concept of projective counter-identification; Grinberg, 1962); but it rarely engages the implications of the analystâs inevitable transference to the patient, which may be entirely malignant without being in the least way sexual in the explicit sense. Nor has there been any clear acknowledgment in our literature of an obvious related problemâwhat might be termed the institutionalized negative countertransference to the patient population, passed down through knowing words in supervision and training programs for generations. We see this first in Freudâs casual denigrations and his (1937) characterization of the typical patient as a âpoor helpless wretchâ (Hilflöse arme Personânotice how Strachey converted Person into wretch). Some intriguing allusions to this phenomenon can be found scattered in the general literature (e.g., Langs & Searles 1980), but they have never been followed up.
In âLapsus linguae,â Muriel Dimen illustrates the moral complexity of the analytic situation, and of her own first analysis, in exquisite detail. She and her analyst tumbled into a problematic and ambiguous, sexually charged physical exchange at the end of the last session before a long weekendâbut it turns out that this was just a surface phenomenon signaling a much more serious relational deformation. For Dimen, the ethical problem had more to do with the fact that her analyst did not acknowledge in any emotionally helpful way that this sexually explicit interaction had even occurred. In her recounting of the event and its aftermath, Dimen struggles over the fact that she was also unable to speak about it, or even to think about what was really happening in her analysis. What she emphasizes, in her painful but lucid reflections on her own history, is that the physical slip of the tongue was not the ultimate locus of the psychic invasion she suffered as an analysand. The analystâs literally intrusive sexual behavior was âover the line,â as we say, but only briefly âout of control.â What Dimen suffered was more profound, something potentially more troubling for us: a betrayal more massive and surreptitious than the analystâs symptomatic parapraxis.
How to describe this more consequential invasion of the analysandâs psychic life? Is it really best characterized as a sexual boundary violation? Is the matter in question even âsexualâ? Or is it a manifestation of another kind of âboundary troubleâ that goes unrecognized, though it lies at the heart of the entire psychoanalytic enterprise? Dimenâs anxiously nuanced reflections on her own experience suggest that while the problem in this, her first analysis, was obviously related to sexual dynamics, something much more insidious than sexual attraction, sexual desire, or transference love was at work.
An attentive reading of her text strongly suggests that the toxic factor in her analysis was not the sexual interplay but rather the analystâs programmatic deployment of the analytic setting as a stage for the rationalization of his unexamined (and I would argue professionally sanctioned) narcissism. The beauty of Dimenâs account is that she renders moot the speculative question of whether her analystâs narcissism was malignant and/or predatory, or merely neurotic and circumstantial. (In online discussions of her paper [IARPP Colloquium, 2011] there was a lot of debate about this.) Rather, she makes a persuasive case, without directly stating it, that his analytic style was probably a fairly typical instance of the prevailing patriarchal culture of psychoanalysis, regardless of the âschoolâ in which he was trained and practiced. The slipâand, more importantly, the failure ever to acknowledge itâwere revealing symptoms, not so much of the analystâs precise character structure as of the organization and practice of psychoanalysis itself.
How can we even begin to contemplate the implications of such a radical proposition? The answers elaborated in this book bring varied methods and perspectives to bear on that question, but all agree that the problems facing psychoanalysis cannot be resolved by appeal to, or by mere application of, an outward facing ethics or deontology. The issue is not whether there should be rules and moral standards, codes and sanctionsâthese are necessary and inevitable because no profession can function ethically as an autonomous social entity (Michels 1976). The question is whether the analytic community should continue to function internally as if such principles and procedures are sufficient from a psychoanalytic perspective.
The difficulties of ethical self-reflection in the group
The import of the papers gathered in this collection can be summarized in the following way. First, that âthe primal crime of sexual transgressionâ is not just something that psychoanalysis objectively identifies, uncovers, and analyzes; it is something that psychoanalysis actually does without realizing that it is doing it. Second, that the only way for psychoanalysis to come to grips with this deeply embarrassing but potentially useful and constitutive fact is to surrender and accept failure of mastery in its own domain. Third, we need to reimagine psychoanalysis as a way of trying to understand not only individuals, but individuals in âgroups,â the group in the individual, and collective phenomena in their own right; notably (in the inaugural traditional of self-analysis; Freud 1900), we need to overcome the inhibition/prohibition against revealing our collective fantasies and âanalyzingâ them together. This is the new We! factor.
We need to acknowledge that Freudâs âdiscoveryâ of the unconscious does not establish an exclusive and privileged object domain, accessible only to the properly trained analyst according to an exclusive method. If Laplanche (1997), following Macalpine (1950) a...
