Social Aspects Of Sexual Boundary Trouble In Psychoanalysis

Responses to the Work of Muriel Dimen

Charles Levin

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780367483784
• eBook ISBN: 9781000206135
• Topic: Psicología
• Subtopic: Sexualidad humana en psicología

Inspired by the clinical and ethical contributions of Muriel Dimen, Social Aspects of Sexual Boundary Trouble goes beyond the established consensus that sexual boundary violations (SBV) constitute a serious breach of professional ethics, in order to explore the cultural and historical implications of their chronic persistence.

In Rotten Apples and Ambivalence, her last major publication, Dimen (2016) maintained that "the phenomenon of sexual transgression between analyst and patient . . . is insufficiently addressed so long as it is only deemed psychological." In responding to and developing Dimen's argument, the distinguished contributors to this volume bring the discussion of SBV to a new level of ethical rigor and depth, challenging the psychoanalytic profession to go beyond its codified complacency. This collection shatters normative professional guidelines by focusing on the complicity and hypocrisy of professional groups, while at the same time raising the taboo subject of the ordinary practicing clinician's unconscious professional ambivalence and potentially "rogue" sexual subjectivity.

Social Aspects of Sexual Boundary Trouble uncovers the roots of SBV in the institutional origins and history of psychoanalysis as a profession. Exploring Dimen's concept of the psychoanalytic "primal crime," which is in some ways constitutive of the profession, and the inherently unstable nature of interpersonal and professional "boundaries," Social Aspects of Sexual Boundary Trouble breaks new ground in the continuing struggle of psychoanalysis to reconcile itself with its liminal social status and its origins as a subversive, morally ambiguous practice.

It will be highly relevant to specialists in psychoanalysis, psychotherapy, critical theory, feminist studies and social thought.

Chapter 1

Introduction

Social preconditions of psycho-sexual violations in psychoanalysis: reflections on the ethics of Muriel Dimen

Charles Levin

Psychoanalysts are people who by definition believe it important to be willing and able to examine themselves and to take responsibility for the way they live their lives. We even believe that we should, like our analysands, be open to letting others help us in the process of self-exploration. Psychoanalysis is a social relationship—if an odd and enigmatic one.

At the same time, analysts believe in “freedom” and “independence”: personal autonomy in the sense that we all strive for moral integrity, which requires expressive freedom, privacy, and clear definitions of our ethical responsibilities. Analysts are especially trained to recognize the individual damage created by mental enslavement to intrusive, controlling, or neglectful dependency figures (internal objects), especially in formative periods of life. We want our patients to be able to think for themselves and we personally aspire to the same ideal.

But one fact of our institutional life seems to throw these comfortable, albeit demanding assumptions askew: the persistence of sexual boundary violations (SBV). Boundary violations force us to tangle in a personal way with something that exceeds the grasp of psychoanalytic “training” as it currently exists.

Boundary violations cause serious moral harm within the entire psychoanalytic community, even when they go undetected. The community that is affected includes not only analysts; it is also made up of patients, their families, friends, their pith and their kith (Ross, 1995). Psychoanalysis involves a wider and deeper social network than we may prefer at times to imagine, whose boundaries are indeterminate.

So the fact of SBV requires us to expand our sense of community. In this vertex, the occurrence of SBV offers itself as an interpretation of group behavior. We are not likely to receive this interpretation gladly, of course; we may want to get rid of it in some way, because it threatens to undermine our sense of who we are, what we are, and who or what is “them.” The persistence of boundary violations confronts the members of the psychoanalytic profession with a moral demand—a responsibility—that perhaps few of us believe we freely chose. When becoming an analyst, we don’t usually say to ourselves, “I want to (or I will) be responsible for the malpractice committed by other analysts.” It would seem to us absurd to be morally saddled in that way. However, even before our profession became especially concerned about sexual misconduct (which was often tolerated and covered up by institutes), we have always tacitly agreed to a form of collective responsibility in the sense that we should, of course, regulate ourselves and even police ourselves. (For a cogent critique of this concept of self-policing, see Gentile, this volume.) Initially, institutionalized psychoanalysis believed (along the lines of Plato’s Republic [see Levin, this volume]) that we could accomplish this goal simply by choosing the right people to become analysts, making sure that they get properly analysed (hence the hierarchical training analyst system), imposing burdensome requirements, and establishing rigorous and even rigid rules for psychoanalytic education (“training”).

Round about the mid-1980s, however (in what I call the “Gabbard Revolution”), we began to realize that psychoanalysis had an image problem and that we needed, at the very least, to demonstrate, in public, that justice was being done. This was the beginning of a long slippery slope in which we have conceded more and more of our sovereignty to the demands of the other. In that era, we drew up and published codes of ethics and created channels for complaint-driven ethical review of our colleagues. We began to think about our own behavior in terms of psychoanalytic principles (a novel idea), challenging morally lackadaisical attitudes and self-serving rationalizations, to the point where it actually became, for example, much more difficult to marry a patient (hitherto a common practice) while retaining peer respect. Above all, we made a show of punishing “offenders,” frequently by banishing them. But the problem still didn’t go away, as Glen Gabbard (2017) lamented, after thirty years of research and consulting on the issue, in a searing and pessimistic review of the problem. Gabbard found no evidence that anything we have done about the problem so far has contributed to the prevention of SBV. This suggests that Muriel Dimen put her finger on something very important when she wrote, in a revealing phrase, that “psychoanalytic life is burdened by a routine dissociation” (2016, p. 370; this volume, p. 39).

Part 1: collective responsibility for the primal crime

The essays in this collection start from Muriel Dimen’s premise that psychoanalytic responsibility for boundary violations is not only moral in nature, it is also social. As Gabbard and numerous others originally recognized, psychoanalysis not only has a public interface; it is itself a kind of social system embedded within the larger society—a social system that we have been reluctant, over several generations of analytic practice, to carefully examine. Not only are boundary violations a part of that social system; the way we handle or mishandle them as a group is symptomatic of that system.

All of Dimen’s arguments about SBV assume our collective moral responsibility—not just when SBVs occur, but for their occurrence in general. Something needs to be done by the group beyond the deliberative exercise of determining whether a violation has occurred and meting out justice. What many consider special about Dimen’s work is that she pushes the implications of the idea of collective responsibility to the point where we find ourselves in unknown territory, somewhere beyond the conceptual site of the Gabbard Revolution. How to explain this?

Reflecting on Dimen’s psychoanalytic work, I think we can see now more clearly how she first shifted the argument and raised it up a notch, particularly through the vertex of feminism and social anthropology, her concomitant areas of expertise. Dimen (2011) showed that our collective responsibility for boundary violations includes an element of collusion, what might be described as tacit participation in a social dynamic of denial and dissociation. The dynamic in question is really a vicious circle in which the group turns a (half-) blind eye to the problem and thus, in various ways, feeds back into it. That dynamic functions on several levels involving the systemic inequalities and biases characteristic of modern patriarchy. Though partially mitigated by law in complex liberal democracies, patriarchy is widely ramified in specialized systems and reproduces itself easily. The psychoanalytic profession is one of these systems.

As members of the psychoanalytic group, we have expected that our professional education, combined with stiff sanctions for ethical infractions, would have a deterrent effect on SBV. Yet the manner in which we address the problem—secretive, defensive, formalistic, administrative—does not inspire hope. There is a general sense of alienation in the profession, and the continuing reluctance or inability of the group and its leaders to deal with serious violations openly increases the sense of distrust and generates a pervasive feeling of inauthenticity. The leaders themselves are often prey to the alienation and even become public role models of cynicism. Indeed, the annals of psychoanalytic atrocity are heavily weighted with its more distinguished members. For these reasons, the seeming inauthenticity of ethics investigations into SBV may actually transfigure the crime into an unconsciously preferred vehicle for other members who are struggling with the impulse to rebel. We all have such motives! The table is then set for the next round of scandal; all that is required to complete another cycle is the statistically inevitable personal crisis that will crop up somewhere within the membership body.

It is in this perspective that Dimen defines SBV as a property of the psychoanalytic group (2016, p. 362; this volume, p. 29 passim). All of her work, even when not devoted specifically to psychoanalytic ethics, suggests that seemingly individual problems—for example, certain kinds of negative (“counter”)-transference that regulate conventional boundaries between normal and pathological, or healthy and perverse—cannot be addressed responsibly when the underlying social structure and dynamic are kept out of view (Dimen, 2003, 2005).

An occupational hazard of psychoanalysis is to see everything in psychological terms. In Rotten Apples and Ambivalence, Dimen comments: “the phenomenon of sexual transgression between analyst and patient … is insufficiently addressed so long as it is only deemed psychological” (2016, p. 361; this volume, p. 29). Dimen made systematically explicit in this paper what she had previously explored in her earlier, partly autobiographical reflections (2011; see also Levin, 2020a), namely, that the phenomena of sexual transgression in psychoanalysis are “also workings of power and vehicles of culture.” To address them adequately, she argued, one needs to “think socially,” and to provide not only an “insider” account of the problem (as she had done before, writing as an analyst and as a patient victim of SBV), but also to take a multi-perspectival look “from the outside in” (2016, p. 361; this volume, p. 29).

This line of thinking suggests a number of troubling questions about how we (the profession) have handled the issue so far. In effect, Dimen is asking, was it even true that we took our moral, if not quite our social, responsibility seriously? One reason for this question, she clearly implies, but did not live long enough to fully articulate, is that even in the thought of our collective responsibility, we have tailored our ethics along individualistic, one-person psychology lines that do not in any profound way challenge the basic feeling of non-involvement that we manage to sustain even as we assume this new (and hopefully developing) sense of collective responsibility.

We know from the histories of North and South America, and of modern colonialism generally, which spanned the globe, including Africa, Asia, the “Middle” East, and Europe itself, that nations and cultures have been built on foundations of generalized violence. Muriel Dimen’s (2014) reflections on the early institutionalization of psychoanalysis suggest that we can learn a great deal by looking at the development of our profession through a similar historical lens. As Dimen noted, Freud’s announcement of the inception of the IPA, with the justifications he provided for it, simultaneously “declares a revolution and forges an orthodoxy” (Dimen, 2014, p. 499). The idea that psychoanalytic institutions were established by means of a kind of violent schismogenesis¹ lies at the root of what she was getting at, I believe, in her important, but neglected concept of the psychoanalytic “primal crime” (Dimen, 2011; see Levin, 2020a, 2020b). The fact that many typical creation myths involve narratives of violent splitting (e.g. the tzintzum in the Lurianic Kabbalah, or the story in Genesis about Adam’s rib) does not derogate from the ethical need for the parties so engendered, in the real world, to keep in mind the likelihood of originary violence at the root of their sense of “identity.” And why wouldn’t we? The answer may be that Freud’s assertion on our behalf of psychoanalysis as a “new movement” (1914, p. 42) whose achievement must be enshrined by orthodoxy in the IPA “headquarters” (1914, p. 43), conceals yet another, still more “primal” violence that we do not wish to remember: the socially transgressive undertones of the psychoanalytic procedure itself—the fact that in spite of Freud’s later protestations to the contrary (Freud, 1910), psychoanalysis is inherently “wild.”

As Freud (1912) inferred from the hypothesis of the “primal horde” in his philosophical reconstruction of human cultural origins (Totem and Taboo), there must have been a critical moment after which “society was now based on complicity in the common crime” (p. 146). Modern cultural anthropology has rightly questioned the validity of Freud’s speculations about human pre-history, but he nonetheless significantly shifted our intellectual ground by suggesting that, whatever the status of violence in the human picture we draw, our authoritarian tendencies can be understood as defensive as opposed to essential or innate. We also learn from Freud that what is most significant over the long term about the moral fact of violence in the process of “nation building” is that the constitutive violence is not only forgotten, its memory suppressed; but also that the violence itself is defensively folded into the culture and ongoing practice of the “nation” as a whole, and the world: it has no other place to go. Originary violence is lived unconsciously and/or vicariously through attitudes, customs, norms and ideals that are taken at face value, though they refract and institutionalize, in subtle ways, the suppressed history.

Not all of what is refracted in the roots of our various collective identities—professional, cultural, ethnic, racial—takes the form of overt social actions in the sense we traditionally define as history and politics. There are areas of human activity that escape our conscious notice. We might describe them more broadly as trans-individual rather than “social” or “societal” in the conventional sense. These liminal and/or unconscious activities have only recently begun to draw the interest of human self-research (psychology, sociology, anthropology, history, evolutionary thought). Try as we might, they resist location on the grids of internal versus external or individual versus social; and they are deeply implicated in our origins and the sense of who we are as psychoanalysts.

Freud not only understood this, he contributed mightily to the development of such a perspective in human cultural evolution, which arguably adds more than his ideas about clinical treatment to the weight of psychoanalysis in our intellectual universe. The implicit analogy of Freud (1912, 1939) recognized that in some way (not necessarily precisely in the forms he speculated), human cultures in general are grounded in sexuality and violence, in the problematics of incest and the dynamics of murder within the group.² This supra-individual and proto-social aspect of sexuality and violence sets Freud’s anthropological speculations apart from earlier theories about the social contract and the state of nature. For Freud, at least by implication, the ways that humans have come to socially organize sexuality and violence are not merely naturalized events belonging to an evolutionary past or a biological heritage—they are ongoing elements of cultural evolution in history as it unfolds in our present lives.

To proceed somewhat programmatically, in the interests of space: the sense of our social responsibility for sexual boundary violations has been suppressed within psychoanalysis at a number of levels. In summary, these include at least three interrelated forms of foundational schismogenesis: 1) the founding of psychoanalytic institutions on the basis of patriarchal and authoritarian models of governance and education dating back to Plato’s Republic, which inhibit freedom of thought; 2) the forging of a professional identity with respect to medicine, psychology, and conventional social thought through forms of group consolidation and control—the “submissive transformation of narcissism” (Levin, 2021b)—harkening back to the Exodus myth and Moses’ divine mission to lead the “chosen” people; 3) asserting the concept of unconscious sexuality as a specific “object domain” proper to psychoanalysis alone and its specialized technique; but then absolving itself from the implications of that understanding of sexuality (see Saketopoulou, this volume)—first, by claiming professional immunity from it (through specialized theory and technique); and then by subsuming sexuality itself into a larger paradigm of individual emotional development (psychosexual stages, object relations, attachment theory, etc.).

To develop these points a bit further, we might say that Dimen’s work tends toward a redefinition of the concept of sexual boundary violation, a revisioning in which the ambiguous and indeterminate role of sexuality is recognized. As we have already considered, Dimen’s concept of the “primal crime” invites us to revisit the status of sexual boundaries at the historical beginnings of psychoanalysis. What is a sexual boundary, after all? We know that the required intimacy of the analytic relationship was widely considered improper in the early days of psychoanalysis, “a most dangerous method,” as William James opined (on this topic, see especially Kerr [1993]). Consideration of the porousness of the frame at that time suggests to us now that psychic “boundaries” should really b...

Table of contents

• Cover
• Endorsements
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of contributors
• Acknowledgments
• 1. Introduction: social preconditions of psycho-sexual violations in psychoanalysis: reflections on the ethics of Muriel Dimen
• PART I: Collective responsibility for the primal crime
• PART II: Social aspects of psycho-sexual boundary violations
• PART III: Locating the psycho-sexual boundary
• PART IV: Psychoanalysis Unendliche
• Index