The Culture-Breast in Psychoanalysis

Cultural Experiences and the Clinic

Noreen Giffney

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9780429856938
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

We are fed at the breast of culture, not wholly but to differing degrees. The Culture-Breast in Psychoanalysis: Cultural Experiences and the Clinic focuses on the formative influence of cultural objects in our lives, and the contribution such experiences make to our mental health and overall wellbeing.

The book introduces "the culture-breast", a new clinical concept, to explore the central importance played by cultural objects in the psychical lives of patients and psychoanalytic clinical practitioners inside and outside the consulting room. Bringing together clinical writings from psychoanalysis and cultural objects from the applied fields of film, art, literature and music, the book also makes an argument for the usefulness of encounters with cultural objects as "non-clinical case studies" in the training and further professional development of psychoanalysts and psychotherapists. Through its engagement with psychosocial studies, this text, furthermore, interrogates, challenges and offers a way through a hierarchical split that has become established in psychoanalysis between "clinical psychoanalysis" and "applied psychoanalysis".

Combining approaches used in clinical, academic and arts settings, The Culture-Breast in Psychoanalysis is an essential resource for clinical practitioners of psychoanalysis, psychotherapy, counselling, psychology and psychiatry. It will also be of interest to researchers and practitioners in the fields of psychosocial studies, sociology, social work, cultural studies and the creative and performing arts.

Chapter 1
Thinking clinically with the psychosocial

Psychoanalysis has been employed outside the consulting room since its inception. This might be as a conceptual tool to think about culture, society or politics (Bell, 1999; Kuhn, 2013a, 2013b; Bainbridge et al., 2007; Dimen, 2011; Weintrobe, 2013; Smadja, 2015; Kohon, 2016; Morgan, 2019; Morgan, 2020; Dwairy, 2015; Akhtar, 2012), or as one of the theoretical frameworks in the development of multidisciplinary areas of study, such as the psychosocial (Frosh, 2015a) or the psycho-cultural (Bainbridge and Yates, 2014a). Psychoanalysis has been integrated with more established qualitative approaches to research to form new methodologies, examples being the visual matrix (Froggett, Manley and Roy, 2015), the socioanalytic interview (Long, 2018), the social dreaming matrix (Manley, 2018) or the reverie research method (Holmes, 2019). It has been incorporated as part of strategic approaches to practice-based endeavours as varied as conflict resolution (Rifkind, 2018), education (Cohen, 2007) or exhibition curating (Bartlett, 2019). Some universities include degree courses, which introduce psychoanalysis as an object of knowledge to be studied, for undergraduate and postgraduate students doing academic programmes (Yates, 2001). Journals like The International Journal of Applied Psychoanalytic Studies (2004–) and Psychoanalysis, Culture & Society (1996–), as well as book series such as “Psychoanalysis and Popular Culture” (2013–) and “The New Library of Psychoanalysis ‘Beyond the Couch’” (2010–), publish articles and books by clinicians and academic researchers which adopt psychoanalysis to think about matters transpiring outside the consulting room. The terms “applied psychoanalysis” or “theoretical psychoanalysis” have been conferred on these efforts, to differentiate them from “clinical psychoanalysis” or “pure psychoanalysis” which attends to happenings that occur inside the consulting room.

The partitioning of psychoanalysis into “applied” and “clinical”, depending on its functions, focus and geographical zones of practice, often has the added effect of elevating one type of psychoanalysis – “clinical” – above the other – “applied”. This has resulted in the establishment of a hierarchical relationship between the two with the result that one becomes perceived as “pure” or “real”, with the result that the other becomes rendered “theoretical” or “watered down”. This has a knock-on effect of policing what is considered to be “clinical” writing in psychoanalytic contexts. Chapter 1 engages with one particular configuration of this issue by concentrating on the place of psychoanalysis within the developing field of psychosocial studies. Psychosocial studies concentrates on both the psychical/unconscious (Freud, 1915) and the social and cultural aspects of experience, stressing the inter-relation between individual subjectivity and the environmental context within which this is formed on an ongoing basis. The two are inextricable. It is not simply that one impacts on the other; they cannot be separated (Frosh, 2015b; Frosh and Baraitser, 2008). Psychosocial studies engages with work being produced in “clinical psychoanalysis” and “applied psychoanalysis”. In doing this, psychosocial studies highlights the messiness not just between the psychical and the social, but also between that which is labelled “clinical” and that which is referred to as “applied”. Psychosocial studies also challenges the privileged position of “clinical psychoanalysis” in a field that is characterised by diverse ways of continuing on work begun by Sigmund Freud. Furthermore, psychosocial studies attempts to disrupt what has traditionally been a one-way traffic of knowledge: from “clinical psychoanalysis” to “applied psychoanalysis”. Psychosocial studies goes further still by integrating other theoretical approaches, for example, feminist theory, queer theory or postcolonial theory, to facilitate thinking (Baraitser, 2016; Giffney, 2017a; Vyrgioti, 2019).

Chapter 1 explores how I have put psychoanalysis into practice through my work on two different psychosocial projects. In doing this, my aim has been to facilitate clinical thinking with the psychosocial through the processes of experience and encounter in a series of interdisciplinary and multidisciplinary endeavours. I will make use of psychoanalytic concepts, such as containment (Bion, 1970c), the facilitating environment (Johns, 2005), potential space (Ogden, 2015), the evocative object (Bollas, 1992a, 1992b, 2009), the transformational object (Bollas, 1987) and the transitional object (Winnicott, 1953) to facilitate me discussing the ways in which my interdisciplinary and multidisciplinary applications of psychoanalysis enrich the capacity for symbolisation for work in the clinic. Firstly, I will describe my long-term work on gender and sexuality which includes the staging of an encounter between queer theory and a number of different traditions of psychoanalysis. This work considers the various social and cultural discourses of gender and sexuality, which emerge from inside and outside the clinic, and their impact on clinical practice. It has resulted in a number of publications and events (Giffney, 2015a, 2016a, 2019; Giffney and Watson, 2017a, 2017b, 2018; Giffney, Watson and Lance, 2018), one of which I will discuss: a book entitled Clinical Encounters in Sexuality: Psychoanalytic Practice and Queer Theory (Giffney and Watson, 2017a). Secondly, I will outline my development of “Psychoanalysis +” (Giffney, 2013–), an international, interdisciplinary initiative that brings together clinical, academic and artistic approaches to, and applications of, psychoanalysis. I will discuss two events I have organised as part of this initiative: “Melancholia” (Giffney et al., 2014), a multidisciplinary collaboration with colleagues, which took place in the National Museum of Decorative Arts and History in Dublin, and “Unconscious Objects” (Giffney and Moran, 2018–2019), a series of conversations around art and psychoanalysis, which I co-convened with Lisa Moran, Curator of Engagement and Learning, at IMMA – The Irish Museum of Modern Art in Dublin.

“Applied psychoanalysis” and “clinical psychoanalysis”

While “[the] locus of psychoanalytic knowledge is in the clinical situation”, according to Stephen Frosh (2010, p. 36), psychoanalysis has and continues to be employed in other settings. It is, more precisely, as Prudence Gourguechon (2013) remarks, the putting into practice of psychoanalytic “concepts and interventions outside the traditional clinical consulting room” (p. 192). This approach to psychoanalysis is evident in Freud’s own writings, some of which feature case studies or vignettes (1905[1901], 1909b, 1918[1914]), while other pieces engage with societal concerns, everyday life, and the arts and culture to advance and illustrate psychoanalytic ideas, which in turn develops and clarifies them for their use in clinical practice (Freud, 1901b, 1907[1906], 1908[1907], 1930[1929]). Salman Akhtar and Stuart Twemlow’s Textbook of Applied Psychoanalysis (2018a) includes thematic chapters on a vast array of subjects, including history, community psychoanalysis, sports, poverty, terror and terrorism, consultation to organisations, health policy, sculpture, photography and theatre. Thus, psychoanalysis is “applied” in a variety of settings, including in contexts relating to healthcare, policy, business, the creative and performing arts, sport and academia. Therefore, it functions both as a theoretical approach to its subject matter and a praxis in the contexts in which it is applied (Akhtar and Twemlow, 2018b, p. xxxii). Psychoanalysis has become, Frosh (2010) explains, “one of the most significant tools available to those who wish to understand the social world” (p. 5). Efforts in “[a]pplied psychoanalysis”, Akhtar and Twemlow (2018b) write, “extend psychoanalytic ways of thinking to matters outside the clinical chamber” (p. xxxi). This is because, as Andrea Sabbadini (2014a) puts it, “Psychoanalysis … is more than what takes place within the walls of a therapist’s consulting room” (p. 117). The use of psychoanalysis outside or beyond the consulting room’s “walls” attends to “sociocultural phenomena” (Akhtar and Twemlow, 2018b, p. xxxi). It involves, Akhtar and Twemlow (2018b) state, the application of psychoanalytic “principles” with the aim of “deepening the understanding of cultural phenomena” (p. xiii).

Anne Erreich (2018) states the “purpose” of applied psychoanalysis as “enriching the discipline to which it is applied … with no expectation of altering psychoanalytic thinking itself” (p. 1066). Thus, it enhances that to which it is applied. In this scenario, psychoanalysis is also positioned as that which gives rather than receives. Erreich distinguishes “applied psychoanalysis” from, what she terms, “interdisciplinary psychoanalysis”, the “goal” of which is “the consideration of data and methodology from other disciplines to improve our theory and praxis” (p. 1066). In doing so, she makes a differentiation between a psychoanalysis that gives and a psychoanalysis that receives. In tracing the development of applied psychoanalysis over the decades, Akhtar makes a distinction between “psychoanalytic anthropology” and “anthropological psychoanalysis”. The former he locates in the past and the latter represents, what he calls, “the ‘new’ applied psychoanalysis”: “The former sought to understand cultural matters using a psychoanalytic lens. The latter brings cultural matters to bear upon psychoanalytic assumptions” (p. 364). In this, Akhtar uses different terminology than Erreich does, to indicate a similar standpoint. In a plenary address to members of the American Psychoanalytic Association, Prudence Gourguechon (2011) argues for a place for, what she terms, “the citizen psychoanalyst” (p. 445). This denotes a psychoanalyst who contributes to society and in turn benefits by advancing the psychoanalytic profession’s recognition to the society in which analysts are located. This “public engagement” (p. 447) takes two forms: “psychoanalytic advocacy” and “psychoanalytic social commentary” (p. 445). She defines “psychoanalytic advocacy” as “taking a principled stand on a public issue and attempting to push a resolution of that issue in a particular direction”, and outlines “the psychoanalyst’s offering public comment on a matter already before the public eye” as “psychoanalytic social commentary” (p. 445). She puts forward both positions as viable options for a discipline with a specialist knowledge of “human interiority” and what “lies beneath the surface” of events (p. 445).

Gourguechon’s stance is potentially a controversial one, in light of the Goldwater rule, which dictates activities “unethical” that involve giving a professional opinion on people in the public arena (pp. 454–455). Gourguechon addresses this and discusses the ethical responsibility of analysts to advocate for social change in cases where human lives are being devalued, focusing on three examples: LGBT issues (pp. 458–460), the need for immigration reform (p. 460), and the need for long-term treatment for soldiers and veterans (pp. 461–462). Psychoanalysts have contributed to public discourse on other issues, such as the nuclear arms race (Segal, 1987) and climate change (Weintrobe, 2013). Akhtar and Twemlow (2018b) refer to the aforementioned as representative of “socio-political praxis” (p. xxxiii). They remind readers of an ethical responsibility not to employ psychoanalysis in a way that overrides, “colonises” or “imposes” on other fields in a “wild” way (p. xxxi). Sigmund Freud (1910a) decried “wild analysis” as the application of psychoanalysis without proper training or expertise in the method. It signifies an ethical breach as well as an ignorant act devoid of proper respect for the limits of one’s knowledge or proficiency. Psychoanalytic technique, he says, “cannot yet be learnt from books” (p. 225). In this, “wild analysis” assumes that psychoanalysis is something that can be learned and applied, in an intellectual way, rather than something that needs to be experienced. Psychoanalytic applications need to respect the integrity and expertise of other fields, in the recognition that any psychoanalytic insights are partial and just one perspective among many possible understandings (Baudry, 1984, 1992; O’Neill, 2005, p. 126). Sylvia O’Neill (2005) takes issue with the name “applied psychoanalysis” because she believes it is “misleading”. She does not think it is possible for it to be “literally applied outside itself because the conditions for its practice are unique” (p. 125). She prefers the word “analogy” to exemplify the activity that others refer to as “applied psychoanalysis”.

“Applied psychoanalysis” clearly differs in its context, focus and aims from “clinical psychoanalysis”, according to commentators. The clinic is “the crucible for its concepts and its practices” (Frosh, 2010, p. 3). The use of psychoanalysis outside the consulting room is often presented as an extension of psychoanalysis (Akhtar and Twemlow, 2018b), something that works “[i]n tandem” with “clinical psychoanalysis” (p. xxxi). In an article on method in applied psychoanalysis, Francis Baudry reminds readers that psychoanalysis “as a theory was not devised to deal with non-living subjects”. Indeed, Frosh (2010) remarks that psychoanalysis centres on “a live encounter” between the analyst and the patient (p. 3). This “liveness” is “necessary” and “integral”, so much so that “[a]nything else, therefore, is not psychoanalysis” (p. 3). In spite of this stark statement, Frosh believes that “the way in which psychoanalysis embodies an encounter provides a model for understanding and promoting all occasions on which ‘something happens’” (p. 4). Critics of applied psychoanalysis, as discussed by Baudry (1984), “urge caution in using psychoanalysis in other than the clinical realm”, pointing to the qualitative difference between a “live patient” and, by inference, a “dead” text (p. 551). He cites free association and the patient’s response as two important absences in applied psychoanalysis (p. 551). The absence of the patient means, Fritz Schmidl (1972) remarks, that “the process of getting more and more information” is not possible (p. 405). “Scant evidence” and “one-sidedness” in terms of the approach to texts are also evident within “applied psychoanalysis”, according to Schmidl, in his discussion of work on literature and history (p. 407).

Much discussion of “applied psychoanalysis” concentrates on methodology and “how this activity should be done” (Gehrie, 1992, p. 239) and, by implication, how it ought not to be done. This focus on the delineation between “clinical psychoanalysis” and “applied psychoanalysis” has the effect of marking out one activity as “psychoanalysis proper” (Schmidl, 1972, p. 417), with the result that the other activity is relegated to being judged against it. A split has developed within the field of psychoanalysis as a consequence of this, between those who consider “applied psychoanalysis” to be “valuable” and “legitimate”, and others who take it to be “a secondary, derivative, even dubious procedure” (Esman, 1998, p. 741). This also has implications for what is considered to be “clinical writing” and “non-clinical writing”, and how both are appraised. In a review of Prophecy Coles’s edited collection, Sibling Relationships (2006), Susanna Abse (2007) expresses “concern” about the “lack of solid clinical material” in the book, which she judges to be “impoverishing” (p. 510). What does Abse mean by the term “solid clinical material”? What qualities does “material” have to have in order to be “clinical”? What elevates it to being “solid”? Simply put, it needs to be produced within the consulting room. Abse writes of “our exacting research into the human mind through the laboratory of the consulting room” (p. 510). This is crucial, according to her, as “[o]ur credibility as a profession” rests on its inclusion, because “without this, all our thoughts and premises seem thin and unconvincing” (p. 510). “It is not enough”, she continues, “to use myth, literature or biographies of the lives of artists alone to fully develop and substantiate our ideas” (pp. 510–511) – cultural objects, in other words.

In including descriptors such as “solid” and “exacting” to refer to research conducted within the consulting room, and terms like “thin” and “unconvincing” to point to work published without such findings, Abse (2007) is privileging one type of work over another. In linking the consulting room with “the laboratory”, and discounting work making use of cultural objects as “not enough” (p. 510), she is articulating a split that pervades psychoanalysis more generally: as to whether it is a science or an art (Slochower, 1964; Bowlby, 1979). Abse does not completely dismiss work on cultural objects. Focusing on them “alone”, she says, means that “our ideas” cannot be “fully develop[ed] and substantiate[d]” (pp. 510–511). Reading Abse’s words, I wonder to whom she is referring when she invokes the term “our”. This “lack” of clinical material in the book leads her to “presume” that it “reflects a wider problem: that of our profession’s failure to take up the challenge of a changing ethical framework that demands consent for publication of clinical material” (p. 511). In the midst of this discussion, Abse poses a question: “What is happening in our psychoanalytic world where a book can be published with almost no material in it from the consulting room?” (p. 510). This suggests a number of things, depending on how one reads the sentence, and where one places the stress. I will take up two possibilities here. Does Abse wonder “where a book can be published with almost no material in it from the consulting room”? In this instance, we might read this as an expression of loss or regret. Does Abse wonder “where a book can be published with almost no material in it from the consulting room?” In this case, we might read this as an expression of bewilderment and frustration. By extension, we might wonder whether Abse is suggesting that books “with almost no material … from the consulting room” ought to be published at all.

This discourse forms part of a larger debate relating to how psychoanalysis as a clinical activity is defined and understood: what is psychoanalysis? This is intimately connected to the question: what is not psychoanalysis? While being played out between “clinical psychoanalysis” and “applied psychoanalysis” at one time or “psychoanalysis” and “psychoanalytic psychotherapy” at another time (Blass, 2010), the discourse is underpinned by anxiety. This anxiety relates to a desire for respect and recognition. It is also a reaction to criticisms that psychoanalytic claims cannot be proven. While boundary setting is an element of any discipline, it is particularly prominent when th...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication Page
• Contents
• List of figures
• About the author
• Acknowledgements
• Series editors’ preface
• Foreword
• Preface: at the breast of culture
• 1 Thinking clinically with the psychosocial
• 2 Encounters with cultural objects as case study
• 3 The culture-breast
• Afterword: experience and the no-breast
• References
• Index