The Annual of Psychoanalysis, V. 23 0881631876, 9780881631876

Volume 23 of The Annual of Psychoanalysis departs from its predecessors in offering three lengthy studies of unususal in

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The Annual of Psychoanalysis, V. 23
 0881631876, 9780881631876

Table of contents :
I. Clinical and Theoretical Papers
The Pragmatics of Empathy; Gedo
The Influence of Hermeneutic Philosophy on Psychoanalysis; Hoit
Technical Appraoch to Eating Disorders in Patients with Borderline Personality Organization; Kernberg
Narcissism: A view from Infant Research; Soref
On the Resistance to Child Analysis: Problems of the Parent and the Analyst; Weiss
II. Psychoanalysis and the Brain
Psychoanalysis and Knowledge: Part 1. The Problem of Representation and Alternative Approaches to Learning; Levin
Psychoanalysis and Knowledge: Part 2. The Special Relationship Between Psychoanalytic Transference, Similarity Judgement, and the Priming of Memory; Levin & Kent
Psychoanalysis and Knowledge: Part 3. Some Thoughts on a Line of Development of a Philosophy of Mind; Levin
III. Early Psychoanalysis in Chicago
The History of Psychoanalysis in Chicago, 1911-1975; Grinker
IV. Applied Psychoanalysis
Henri Matisse: Love as Art, A Psychobiographical Study; Ravenal
Author Index
Subject Index

Citation preview



7995 Edited by Jerome A. Winer for the Chicago Institute for Psychoanalysis

POSTTRAUMATIC NIGHTMARES Psychodynamic Explorations Melvin R. Lansky with Carol R. Bley "This book represents an important clinical contribution to the understanding of trauma, a field of increasing importance to all therapists. In a well-written, psychodynamically informed study of a group of seriously traumatized psychiatric patients, Di: Lansky makes a significant clinical contribution by placing trauma and posttraumatic nightmares in the context of a patient's life. This is the first work in many years that appreciates the full clinical complexity of posttraumatic nightmares and flashbacks and their relationship to our complete life stories."

Ernest Hartmann, M.D. 0-88163-193-0


208 pp.

HIDDEN QUESTIONS, CLINICAL MUSINGS M. Robert Gardner "What a treat this collection is! Robert Gardner is a necessary voice of sanity, restless curiosity, and humor in psychoanalysis. In this abundant harvest of his musings and reflections, his recollections of his patients, colleagues, teachers, and himself, his slowly and gently achieved understanding of human nature (he would never countenance it being called wisdom), Dr. Gardner has given us, in one place, a kind of summation of what he has learned in a professional lifetime."

Shelley Orgel, M.D. 0-88163-212-0


184 pp.


"In all, a delightful, provocative series of essays by a master of psychoanalytic controversy."

R. Shilkret, Choice "It is astounding how many different problems Gill is able to· engage in an illuminating fashion in this slim volume .... The psychoanalytic world is not soon likely to benefit from a mind and a spirit as incisive and intellectually passionate as Merton M. Gill's." 0-88163-112-4


200 pp.

Stephen A. Mitchell, Ph.D. Contemporary Psychology

ISSN: 0092-5055 ISBN 0-88163-187-6

The Analytic Press, Inc. 10 Industrial Avenue Mahwah, New Jersey 07430-2262

9 780881 631876


ISBN 0-88163-187-6




Winer Chicago Institute




Edited by Jerome A. Winer for the Chicago Institute for Psychoanalysis Volume 23 of The Annual of Psychoanalysis departs from its predecessors in offering three lengthy studies of unusual interest. Fred Levin's three-part examination of psychoanalysis and knowledge is a stimulating, timely effort to relate "a psychoanalyst's thinking about knowledge" to both the clinical situation and what is now . known about learning, memory, and knowledge formation in the neurosciences. The late Roy R. Grinker, Sr. 's history of analysis in Chicago was solicited by The Annual in 1975 but declined for publication at the time as too abrasive in tone and' too critical in content. It is published here in unexpurgated form, and emerges as both a provocative historical document and a valuable commentary on the state of psychoanalytic education 20 years ago. Finally, in a fascinating contribution to applied analysis, Carol M. Ravenal reexamines Matisse's artwork in the context of the painter's early arrested development and subsequent adult conflicts in "Henri Matisse: Love as Art - A Psychobiographical Study."


These major contributions are supplemented by clinical and theoretical papers of characteristic excellence. John Gedo's probing evaluation of the "pragmatics of empathy" highlights how empathic responsiveness obliges analysts "to tailor our manner of discourse to the specific requirements of the analysand's current state." Michael Hoit argues that the hermeneutic point of view is an important addition to clinical theory, allowing analysts to understand phenomena outside the boundaries of specific schools

(continued on back flap)

and theories. Otto Kemberg examines the psychoanalytic psychotherapy of eating-disorder patients with borderline personality oi'ganization. Alice Rosen Soref proffers a revised understanding of the etiology and treatment of narcissistic pathology on the basis of three decades of infant research. And Samuel Weiss discusses the resistance to child analysis of parents who know their children need help but balk at the actual recommendation for treatment. In all, Volume 23 is a worthy response to the ferment of the present time. Encompassing a key period in psychoanalytic history, a scholarly investigation in applied analysis, and a thoughtful assessment of psychoanalysis and brain research, it offers a fine overview of the major tributaries of contemporary analytic scholarship. Supplement these monographic efforts with a careful selection of clinical and theoretical studies and you have an exemplary contribution to the literature.

Jacket design by Michael G. Rygiel Joanne Toth Associates, Upper Montclair, NJ



Editor Jerome A. Winer, M.D.

Editorial Committee Virginia Barry, M.D. Bertram Cobler, Ph.D. Barbara Fajardo, Ph.D. Benjamin Garber, M.D. Jack Graller, M.D. Roy R. Grinker,Jr., M.D. Meyer Gunther, M.D. Barbara Rocah, M.D. Saul Siegel, M.D. Marian Tolpin, M.D. Jerome Winer, M.D., Chairman

To submit new manuscripts, send an original and three copies, together with an abstract of no more than 960 characters (letters, numbers, spaces), to:

Jerome A. Winer, M.D., Editor THE ANNUAL OF PSYCHOANALYSIS 180 North Michigan Avenue Chicago, IL 6060 I


Edited by Jerome A. Winer for the Chicago Institute for Psychoanalysis

7}@ THE 1995


Hillsdale, NJ


Chapters in this volwne are abstracted and indexed in Psychoanalytic Abstracts.

© 1995 by the Institute for Psychoanalysis, Chicago.

All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means, without prior written permission of the publisher. Published by The Analytic Press Editorial offices: 101 West Street Hillsdale, NJ 07642

ISSN: 0092-5055 ISBN: 0-88163-187-6

Printed in the United States of America

10 9 8 7 6 5 4 3 2 l

Acknowledgment We would like to thank Ms. Christine Susman, who provided secretarial and editorial assistance.

Contents Contributors





The Influence of Hermeneutic Philosophy on Psychoanalysis



Technical Approach to Eating Disorders in Patients with Borderline Personality Organization



Narcissism: A View from Infant Research



On the Resistance to Child Analysis: Problems of the Parent and the Analyst



II PSYCHOANALYSIS AND THE BRAIN Psychoanalysis and Knowledge: Part 1. The Problem of Representation and Alternative Approaches to Learning



Psychoanalysis and Knowledge: Part 2. The Special Relationship Between Psychoanalytic Transference, Similarity Judgment, and the Priming of Memory FRED M. LEVIN ERNEST W. KENT vii




Psychoanalysis and Knowledge: Part 3. Some Thoughts on a Line of Development of a Philosophy of Mind



III EARLY PSYCHOANALYSIS IN CHICAGO The History of Psychoanalysis in Chicago, 1911-1975



Preface hy ROY R. GRINKER,JR. Afterword by FRED P. ROBBINS

IV APPLIED PSYCHOANALYSIS Henry Matisse: Love as Art. A Psychobiographical Study



Author Index Subject Index

253 259

Contributors John E. Gedo, M.D. has retired. In various capacities, he has contributed 14 volumes to the psychoanalytic literature. Roy R. Grinker, Jr., M.D., Training and Supervising Analyst, Institute for Psychoanalysis, Chicago; Senior Attending Physician, Michael Reese Hospital and Medical Center, Chicago, IL. Roy R. Grinker, Sr., Ph.D. {deceased), formerly Training and Supervising Analyst, Institute for Psychoanalysis, Chicago; Founder and Director, PPI, Michael Reese Hospital and Medical Center, Chicago; Professor Emeritus of Psychiatry, University of Chicago, University of Illinois, and Northwestern University. Michael Hoit, M.D., Faculty, Chicago Institute for Psychoanalysis; Faculty, Residency Training, Northwestern University Hospitals, Chicago, IL. Ernest W. Kent, Ph.D., Chief Scientist, Intelligent Systems Division, National Institute of Standards and Technology, Gaithersberg, MD. Otto F. Kernberg, M.D., Associate Chairman and Medical Director, The New York Hospital-Cornell Medical Center, Westchester Division; Professor of Psychiatry, Cornell University Medical College; Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research. Fred M. Levin, M.D., Training and Supervising Analyst, Institute for Psychoanalysis, Chicago; Assistant Professor of Clinical Psychiatry, Northwestern University Medical School; Lecturer in Neurology and Psychiatry, Chicago Medical School. Carol M. Ravena), Ph.D., Associate Professor, Studio and Art History, The American University, Washington, DC; formerly Vice-President, International Psychohistorical Association. Fred P. Robbins, M.D., Training and Supervising Analyst, Institute for Psychoanalysis, Chicago; Senior Attending Physician, Michael Reese Hospital and Medical Center, Chicago, IL. Alice Rosen Soref, M.A., Member, Infant Research Study Group, Boston Psychoanalytic Society and Institute; private practice of psychoanalytic psychotherapy, Newton Centre, MA. Samuel Weiss, M.D., Training and Supervising Analyst, Chicago Institute for Psychoanalysis; Child Faculty, St. Louis Psychoanalytic Institute. ix



The Pragmatics ofEmpathy JOHN E. GEDO

For a generation at the very least, there has been no disagreement within psychoanalysis about the essential role of empathy in making possible the accomplishment of the clinical goals of its procedures (see Kohut, 1959; Stone, 1961, 1981; Schwaber, 1981; Gedo, 1981, chapter 6; Gehrie, 1993). We also have consensus about defining empathy as a mode of observation based on a trial identification with the person observed, predicated on the common human characteristics of the participants. It is not uncommon, however, to encounter statements in the literature equating empathy with the acceptance without demurral of the subjective viewpoint of the analysand {see Kohut, 1984, p. 174; also Schwaber, 1983); self psychologists, in particular, tend to look upon any analytic intervention that causes the analysand pain or humiliation as "unempathic." Hence it is by no means obvious how, in practice, analysts should conduct themselves "empathically." Is it sufficient to devise interventions informed by the results of empathic observation? Should the analyst, in addition, affirm the legitimacy of the analysand's subjectivity or strive to avoid injuries to the latter's self-esteem? Is it desirable to make certain that the analysand feels the "healing power" so often attributed to empathy? In my clinical experience, most analysands regard the ordinary routines of psychoanalysis as empathic to a degree unprecedented in their past: the nonjudgmental effort to discern their motivations is generally appreciated as true acceptance. Whenever this is the analysand's reaction to treatment, any doubts we may express about the rationality, wisdom, or accuracy of his or her subjectivity is easily accommodated as helpful and potentially illuminating. These are the conditions Zetzel (1965) called a therapeutic alliance, Winnicott (1954) and Modell (1976) named a "holding environment," and

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Kohut (1977) regarded as the establishment of a "selfobject transference" of the idealizing kind (see also Gedo, 1975). 1 The questions I have posed about how to be effectively empathic become relevant with those analysands who develop an archaic transference (Gedo, 1977; Gedo and Gehrie, 1993; Gehrie, 1993; Gunther, 1984) wherein the analyst is experienced as the reincarnation of a traumatically unempathic caretaker of early childhood. In such circumstances, our attempts to make (even accurate) transference interpretations are likely to be misconstrued as denials of responsibility that only prove our guilt, and any assertion that the patient is distorting reality will only lead to angry rebuttals. Hence, these contingencies are necessarily to be dealt with by starting with the analysand's subjective reaction as a given, to be taken for granted, and then exploring the analytic transactions that precipitated it-as Schwaber (1983) advocates doing. In Kohut's (1984) terms, we have to investigate why the idealizing transference has failed to endure (or, in some extreme circumstances, even to be established). In some cases, even the foregoing policy of caution, tact, and "empathic responsiveness" (Ornstein and Ornstein, 1990) is very difficult to carry out. Gehrie (1993) reports on a patient, Ms. B., who responded to such efforts on his part with the paranoid outburst, "You're lying, you asshole" (p. 1095). In a case conference he and I led jointly, a candidate presented an analysis (Gedo and Gehrie, 1993, chapter 5) that had rapidly evolved into demands that she concur with some opinion of the patient she believed to be absurd. The analyst felt that she was being driven "crazy" but eventually allowed herself to be browbeaten into insincere compliance with the patient's demand. But the analysand could not allow a consensus on this basis either-later in treatment, it became clear that she was literally traumatized by the pleasure of such acceptance. The analyst's "reluctant compliance" (Kohut, 1971) was immediately followed by the patient's abandonment of the position formerly uncompromisingly insisted on. It simply is not feasible to sidestep an active negative transference by being "empathic enough." 1

Although it is not centrally relevant to the topic of this paper, it may be well to note here that a fad has recently developed disclaiming that analysts have any valid expertise in assessing rationality or the distorting effects of the analysand's subjectivity. This intellectual fashion (congruent with the deconstructionist epistemology imported from France as well as with feminist and Marxist critiques of the establishment) is now cal]ed the "intersubjective" viewpoint (see Stolorow and Atwood, 1992). Although the analyst's own subjectivity may, of course, interfere with valid assessments of data, this caveat does not imply that we must refrain from making judgments, as close to objectivity a..s possible, about a wide range of the analysand's adaptive choices. Like those of other professionals, our judgments cannot be (and need not be!) flawless, but our diagnoses of pathological behavior should be as reliable as those of radiologists, pathologists, or other experts in various aspects of human biology.



To illustrate, Gehrie's patient (Ms. B.) initially had at her disposal only two alternative modes of organization: either she felt helplessly controlled within an archaic mother transference, or (if she mastered this through progress to a more mature mode along the developmental axis) she achieved command of the situation in an erotic father transference in which there was no taboo about incest. As long as the analyst resisted her sexual demands, she could only reproach him for pushing her back into the unbearable frustration of the unhappy transactions with her mother-as she put it, she could not stand the insistence of any caretaker on an agenda she did not welcome. (She was one of the passionate creatures who, according to Freud, understand only "the logic of soup, with dumplings for arguments .... ") To put this another way, this analysand declared that, for her, empathy was not enough: the analyst had to comply with her openly illicit agenda, as she had been forced to submit to that of her father. And he was not to offer her the unsatisfactory substitute of mere words. Gehrie is entirely convincing in demonstrating that in such a situation there is no way to avoid rekindling the traumatic frustrations of the past. From a technical perspective, archaic material encoded in a presymbolic manner (see Makari and Shapiro, 1993) cannot be clarified by following Schwaber's recommendation to stick to the analysand's subjectivity. Hence, in these circumstances it is no more empathic to talk about the sources of the patient's demands than it is to focus on the attempted reversal of the victimization at father's hands. At these levels of regression, all words are ineffectual-a point Gehrie's analysand was trying to communicate by insisting on a wordless (sexual) transaction. Consequently, appropriate empathy should lead the analyst to intervene in some legitimate manner that does not principally rely on word meanings. Because Gehrie's account does not specify how the impasse was overcome, let me illustrate the point by citing a case of my own. My analysand was a highly successful businessman in late middle age whose adaptive difficulties (mostly in the sphere of human relationships) resulted from covert adherence to magical thinking, in identification with his quasi-psychotic mother. Although his belief in his own magic was disavowed, he never acted in disregard of this sense of omnipotence, no matter what conclusions were reached in the analysis; the magical system was logicproof and impervious to words-just as his mother had been when he was a child. I do not mean that the patient could not follow my statements: he knew quite well what I meant when I told him that dealing with him was like barking at the moon. (He let me bark and bark.) But when I began to respond to his obstinacy by imitating a dog that howls in distress, he finally got the point that he was now treating me as he had been treated as a small


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child. He started to plead that he was afraid to violate the precepts of the magical system (i.e., to defy certain superstitions), but he did not persist too long in using this alibi after I pointed out, with obvious sarcasm, that his confidence in his omniscience was worthy of a Professor of Psychiatry.... In my judgment, my tactics proved to be effective, whereas interpretations encoded in secondary process terms had gone unheeded because, when the relevant development level was in focus, this person could only process messages primarily conveyed through affects. The point I am trying to make through the foregoing clinical vignettes is that the analyst's responses, when guided by true and accurate empathy, are not necessarily "nice," warm, or gentle. (If we can make the point we need to make in a kindly way, let us by all means satisfy everyone concerned by an impeccable bedside manner. Unfortunately, we cannot anesthetize our analysands when the necessities of treatment prove to be painful for them.) In fact, there are clinical contingencies in which empathic responsiveness calls on the analyst firmly to set limits, sharply to warn of dangers, indignantly to oppose abuses. The emphasis in this statement should be put on the adverbs: limits can only be set firmly, warnings must be issued sharply, and abuses opposed effectively only through indignation. Numerous contributors (Winnicott, 1965; Modell, 1976, 1979; Kohut, 1977; Gedo, 1979; Stone, 1981; Gehrie, 1993) have asserted that measures "beyond interpretation" may have to be applied in certain cases as "preconditions for insight" (Blum, 1981). All these authors agree that among the measures necessary to make analyzability possible, "empathy" is one of the most important. Only Stone {1961) acknowledged, however, that "in certain special contingencies" the analyst may have to provide "some urgently important advice" (p. 31). In Beyond Interpretation {Gedo, 1979), I offered an illustration of such a contingency (chapter 5): a prospective analysand needed guidance about an acceptable solution for the problem of suitable arrangements to finance his analysis. The issues of intrapsychic conflict that underlay his paralysis could only be discerned after a considerable amount of analytic work. Without external assistance, this person could not have permitted himself to borrow the funds he needed to salvage his life. Although the potential need for such "parameters" (Eissler, 1953) is now widely conceded, few authors have agreed with my contention that, when patients are regressed enough to require such guidance, their ability to communicate in the routine manner of psychoanalytic discourse is also likely to be impaired. However, effective interventions in the "operatic" style I advocate occasionally crop up in the literature, without comment about their unorthodox nature. For instance, Kohut (1984, p. 74) reported that when an analysand engaged in dangerous driving and provocativeness



with the police on his way to a session, his own response was to tell the man that he was behaving idiotically. Exactly. In my work as a supervisor of candidates and a consultant to colleagues puzzled by difficult analytic problems, I have frequently found that analysts are very reluctant to intervene in a forceful manner, either because they believe such behavior to contravene the desideratum of technical "neutrality" or because they fear to injure their patients in the process of making such "unempathic" responses. Both rationalizations are wide of the mark. I can best illustrate this point by citing a case from the seminar I conducted in collaboration with Gehrie {Gedo and Gehrie, 1993, chapter 3): when a suicidal patient decided not to seek potentially life-saving treatment for a metastatic carcinoma, the analyst insisted that she must do so-that he would not allow her to destroy herself through an act of omission. However, he shamefacedly told the seminar that in doing this he had stepped out of his analytic role. Of course, he was incorrect in his belief that the technical principle of neutrality compels analysts to be indifferent about matters of life and death. At least, in the foregoing instance, nobody could accuse the analyst of any lack of empathy. In my experience, many colleagues are unable to protect themselves from being abused {not merely verbally, but even in terms of real enactments), and this countertransference difficulty is often justified on the ground that the archaic personalities who engage in such behaviors are too fragile to be able to tolerate the condemnation implicit in any effort to stop the abuse. The most glaring instance of this kind I have encountered was that of a supervisee who felt raped by her male patient, who "forced her" to initiate an analysis before she had agreed to work with him. This pattern of sadistic control over their transactions continued, although I repeatedly advised the candidate to put a stop to it by setting clear limits. The analyst insisted that such a course would be "unanalytic." She felt that the only legitimate technique she could use was to find a valid interpretation of the motives for the patienfs sadism that would dissolve this pattern of enactment. The impasse continued for a number of months, with more and more distress for the candidate. She finally blurted out that she could hardly expect her patient to stop his cruel behavior when her own analyst allowed her to indulge in similar conduct. Although sadomasochistic transactions of this kind seem to be rather common, they are by no means the only type of dyadic enactment {Gedo, 1988, chapter 9) encountered in practice. Even in the case I have cited, there Was an obvious sexual undercurrent; in many others the erotic component is so much in the forefront that it is not immediately obvious that the analysand is being sadistic in attempting to exercise sexual power in the analytic situation. The fact that the patient is being abusive may be disguised by


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verbal propaganda implying that it is the analyst's lack of responsiveness that is cruel (see Gehrie, 1993, case of Ms. B.). Attractive young female patients may act grossly seductive (in posture, gesture, dress, or the recounting of sexual exploits in pornographic detail), especially with male analysts. (Male analysands undoubtedly do the same with female analysts, although the seductiveness must take different forms.) In sum, the number of ways in which patients may persevere in provocative behavior, despite having been told about their motives for doing so, is ahnost infinite. Theoretical understanding of clinical developments of this kind has been facilitated by Melanie Klein's (1952) concept of projective identification. However, I think it is even clearer to look upon such developments as consequences of regression to a mode of organization wherein memory is focused on the subjective component of events. When these infantile transactions are relived within the transference, what is essential for reenactment is to reproduce the original feeling state; the assignment of specific roles to each participant depends on the ability and willingness of the analyst to comply with the requirements of the analysand's scenario, as Klein also postulated. Analysts are very seldom willing to play the villain of the piece, so that usually the drama can only take place if they become its victims instead. It is widely understood that analytic progress is contingent on conveying the foregoing insight to the patient, but this may be extremely difficult to accomplish, as illustrated by Ms. B. (the analysand described by Gehrie [ I 993]), because at these levels of regression verbal messages are poorly attended to. To return to the question of the varieties of enactment in the analytic situation that require the setting of limits, perhaps the most insidious of these is the one wherein the analyst becomes persuaded that the patient is so fragile that he or she must be handled with kid gloves. Such a development may occur as a result of projective identification (the analyst having been assigned the role of a caretaker unable to resist unreasonable demands), but very often the communication of the irrational therapeutic prescription is made quite explicitly, generally with considerable heat. In analytic communities strongly influenced by self psychology {or the belief that a benign object relationship can provide analysands with "a new beginning" [Balint, 1932]), it has been widely accepted that the analyst has no choice but to comply with such demands. Even the attempt to question whether such compliance with a prohibition against stating unpleasant truths is really necessary is often regarded as "unempathic." In circumstances of this kind, analytic empathy is no longer regarded as a channel of data collection-in fact, the very effort to collect data has been abandoned, under the slogan that it is unempathic. Instead of empathically determining what the analysand actually needs at the moment, the analyst



has become persuaded that the most urgent therapeutic task is to demonstrate overtly that the treatment is being carried out in an "empathic ambience" (Wolf, 1976). In my view, such a surrender of our analytic functions does not constitute the exercise of true empathy; rather, it is the transmission of the highly dubious claim that the analyst is kind, gentle, and warm. I do not mean to imply that analytic patients are invariably able to make use of unpleasant truths; those who do not register messages carrying such information and those who, upon registering them, become traumatized or suffer further regression have to be approached in a manner that avoids creating such an impasse. In my experience, however, contingencies of that kind are extremely infrequent; it is almost always possible for patient and analyst to reach a consensus about the fact that the analysand's passionate demand not to be "criticized" (or to be supported in terms of some attitude that is irrational in an adult context) is in itself a highly significant analytic finding-a repetition of a patterned transaction from the infantile past. It is true that, on the way to this insight, a great deal of primitive hostility may be unleashed, and that it is imperative that the analyst be able to contain such a storm without retaliation, avoidance, or evidence of having been damaged in the process. At a recent colloquium, a courageous colleague (Vida, 1993) reported on a failed attempt to analyze someone whose previous analyst had unexpectedly died in midtreatment. The presenter implicitly blamed herself for having been unable to provide an analytic ambience that could hold this patient, who had become increasingly anxious and had broken off the treatment. Although there were hints that the analysand was most concerned about magically destroying her (as he apparently thought he had destroyed the first analyst), it did not occur to the analyst that an appropriate holding environment for such a person had to be firm and rational, rather than warm and giving. To recapitulate, it is necessary sooner or later to stop patients from tyrannically dictating what must (or must not) occur in the analytic situation. In my experience, the sooner we succeed in setting such limits, the betterand the most direct way to interfere with such an enactment is emphatically to warn the analysand that compliance with these demands would be extremely dangerous. For instance, I have found it highly effective in such circumstances to say, with as much passion and conviction as the analysand used in making the demand, "Goddam it! You don't know the first thing about it! You are going to cut your own throat!" At a minimum, patients have always given me credit, after such an intervention, for having their best interests at heart. I believe that it is such opposition to a patient's selfdestructive infantilism that constitutes true empathy with the person's desire to mature emotionally.


Pragmatics ofEmpathy

Conversely, to support the alleged necessity of infantile solutions does not constitute constructive "empathic responsiveness"; on the contrary, it is the arbitrary assertion of the depreciating falsehood that one's patient is nothing but a specimen of psychopathology. A case presented in my seminar on clinical impasse (Gedo and Gehrie, 1993, chapter 4) serves as a cautionary tale in this regard: A young woman began her analysis with a temper tantrum about the candidate's statement that missing analytic sessions because of alternative commitments would not lead to optimal results. That the patient stormed out of the office in a rage, accusing the analyst of wishing to stifle her vocational ambitions, was never alluded to by either participant, as if the topic had been too hot to handle. Toward the end of the first year of treatment, the analyst allowed her patient to intrude on her family's celebration of Thanksgiving by returning a phone call from that setting. This transaction was not discussed either, until years later, when the analysand happened to read the obituary of the analyst's father. In that context she was once more enraged because the obituary discredited a secret fantasy she had harbored since the Thanksgiving phone call about the analyst's family circumstances. She embarked on a campaign of sadistic verbal abuse and uncontrolled intrusiveness within the consulting room, to which the candidate was unable to make any response. After some weeks of this stalemate, the patient left treatment-with a shared illusion that a "termination" had been reached. A couple of years later, the patient returned for assistance because she was back in the state that had led her to seek help in the first place. I believe this case report demonstrates that we are not being either kind or empathic when we treat people as too fragile to tolerate confrontation with their delinquencies, irrationalities, or destructiveness. Some members of the seminar, however, who were committed to the viewpoint of self psychology insisted that the problem with the conduct of the analysis was that the candidate had shown insufficient empathic responsiveness because she once responded to a phone call at 2 a.m. by promising to discuss what the patient wanted to tell her during the scheduled session next morning. I can only say in rebuttal that I have never received emergency phone calls from patients past my bedtime, and I have never had to tell anyone (not even schizophrenics) that these were my ground rules. I believe my attitude and bearing make it self-evident that I will not tolerate such abuse, or any other kind. Hence I am inclined to believe that putting up with mistreatment is very likely to be a reaction formation to the analyst's sadism. (For introspective insight into such a countertransference problem, see Ferenczi's Clinical Diary [Dupont, 1988].) Contrary to the arbitrary assumption that analysands cannot tolerate the setting of limits on their sadism or destructiveness, I have found that numerous patients actually welcome external controls to assist them to stop such



enactment.s. Most people who fall into misbehaviors damaging to others are actually aware of that fact and judge themselves severely as a consequence (through either guilt or shame). For example, one patient presented to me in consultation interrupted an earlier attempt at analysis and sought out a different analyst explicitly with the hope that, unlike the first analyst, the second would be able "not to let [him] get away with anything." This proved to be difficult in practice, for the analysand kept testing the analyst's resolution to maintain a stable framework of ground rules, but there was never any question of humiliation or trauma when the patient was confronted with the requirements of a workable treatment. (See also Gedo, 1979, p. 125, n. 4.) Some years ago I published a more detailed description of such a transaction (Gedo, 1981, chapter 6, case 14). The patient, who was a pious and guilt-ridden religious fanatic, gradually developed a pattern of sadistic provocativeness in the analytic setting, mostly consisting of deliberately misconstruing what I was telling her, although she generally understood my communications without trouble. I shared with her my conviction that her provocativeness was almost always unprovoked and that it was a deeply meaningful pattern of behavior, although for the time being I found it incomprehensible. It took time for her to stop the pattern of misconstruing what I meant, but she did so as soon as I showed her that I was on the verge of getting angry. Her associations then revealed that, as a child, she had been the victim of similar sadistic teasing by her psychotic father-and that his assaults had also been incomprehensible, because they were seemingly unprovoked. The patient was grateful that I had managed to stop her sadistic behavior, because she felt extremely guilty about her "wickedness" while she tried to torture me. Thus she was greatly relieved to shed her identification with her wicked parent. Perhaps I have now elaborated the point that empathic interventions may well have to create temporary unpleasantness for analysands at sufficient length to turn to a different, though related, matter: in my experience, empathy may require the analyst to refrain from interventions that produce pleasant reactions. We may have to avoid these not for the sake of a theoretical ideal of "neutrality," but because many patients become overstimulated by too much kindness, warmth, or intimacy. I have already cited the case (from Gedo and Gehrie, 1993, chapter 5) of one person who always made certain that she and her analyst would not have a consensus because she was (rightly) afraid that such harmony would traumatize her. A similar quandary was recently described to me in a private seminar ( 1992); in that instance the analysand was unable to forestall the pleasurable effects of the analyst's showing that he understood her accurately, and she was so overstimulated by these transactions that she would lose her ability to participate in rational discourse-instead, she made frantic retaliatory efforts to stimulate him, in turn, by regaling him with pornographic tales.

Pragmatics of Empathy

Although it is probably impossible completely to avoid traumatic incidents with analysands who have this kind of vulnerability, it is desirable to minimize the frequency of such incidents by empathically restraining our tendency to promote intimacy, warmth, consensus. Sometimes less is truly more! (If a more austere analytic style succeeds in avoiding such therapeutic setbacks, it is safe to conclude that such setbacks do not constitute "negative therapeutic reactions" based on a need for self-punishment [see Moraitis, 19811). Needless to say, I do not advocate. mindlessly substituting coldness and distance, or an argumentative manner, as the proper standard for the analyst's attitude. I am trying to say that empathic responsiveness entails the responsibility to tailor our manner of discourse to the specific requirements of the analysand's current state. If the foregoing principle is accepted, it follows that striving for consensus, warmth, or intimacy, a kindly couchside manner, and efforts to avoid humiliating or otherwise upsetting the analysand are only "empathic" if these characteristics of the analyst's activities have been chosen because they are specifically indicated. If they are used because the analyst assumes they are always optimal, then they are not empathic but formulaic. In my judgment, relatively few analysands actually require an approach characterized by such tactics. As I have already stated, they are not likely to be of much use when patients are developing an archaic negative transference. And, as we all know, tactical questions are unlikely to cause problems when the transference is focused on positively toned past transactions. To pinpoint the specific circumstances that call for the kind of responsiveness that echoes the good-enough holding environment of a growthpromoting childhood, in my judgment such tactics are called for when it seems prudent to postpone the potential development of an archaic transference because it threatens to be unmanageable (see Gedo and Gehrie, 1993, chapter 2). By establishing a new kind of object relationship, without precedent in the patient's past, it may be possible to expand the patient's repertory of basic adaptation al skills (if necessary, through explicit instruction) so that, when the storms of the negative transference later supervene, it might be possible to master them (see Gedo, 1988, epilogue). I do not claim that a new relationship can overcome the pathological legacies of the past; in my view, it merely provides the proper context for promoting new learning (see Wilson and Weinstein, 1992).

References Balint, M. ( 1932), Character analysis and new beginning. In: Primary Love and Psychoanalytic Technique. London: Maresfield Library, 1985, pp. 151-164.



Blum, H. (1981), Some current and recurrent problems of psychoanalytic technique.J. Amer. Psychoanal. Assn., 29:47-68. Dupont, J., ed. (1988), 77,,e Clinical Diary of Sandor Ferenczi,. Cambridge, MA: Harvard University Press. Eissler, K. R. (1953), The effect of the structure of the ego on psychoanalytic technique.]. Amer. Psychoanal. Assn., 1:104-143. Gedo, J. (1975), Forms of idealization in the analytic transference.]. Amer. Psychoanal. Assn., 23:485-505. ___ (1977), Notes on the psychoanalytic management of archaic transferences. J. Amer. Psychoanal. Assn., 25:787-803. - - (1979), Beyond Interpretation, rev. 2nd ed. Hillsdale, NJ: The Analytic Press, 1993. ---(1981), Advances in Clinical Psychoanalysis. New York: International Universities Press. - - (1988), Vze Mind in Disorder. Hillsdale, NJ: The Analytic Press. - - & Gehrie, M., eds. (1993}, Impasse and Innovation in Psychoanalysis. Hillsdale,~: The Analytic Press. Gehrie, M. (1993), Psychoanalytic technique and the development of the capacity to reflect.]. Amer. Psychoanal. Assn., 41: 1083-1111. Gunther, M. (1984), The prototypic archaic transference crisis: Critical encounters of the archaic kind. In: Psychoanalysis: 11,,e Vital Issues, Vol. 1,ed. J. Gedo & G. Pollock. New York: International Universities Press, pp. 69-96. Klein, M. (1952), Some theoretical conclusions regarding the emotional life of the infant. Writings, 3:61-93. New York: Free Press, 1984. Kohut, H. (1959), Introspection, empathy, and psychoanalysis. j. Amer. Psychoanal Assn., 7:459-483. - - - (1971), 77,,e Analysis of the Self New York: International Universities Press. - - - (1977), 11,,e R.estoration of the Self New York: International Universities Press. --(1984), How Does Analysis Cure?ed. A. Goldberg & P. Stepansky. Chicago: University of Chicago Press. Ma.k.ari, G. & Shapiro, T. (1993), On psychoanalytic listening: Language and unconscious communication.]. Amer. Psychoanal. Assn., 41:991-1020. Modell, A. ( 1976), The holding environment and the therapeutic action of psychoanalysis. J. Amer. Psychoanal. Assn., 24:285-307. - - (1979), Character structure and analyzability. Bull. Assn. Psychoanal. Med., 19:97-103. Moraitis, G. (1981), The analyst's response to the limitations of his science. Psychoanal. Inq., 1:57-79. Ornstein, A. & Ornstein, P. {1990), The process of psychoanalytic psychotherapy. Rev. Psychiat., 9:323-340. Schwaber, E. (1981), Empathy: A mode of analytic listening. Psychoanal. Inq., 1:357-392. (1983), Psychoanalytic listening and psychic reality.Internal. Rev. Psycho-Anal., 10:379-392. Stolorow, R. & Atwood, G. (1992), Contexts ofBeing: Vze Intersuhjective Foundations ofPsychologi,cal Life. Hillsdale, NJ: The Analytic Press. Stone, L. ( 1961}, 17ze Psychoanalytic Situation. New York: International Universities Press. (1981), Notes on the noninterpretive elements in the psychoanalytic situation and process.]. Amer. Psychoanal. Assn., 29:89-118. Vida, J. (1993), Ferenczi's Clinical Diary: Roadmap to the realm of primary relatedness.]. Amer. Acad. Psychoanal., 21 :623-635. Wilson, A. & Weinstein, L. (1992), An investigation into some implications for psychoanalysis of the Vygotskian view on the origins of mind.]. Amer. Psychoanal. Assn., 40:357-387.


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Winnicott, D. W. (1954), Metapsychological and clinical aspects of regression in the psychoanalytical set-up_. In: Co[lected Papers. London: Tavistock, 1958, pp. 278-294. - - - (1965), The Maturational Processes and the Facilitating Environment. New York: International Universities Press. Wolf, E. (1976), Ambience and abstinence. The Annual ofPsychoanalysis, 4: 101-115. New York: International Universities Press. Zetzel, E. (1965), The theory of therapy in relation to a developmental model of the psychic apparatus. Internal. J Psycho-Anal., 46:39-52.

The Influence ofHermeneutic Philosophy on Psychoanalysis MICHAEL HOIT

Hermeneutic philosophy is the study of how meaning is derived from experience and of the role played by interpersonal communication. Modern hermeneutists have incorporated an antiscientistic movement in philosophy regarding the humanities. They classify psychology as one of the social sciences in which data are derived from empathetically recognizable personal intentions, and not as one of the natural sciences where the criteria involve measurement, replicable experimentation, and the belief that there is an underlying discoverable structure of reality. Hermeneutics has been inspired by psychoanalysis in that it considers dreams and associations or any other product of human thinking to be the equivalents of texts. In turn, it claims to offer an enhanced understanding of the psychoanalytic process, since psychoanalysis is an interpretive discipline par excellence. In the social (human) sciences, evidence that can be used to make general statements about reality is derived from an empathic immersion in some product of human culture, such as a text, or a narrative of a life. Hermeneutic studies focus at the interface between social and individual psychological functioning and propose models by which one can understand how persons encounter, decipher, and find meaning in texts that have been produced by someone who may be quite differently constituted in terms of prejudices, beliefs, and knowledge. Some psychoanalysts feel that hermeneutic philosophy has supplied a general understanding of the act of interpretation and can throw additional light on the psychoanalytic clinical relationship and add to the ability of psychoanalysis to effect useful changes in analysands. In this essay I will discuss hermeneutic philosophy and its applications to psychoanalysis. 13


Influence ofHermeneutic Philosophy

Modern hermeneutics views the individual as needing to be integrated into a social community to find a system of meanings, encoded in a language, by which one can organize the many internal and external stimuli that one encounters. At the same time, the individual needs to impress a personal experience on the group in order to develop and enhance a sense of authenticity. Many of the things we already normally do in our work as psychoanalysts have this interpersonal dimension, and a better understanding of this underconsidered aspect of the transference will enhance our ability to use the clinical relationship for therapeutic purposes (Hoit, 1994). Woolfolk, Sass, and Messer {1988) define the conceptual difference between empathic data and the data of the natural sciences. They state: "Because its subject matter consists of meanings and signifiers as opposed to nonintentional events, the human sphere is different from the domain explained by the physical sciences. There is no transcendental ground beyond history and culture from which to render human life in purely objective terms,, (p. 7). Woolfolk et al. claim that the fundamental data of psychoanalysis are meanings, intentions, plans, goals, and purposes and are not reducible to any underlying physical properties. By putting himself in the place of the analysand and through an empathic immersion, the analyst may attain a fundamental understanding that is not otherwise possible. This clinical orientation is derived from the writings of hermeneutic philosophers who claim that psychological behavior is properly represented in narrative statements that have validation in intersubjective discourse, and are not organized by underlying structures. Therefore, hermeneutically influenced psychological theory is presented in terms of functions of the self in relationship to the environment, rather than in terms of structural concepts such as the ego and internal objects, as classical psychoanalytic theory would have it. There is no more basic structure than the narrative statement, and the truth of a statement is derived only from the context of explanation in which it exists. Gadamer (1976) has noted that individuals bring systems of meaning to every situation and that these systems of meaning are developed through learning and experience. Everyone has a system of concepts and prejudices, encoded in language, which allow meaning to be found in experience. These preconceptions are necessary in order to find meaning and a place in the culture. Hermeneutic philosophy considers how persons can communicate understanding in the context of necessarily differing systems of preconceptions. In classical psychoanalytic theory, analytic work is believed to bring the analyst an increasingly accurate vision of the past as it was actually lived. In psychoanalysis influenced by modern hermeneutic thinking, the version of the past that is developed in the course of an analysis is taken to be an ad hoc construct that provides a plausible background for explaining current aims



and is framed in terms of those aims. The basic aim is the search for a relationship in which understanding can be enhanced through dialogue and negotiation. Failure to establish a therapeutic relationship organized around these aims is a primary source of therapeutic motivation. Cure of psychopathology is brought about through constructing meaningful narratives that are internally consistent and inclusive within a therapeutic dialogue. This provides a sense of cohesive self organization and a capacity for acculturation. It is within a culture that meaning is constantly renegotiated as experience brings the need for understanding.

Development of Hermeneutic Philosophy: An Overview Hermeneutics was developed to establish criteria for the interpretation of ancient writings, particularly religious texts. During the Protestant Reformation, it was believed that a system was needed to demonstrate that textual interpretation could be systematized and that meaning could be derived from the scriptures independently of the authority of a hierarchical church. The ideas that were developed were found to be useful generally for any textual interpretation, but especially of ancient, classical texts. During the Enlightenment, philosophers believed that ideal formal systems could be derived that were appropriate for various kinds of studies. On this basis, ancient texts could be investigated for authenticity and their meanings could be clarified, using the models of ideal texts. Meaning was related to form. Schleiermacher, in the early nineteenth century, advanced hermeneutics and the understanding of interpretation in concert with the transcendental movement of romantic philosophy and the enhanced appreciation of the human individuality. He introduced individual psychology into the study of meaning with the insight that understanding a text requires that it be seen as part of a life process of the author,in addition to an occasion for the study of ideal forms. Schleiermacher said that in order to understand a text, it is necessary to put oneself in the position of the author with a particular history in a particular society. He believed that beyond the plain text of the Bible, for example, there are latent meanings. To understand these latent meanings, and particularly to apply the biblical messages to current life, it is necessary to understand ancient culture and the sensibilities of ancient peoples. From the time of the Enlightenment, the hermeneutic orientation to interpretation has provided otherwise unavailable meanings of human cultural products no matter how disparate the fields of interest may be. Schleiermacher's epistemological model of hermeneutics is similar to the Freudian model of clinical understanding in that they both attempt, through a process of identification, to achieve an objective view of the meaning that the creator of a text intends. In both there is a belief that there exists an

Influence ofHermeneutic Philosophy


objective external reality, separate from the observer, that can be reconstructed. 1 In Freud's epistemology the individual is thought to be constantly enacting versions of universal developmental stages in his behavior inside and outside of the clinical situation. This permits a psychoanalyst to understand latent suppressed meanings in the current behavior of an analysand, since the distortions that arise in the transference are representatives of underlying fantasies. Here, understanding comes from the application of scientific principles of causality to observed clinical data through matching the data to standard models of psychological organization. It is tested for consistency by comparison with alternate explanations and by clinical results. Hermeneutics has undergone a further evolution. The epistemological model of meaning has been complemented by an ontological model of meaning. Dilthey (1926) proposes that understanding comes from an empathic immersion in the experience of another, but only when the observer has been prepared by his own experiences. This idea was transitional to the work of Heidegger. Heidegger (1927) introduced the ontologic branch of hermeneutics by proposing that the search for meaning in human experience is a broader concept than the epistemological point of view would suggest. For Heidegger the search for meaning is a basic motivation in the human condition: a person is "thrown" into a world of possible meanings, having to organize a cohesive view of reality and needing a social milieu to do so. Society thus creates the individual by being the environment within whose terms the individual creates himself, and the individual affirms his existence by his contributions to the social organization of meaning. It is intolerable to the individual to lack understanding and it is intolerable for the group to have unresolved conflicts of interpretation within itself. Resolving these conflicts is a central function of society. Post-Heideggerian hermeneutic philosophers have embraced these insights. For them, meaning does not describe underlying universal themes. Rather, meaning in human life is an ever-changing product and function of social existence. The individual's past experiences in searching for meaning are brought to bear on current experience. Meaning exists in a historical context. These philosophers believe that reality is organized and made coherent only within the human mind and that thought itself gives reality its structure. Validation is through coherence, internal consistency, and social consensus. Within radical hermeneutic thinking there is no basic underlying prescribed form for predicting meanings of experience that transcends the group construction. Gadamer (1976) has suggested that Heidegger did not go far enough in escaping from the classical view of human understanding, since Heidegger 1

Ricoeur (1977) claims thal a person can also be thus understood as a text.



continued to hold that an observer is in a pristine and privileged position from which to form an objective view of an outside reality. Gadamer noted that the observer brings his own set of preconceptions and prejudices to bear and that these are the essential functions by which any understanding at all is possible. Empathic immersion in a text or in a relationship reveals failures in understanding which are then corrected through dialogue in order to experience deeper and more complex meanings beyond the preexisting system of thought. The onto logic turn in hermeneutics has excited a group of psychoanalysts who are searching for a background of rationality for describing object relations and the origins of the sense of self. For psychology, when it employs the radical hermeneutic framework, meaning is developed within the experience of people who are sharing a life process. It comes out of a need for understanding. There are no foundational structures that govern the organization of meaning outside the rules of language and logic. Of course, over time, general insights are accepted as valid by the individual and the group. Schools may form among practitioners, organized along the lines of mutually accepted propositions regarding human and social functioning. If they meet with success, they can rightly claim that their theories and proposals have validity. From a hermeneutic position, however, that validity is understood to be a momentary position of an ongoing dialogue, and one is required to be open to those times when the system fails to provide understanding for experience. Then a hermeneutic situation exists and the model of explanation has to be modified. Alternate schools may develop which have the responsibility to engage and negotiate with each other to seek the greatest attainable truth, although this effort may not succeed. Each explanation is uniquely created in the act of deriving it and serves a basic human need for understanding. No explanation has a claim to relevance beyond its holder's ability to argue for its current usefulness. Scientific certainty is not a goal: narrative coherence among ideas is the goal. Some hermeneutic philosophers have said that all of the common rhetorical devices are properly employed in the search for shared meaning. Just as a child internalizes the ideas that are extant in the environment and yet must stamp an individual contribution on that environment, so the individual continues to seek understanding within the social environment. This extreme environmentalism is central to contemporary, post-Heideggerian thinking. There are no universal programs underlying social experience that the more knowledgeable individual can point to in order to command agreement. Rather, through discussion, common understanding can be approached. Stolorow, Brandchaft, and Atwood (1987) state that their revisions of psychoanalytic theory are influenced by hermeneutic philosophy. The action language of Schafer ( 1983) is an attempt to bring psychoanalytic


Influence ofHermeneutic Philosophy

clinical theory into accord with the insights of hermeneutic philosophy. Hoffman (1991) has proposed a social-constructivist view of development and of the psychoanalytic process. For clarification by way of contrast, recall that Freud postulated the mind of the analysand to be a comprehensive system of interrelated and mutually regulating ideas and feelings. The regulation of the mind occurs through the regulation of fantasy, which is the mental perception of the pressures of the drives. For ego psychology the mind ca~ be conceptualized as a closed system of functions and structures that is influenced by interpretation because of the ultimate organizational capacity of the ego. The mind is believed to have a definite and defined structure that existed prior to the analytic experience which works upon it. In this model of treatment, the analyst is expected to function as an expert observer who matches the analysand's thinking patterns to previously known patterns of human emotional conflict, with a special organizing place for oedipal experiences. Cure comes from interpreting these patterns and by raising unconscious functions to the level of consciousness, permitting the ego to accomplish its functions of conflict resolution and structure building. The analysand is inclined to use the analyst's interpretations because of the esteem projected onto the analyst and because the interpretations make compelling sense. Freud believed that most analyzable character psychopathology could be encompassed by the therapeutic potential of these insights regarding unconscious functioning, and many analysands do, indeed, demonstrate these principles much of the time. For Freud, object relations conflicts are secondary and derivative. In practice, one may reasonably apply the classical insights or their modifications in self psychology or in object relations models. Hermeneutic philosophy, however, has offered us a point of view that demands a constant critique of any accepted understandings, which must be tested against the possibility that they are not relevant according to current needs and aims but that they may be superimposed presuppositions. Ego psychology maintained Freud's closed-model metapsychology as mounting evidence affirmed the importance of object relations and the therapeutic alliance. Freud's theory of ego psychology is a monumental synthesis of ideas into a grand and efficacious technical and explanatory structure. It is limited only by its inability to account for some clinical data and by the demand that it enter into a dialogue with detractors and holders of different views. Its strengths are its comprehensiveness and its clinical power. Eissler (1953), considering clinical experiences that are not accounted for by the basic theory of psychoanalysis, recommended that psychoanalytic work per se should be temporarily suspended in some cases in favor of a narrowly considered psychotherapy in order to avoid retraumatizing the



analysand when the transference situation cannot lend it.self to analytic interpretation. Analysts who are influenced by hermeneutic methods of working claim they provide a more comprehensive understanding of these shifts in the analyst's orientation by describing the problem more generally: the problem is described as the need for a discovery of meaning in a situation for which one's preconceptions do not provide adequate explanations. Many analysts have recognized this need for an expanded understanding of the psychoanalytic interpersonal relationship to account for the special techniques that are necessary to have some analysands bring the underlying oedipal organization of their personalities into a workable transference and in order to account for the analysands who seem to benefit from psychoanalytic treatment but who do not manifest a significant oedipal organization. These analysts have prepared the ground for understanding the hermeneutic contribution. For Kohut (1971), for example, the clinical object is defined largely in its role as a selfobject, used by an individual for the performance of necessary self regulating and sustaining purposes. In this mode the independence of the object from the self, which is a sine qua non of classical interpretation, is not relevant except as it represents a defensive mode of thinking: conflicts over the drives are thought of as breakdown products of a failing self. The Kohutian analyst focuses almost exclusively on the use that the individual makes of the object within the framework of his narcissistic needs. Kohut has stated that in his work reconstruction of breaks in the continuity of the therapeutic relationship based on selfobject failure has replaced the classical model of interpretation. Hermeneutic thought would redefine Kohut's breaks in empathy as states of a failure in communication of meaning, but his clinical observations on the failing self would serve as an introduction to the hermeneutic problem in the clinical situation. Winnicott ( 1960) has proposed a psychology that centers around the development of self structures and has noted that in earliest childhood it is not possible to think about the behavior of the subject without including relevant functions of the objects in the environment. Terman ( 1988) has fostered the use of the term "optimum responsiveness" to orient his readers to his concept of psychoanalytic treatment in which the analyst views his functions primarily within an interpersonal model. "Optimum responsiveness" is intended to note a divergence from the technique of Freud for whom "optimal frustration" defines the proper orientation of the analyst in relationship to the analysand's fantasy life. These authors have provided a bridge to hermeneutic psychoanalysis in that they have made the analyst's interpersonal role more acceptable and understandable. Within hermeneutic thought, the functions of the individual to acquire, organize, and share meaning within a social organization are the proper


Influence ofHermeneutic Philosophy

focus for psychoanalysis. This change characterizes those analysts who have come to believe that unconscious fantasies are not the basic functions of the psychoanalytic clinical process, but that object-seeking functions are basic, since objects are seen to function to regulate and integrate psychological activity. Goldberg (1990) has discussed this view of hermeneutics. The difference between those analysts who have made the hermeneutic shift and those who retain the classical orientation to drives can be illustrated by com paring the work of Laufer and Laufer (1984) with the work of Dorpat and Miller (1992). These researchers have worked out different ways to extend psychoanalytic treatment into problems of ego deficiency. The Laufers work with a group of adolescent analysands whose development has become derailed and whose symptomatology is severe. The Laufers describe a fantasy they call the "masturbatory fantasy" that has a unique organizing function in the unconscious of an adolescent and carries the derivatives of the developmental issues and difficulties that the adolescent has failed to master. They view the adolescent process as centering about the need to find nonincestuous sexual objects so that development can proceed and they suggest that development can be fostered by interpretive work in the area of the masturbatory fantasy. Laufer and Laufer feel that severe psychopathology can be resolved using an intrapsychic model of explanation, as Freud had wanted. Dorpat and Miller (1992) have taken a radical step toward hermeneutics, departing from Freud in basic ways of conceptualizing psychology. They write: Freud was mistaken in thinking that primary process manifestations stem from unconscious fantasies and that primary process functioning is isolated from interactions with the environment. Recent studies reveal that the primary process system is directly engaged in actual, not fantasy, interactions with others and that it unconsciously analyzes the meanings of those interactions and represents them in various primary process products. The so-called primary process derivatives that are commonly misunderstood as stemming from unconscious fantasies are actually constructed from the individual's unconscious attempts to evaluate and represent the meanings of his actual (not fantasied) interactions with others (p.2]. In summary, the Laufers have extended the limits of psychoanalytic efficacy within the structure of the classical model by describing a type of adolescent restitutional fantasy. Dorpat and Miller, on the other hand, believe that human psychology is organized around the interpersonal search for meaning. Stern ( 1985) has described the discontinuous development of the self in steps of increasing complexity, always in relationship to a supporting environment. The "core self," which develops around 9 months of age, requires



the attunement of an involved mother. The infant checks with the mother to see if she is in synchrony with his/her understanding of meaning. Stern calls this process "social referencing.'' The maternal counterpart is to show the child that she shares his or her sense of understanding. The core self and the intersubjective self link up to become the subjective self, or the "me." Stolorow et al. (198 7) present models of psychoanalysis expressed in terms of intersubjectivity. Mitchel (1988} claims that the meaning of behavior within a one-body psychology of internally regulated structures is obsolete. The status of identifications and of fantasy needs to be revised from the classical Freudian model: transference is not understood to represent inner fantasies derived from the regression of established psychological structures, lived out as if occurring between the analyst and the analysand. Rather, transference is the structure of the analytic relationship wherein a dialogue is established for the mutual seeking of meaning in experience. Existence within a relationship that serves to seek out meanings is the essence of personhood and of psychoanalytic cure. While resistances in the clinical relationship continue to be the focus of treatment in this revised model of psychoanalysis as it is in the classical model, the meaning of resistance has changed. It does not represent a compromise between a drive and defense. Instead, resistances are the analysand's (and often the analyst's) response to failures of understanding in the therapeutic relationship and are based on historic failures of interaction and communication. Thus, the analyst is not expected to be an expert who supplies interpretations; but he or she is one who knows how to undertake a search for meaning when resistance in the treatment process indicates that there has been a failure of understanding, and who is expected to participate as a partner in a quest. Cooper (1993) states that in his work also, the hermeneutic model of psychoanalysis replaces the classical model. Cooper asks what analysts know and how they know it. He says that truth is contextually, rather than objectively, defined. He derives his stance, at least partially, from outside a limited scientific orientation when he claims something in the nature of a political belief that renders the classical model obsolete: it defines truth according to the rules of hierarchal power and authority and their accompanying capitalist belief system which belong to an antiquated social organization and are therefore no longer comprehensible. Cooper feels that such thinking has to be discarded for egalitarian and humanitarian principles: we must move away from the picture of the analyst as an "expert decipherer'' and see him/her, rather, as a participant observer. This is a good example of how hermeneutically oriented thinkers describe the cultural organization as playing a role in the construction of systems of (currently) possible meaning.


Influence ofHermeneutic Philosophy

Dreyfus and Wakefield (1988) upbraid Freud for what they understand to be his narrow epistemological point of view and for his dependence on the concept of the unconscious representation {a structural concept}-shortcomings which they feel left Freud limited to symptom analysis and unable to approach problems of character. An analysis of character pathology, according to Dreyfus and Wakefield, would require that Freud have an ontologic point of view, as character pathology deals with the individual needing to fit into a social organization. Having outlined the understanding of hermeneutics and their relationship to the clinical field of observation, however, I observe that some analysts and philosophers who have been impressed by the usefulness of hermeneutic insights into basic psychological functions nevertheless believe that, by itself, hermeneutic philosophy cannot be a comprehensive orientation to clinical psychoanalysis. For these writers hermeneutics defines the limits to understanding when our understanding is not able to encompass experience and prescribes a course that permits progress to occur. Here, a sensible compromise is made between the insights of the classical models of psychoanalysis and the new insights presented by philosophers of meaning. It recognizes that for the practitioner, psychoanalysis is a clinical project and proposes a point of view that promises to expand the applicability of psychoanalytic work. Laplanche (1992) believes that a synthesis of hermeneutics with the classical point of view will be a stronger tool than either one alone. Problems of guilt and other self-limiting internal functions require the analyst's recognition and interpretation of defenses against the drives, understanding conflict in the transference to be a function of fantasies in the mind of the analysand derived from a repressed unconscious system of ideas. It supposes that the mind of the analysand can be studied and understood as a structure independent of an observer, as the classical model proposes. However, the hermeneutic viewpoint demands a radical and continuous examination and critique of the analyst's understanding from the point of view of an intersubjective and contextual definition of meaning. It may then be supposed that the analyst's preconceptions regarding values and functions will be recognized for the part they may play. One proper use of hermeneutics asks, How can we best understand internal conflict and resistance if we recognize that these concepts have to be seen in the context of questioning the analyst's strongly held beliefs and prejudices? Hermeneutics has shown the importance of a strongly held point of view, but it also describes the limitations that are involved in a strongly held point of view and describes a solution to this predicament. The psychoanalytic process must take into account structural concepts. Without this integration psychoanalytic treatment will often produce only superficial restitutive structures, and hermeneutics might lead to extreme relativism incompatible with



a clinical field. Kovel (1988) writes, out of a similar concern, that Dreyfus and Wakefield misunderstand the complexity of Freud's work. Kovel claims that they overlook the very real attention to ontological issues that Freud had achieved and that they ignore the complexity of motivation in human psychology. Gadamer (1976) himself supports this view when he states: This observation [that observation includes the awareness of observing) indicates the special circumstances in which the hermeneutical problem appears. The problem clearly does not arise as long as one is involved directly in taking up and continuing a specific intellectual tradition. It does not arise, for instance, with the Renaissance humanists, who rediscovered classical antiquity and tried to be the successors of the ancient authors, imitating them, indeed, openly competing with them, rather than merely "understanding,, them. The hermeneutical problem only emerges clearly when there is no powerful tradition present to absorb one's own attitude into itself and when one is aware of confronting an alien tradition to which he has never belonged or one he no longer unquestioningly accepts [pp. 45-46). In this passage Gadamer has given guidelines for when the hermeneutic orientation to clinical data is useful. He feels that when there is a failure in overcoming a stalemate in the treatment or when there is a failure in understanding a resistance, then the hermeneutic point of view will be found helpful. When the data conform to what is known, then the extant "scientific,, model remains adequate, with the proviso that understanding is to be rigorously critiqued from the intersubjective point of view. I believe that in this orientation such concepts as the false self and questions of the authenticity of the clinical experience will be addressed. For analysands who have been severely traumatized this skepticism may be necessary in order to adequately respond to their great reluctance to expose themselves to another person and their need to know that their individuality is respected. Even the most well developed personalities have a need for some kinds of interpersonal help in order to maintain their security within the analytic process and to sustain the therapeutic commitment during periods of the repetition of faulty object relationships. While it is certainly not true that anything is explained solely by faulty parenting, nor solved by reparenting, it is nevertheless the case that in many instances the effects of overstimulation and excessive inner conflict might have been exaggerated by parental neglect and might have been ameliorated by parental support. Hermeneutic Understanding of human development helps us to continue our investigations of the clinical process as a developmental process and frees us from a


Influence ofHermeneutic Philosophy

sole dependency on ego psychology with its central focus on regression and fantasy. This may ultimately allow for deeper insight. The classical and the hermeneutic approaches to clinical data are complementary. Considering the concepts of "optimum responsiveness" and "optimal frustration" as described above, a moments thought will show that these terms are complementary and not opposed. A concept of optimization of frustration necessitates attention to responsiveness and an effort to keep the frustration within tolerable bounds. Also, the concept that internal conflicts are "breakdown products'' of a failed self-selfobject organization is useful as a guidepost to those clinical experiences that are best described as failure of the self or of supporting objects. Other clinical moments require other principles. Internal conflicts represent ego states and may require analytic investigation in their turn and in the classical mode. The greatest gain from incorporating hermeneutic principles is that greater flexibility is allowed to the analyst in determining when to function as an independent interpreter and when to reconstruct the effects of object failure or even when to engage in interpersonal supportive functions. All may be parts of an analysis in varying proportions. How then might the principles of hermeneutic philosophy be applied in the actual clinical situation? The analyst cannot be only a blank screen who reflects transference projections: he or she must operate as a sympathetic searcher for a solution to a problem in which he or she is personally and affectively involved. The fact of the current clinical impasse is the focus of investigation and the solution may be in the discovery of a failed object relationship that the analysand is afraid to repeat, even as he is repeating it. It is understood that the analyst is being made a participant in the repetition and is experienced as the historically failing object as well as the corrective object whom the child may have fantasied in a hope for restitution and whom the analysand has continued to seek throughout life. The analyst's discomfort will reflect more than countertransference feelings, but will reflect a discomfort based on feelings of incompleteness in that he or she feels unable to pursue the work that is part of a self-definition. The search for meaning and the active efforts to include the analysand in that search are themselves the basic therapeutic activities in psychoanalysis. All other techniques ride upon this basic structure of interpersonal relationship.

Case Material In this clinical illustration I will discuss a few moments in an analytic treatment where an expanded view of transference was essential. I will suggest that hermeneutic understanding was of great aid to me in allowing me to distinguish those times when the analysand withdrew from analytic



work and the analytic relationship, refusing any interpersonal interchange, and those times when he overcame this withdrawal and participated in a meaningful and development-enhancing manner, offering the possibility of a productive interchange. This differentiation was helpful in sustaining an analytic dialogue. Mr. C, a 20-year-old undergraduate student at a junior college, came into analysis stating that he was doing relatively poorly at school and not able to formulate any meaningful plans for the future. He was ashamed that he attended "only a junior college." He was also unable to form meaningful relationships with women in spite of a great attraction to them. As soon as a woman returned his interest he would withdraw: it was as if there have been no relationship at all and as if he had not had any attachment at all. The whole thing might have been a dream. Yet, he remembered that he had had feelings of great excitement and that they had vanished. In their place was a void. Mr. C's father had been a chronic failure but had been a man with great ambitions who had often begun businesses with a sense of excitement and imminent success, only to see them fizzle out. He felt superior to other men and felt cheated whenever he had to accept an inferior position because one of his plans had failed to work out. Mr. C's mother felt trapped in her husband's affective cycles, and there was a divorce when Mr. C was 8 years old. Mr. C's father explained to his son that he had begged his wife to take him back but she refused. Therefore, he said, the breakup and subsequent abandonment were his wife's fault. He asked to be exonerated from any blame for his son's sense of loss. We subsequently discovered that Mr. C felt this to be a betrayal, but this feeling was repressed at the time in favor of an idealization of his father based on an identification with his grandiosity. Mr. C, left with his mother and a younger sister, felt called upon to assume many of the adult roles his father had forfeited. His father had moved to a distant city and there were occasional contacts between them, always instigated by the son, which, nevertheless, always renewed Mr. C's hopes that a relationship with his father was about to be reestablished. In his fantasies there had been no interruption. But, there was no follow-up on these contacts on the part of the father in spite of the implied promises. In the first year of analysis, Mr. C described a fantasy that had been recurring for many years, in which his father had come back and had become a business success and had taken Mr. C into partnership. Later, it became clear that this fantasy was even more encompassing than had first appeared to be the case. Mr. C said that he was afraid to regress in the transference because if he accepted the analyst's help, it would signal that he recognized that his father was a chronic failure who had abandoned him and Who was not ever going to fulfill his wishes. The analyst was an inviting


Influence ofHermeneutic Philosophy

substitute but had to be rejected for that reason. The resistance was based on an inability to accept reality and change objects. VIGNETTES

Mr. C experienced a feeling of connectedness immediately at the start of the analysis which allowed him to hope that he could avert a lonely future. He hoped that analysis would help him to think through to a future of success. He had many friends and was very attractive to women, but he was also very diffident and easily intimidated and he quickly gave up whenever he met obstacles or had problems at the beginning of a project. Each semester he began with great intentions and always started out with enthusiasm, but this quickly gave way to apathy and failure. In the analytic work Mr. C focused on the early loss of his father and his identification with him. Mr. Chad a clever sense of humor, but when alone he suffered from loneliness. In his mind's eye, he was with the most beautiful woman and the most enviable possessions and was the focus of envy of everyone. Mr. C was intensely invested in the analysis, and I found that in my presence he felt secure. He was even able to begin to date a beautiful woman and to sustain his interest as the relationship developed. The identification of the analyst with his exhibitionistic father made him feel confident, but the ambivalence made it untenable in the long run. He felt that he was also a pretender. He wanted the woman to be proud of him, as he had once been proud of his father, and, in his optimism, he felt capable of anything. Eventually he began to have doubts. His relatively poor school performance and his lack of confidence in the future began to overwhelm the relationship. He started to withdraw and the woman became angry and disillusioned. In the therapeutic relationship Mr. C found himself unable to maintain a working alliance. He felt that the failure of his romantic relationship was an indication that the analysis was failing. Periods of silence occurred, as he was unable to maintain an idealized transference. In my waiting room, he felt excitement meeting with me but this would dissipate, often before an hour began, and had to be discovered by reconstruction, because by the time we began the hour Mr. C was silent and affectless, and only persistent analytic work and activity on the part of the analyst would draw him out into a working relationship. The silences were frequent and, on the surface, the relationship seemed stuck at an impasse. When I suggested that the distance he maintained from me represented the abandonment by his father, he stated: "I am afraid to rely on you because it would feel like giving up on my father." Even though this insight demonstrated that he retained the ability to work sensitively, I found it frustrating



that nothing seemed to sustain the working relationship. In the course of this work, Mr. C recalled that he had been a school phobic in his early school years. He remembered sitting in the classroom feeling empty and longing for his mother. Her betrayal had been the first he remembered and the loneliness had a long history. But in the early years of the analysis, Mr. C focused spontaneously on the missing father. At the beginning of an hour, after a few years of work, Mr. C said, "I had an insight on my way home from your office last night." I asked him what the insight had been. I had noticed with an inner excitement that he had spontaneously volunteered the results of his own psychological work-an obvious increase in his available energy and new in the analysis. He continued, "I can't count on spectacular possessions and attractive women to give me a feeling of confidence. I need to feel good about myself, independently, first. Then, I might be able to make a relationship. As it is, I can't maintain my goals because I am always waiting for my father to return to make me feel secure and he is never going to do that." Mr. C went on to describe the pain he had felt at the loss of the recent love relationship. He could not get over it. He had many other relationships with women but they felt empty. He wondered if the girlfriend had felt equally empty when he withdrew from her and was unable to fulfill his promises. Mr. C lapsed into silence. I asked him about the silence and he said he did not understand it, but that he felt absent and had not been involved with the analysis at all that day. I said I was surprised to hear that he felt absent because he had just shared a great deal of work and insight and that would not be possible if he had not been participating. He asked, angrily, why I had not complimented him before. He explained that this is what he had always been longing for and his withdrawal was out of frustration. He said, "When I work hard and you are silent, I feel that you don't care." I said I understood his need to doubt me because his father had been absent and he felt I was withholding myself, as well. When I used the term withholding, he repeated it with excitement. He said he wanted to pay me back for all of the times I had not been forthcoming. "That's it. You have always withheld from me. If you know I need to be responded to, why did you withhold it?" He said that he prefers to be in a relationship where he is the one who withholds. That way, he can feel some power. He was hopeful that he could do better in the future, rather than remaining so hostile. He thought that other people are not really so ready to reject him or ridicule him as he had feared. Mr. C's ability to remain in the analytic process slowly improved but remained fragile and easily lost. Working through the resistance by reconstruction of his withdrawal from a working relationship had to be repeated over and over. For a very long time, he continued to deny angry feelings.


Influence ofHermeneutic Philosophy


I have presented a lengthy description of Mr. C's background and I have tried to give a picture of the clinical process in order to permit any psychoanalyst reasonably to agree or disagree with my understanding of the case and my theoretical justification. I will focus on the points in the treatment where Mr. C showed a spontaneous effort to engage the analyst. These experiences were signposts suggesting progress in a long and difficult process in which the apparent absence of a working relationship was a challenge to my confidence and ingenuity. He generally seemed unable to sustain the relationship without my active efforts to engage him. At one point he allowed me to know that he was waiting for his father's return and this helped me to understand his reluctance to chance a therapeutic relationship. How could he come to believe that this unknown process could be a better alternative to his defensively idealized father given that he maintained a split image between that expected, idealized father and the disappointing father of his traumatic experiences? At a later point he showed that he was intensely involved in the process by sharing an insight that he understood he had to change if he was to succeed in any activities in his life. He could not remain passive and wait for his father. When he returned to his passive stance in the transference, however, I did the work of bringing together the obvious fact of his participation with the picture of his customary silence. I believe that I helped him begin to resolve a split object relationship by responding to and mirroring his spontaneous and authentic involvement. Only then did he address me directly in terms of anger that, obviously, could also relate to his father. He accused me of withholding my help from him. He said that he had needed my approval and my affirmation and that I knew that and did not respond. At the same time he was showing that my constant efforts to engage him had had a positive effect and that there had been slowly developing, often silent, progress. When he risked showing himself to me and allowing my response to be helpful, he had already improved. However, although he could state the reality of the father's abandonment, he continued to deny it affectively and unconsciously, and he continued to maintain a firm attachment to his internal object relationships. I believe that this demonstrates the usefulness of structural thinking in clinical work with analysands who have character deformations. At the same time, this also shows that the synthetic function of the ego may be an inconstant phenomenon and that an active interpersonal relationship based on overcoming an actual failure to establish a meaningful dialogue is an essential aspect of clinical work. I believe that one organizing therapeutic agent was my constant effort to engage Mr. C and my readiness, unlike his father, to respond



affirmatively when Mr. C chose to try to engage me. This created an environment in which he could come to trust me and to know me as a potentially helpful person. A potential stalemate was avoided by engaging in efforts to find a way to share an understanding and a search for understanding. The factor that made it possible to work out a relationship was that I found myself frequently feeling ineffectual and that my efforts were futile. After a period in which there were signs that a workable alliance was forming, Mr. C would lapse back into inactivity in our work. This would exacerbate my own tensions, because I would feel hopeful, only to be disappointed. In retrospect I discovered that I was recreating in myself what had been Mr. C's central experience. When Mr. C let me know that he was helpless to act until his father returned, I realized that we had the beginning of a narrative statement that would show a similarity between his feelings of ineffectuality and my own. Then, when Mr. C made a major advance into working only to regress again, I was able to construct and communicate a narrative statement that made the relationship with me the normal continuation of his search for efficacy. I believe that the idealization of the father was, in part, a restitutive structure intended to help solve a lifelong problem of loneliness and helplessness. His ability to use me substituted one restitutive object for another but made for a continuing story. The problem of healing at a deeper level required carefully dosed disillusionment and the discovery of the background vulnerability. Ego psychology predicts that the resolution of problems of character pathology will depend upon the capacity of the analytic process to resolve internal conflicts in object relationships and in the organization of the drives. However, we can see that this point of view may be modified by an understanding of the importance of relational theory and of the active ongoing therapeutic relationship in psychoanalysis. The active search for meaning may be a constant effective principle in every successful analysis. Within this central organizing relationship, each analysand will assign to that relationship a particular meaning in an ongoing narrative of his or her life. While many analysands will interpret the search for understanding as if it were a seduction or a competitive activity, others may understand it as the provision of a selfobject function or an opportunity to displace affects or project internal structure. Also, each analyst, given his training and development and political allegiances and prejudices, will be prepared to understand the analysand's reactions according to a limited number of models. This defines the background for the hermeneutic situation. If an analyst is limited to one school, there will be no opportunity to expand insight beyond those limits and many analysands will be deprived of the deepest possible


Influence ofHermeneutic Philosophy

analysis if their own language or the nature of their psychological development does not respond best to those limits. Each analyst owes it to his work to be open to the ideas of competing schools, even when having a special set of convictions. At the same time, the analyst faces the problem of finding a common understanding with his analysand, given their diverse backgrounds, even if within a common language tradition. Ontological hermeneutics does not imply that the goal of therapy is to achieve a cohesive and inclusive narrative. It is the search for such a narrative itself that is the essence of human being. Failures in the therapeutic relationship are often recreations of childhood interactive failures, and clinical interaction is a route to a therapeutic relationship. Every effort was needed to bridge Mr. C's withdrawal and to work through the disillusionment with me. Whenever he fell short of his grandiose ambitions, he felt that as a failure in our relationship. It was not possible to solve the problem of withdrawal by the interpretation of transference anger, or by the interpretation of frustration of a wish for any gratification, until I could demonstrate to Mr. C that, in fact, there was a significant relationship that he was having to deny. His uses of denial and dissociation had made him impervious to that demonstration because the fear of abandonment made it necessary to avoid risk. However, the anger was available and conscious when, paradoxically, I could affirm his own positive contribution. "Why did you withhold yourself from me?" he asked. And at that moment, the positive and negative images merged into an object relationship and at that moment he could be angry because he could be aware of his longing in the transference.

Conclusion The hermeneutic point of view is an important addition to psychoanalytic clinical theory. It allows analysts to understand phenomena outside the boundaries of psychoanalytic schools and their theories. It has long been accepted that an analyst will necessarily use a variety of technical procedures besides interpretation and that reconstruction, clarification, explanation and other techniques are also valid. Hermeneutic philosophy has made these techniques understandable in a developmental context, by describing early human relationships during which the infant is first developing a sense of self and when he or she depends on continuous input and feedback from the environment in order to develop adequately. The ontologic model may help the analyst maintain a developmental understanding of the clinical process. However, hermeneutic ontologic philosophy may stress an exaggerated relativism that is insufficient for clinical work. The ontologic point of view must be complemented by the epistemologic



one. The scientific exploration of structure then should be conditioned by an understanding that the analyst's point of view is partly determined by private experience and prejudice. This can be effected by an open dialogue with adherents of other perspectives. Hermeneutic ideas are used to indicate the limits of theory and the need for going outside of any one position in order to accommodate others. It gives psychoanalytic work a needed flexibility and permits it to encompass a variety of forms of psychopathology. References Cooper, S. H. (1993), Interpretative fallibility and the psychoanalytic dialogue. ]. Amer. PsychoanaL Assn., 41 :95-126. Dilthey, W. (1926}, The hermeneutics of the human sciences. In: The Hermeneutics &ader, ed. Kurt Mueller-Vollmer. New York: Continuum, 1992, pp. 148-164. Dorpat, T. L. & Miller, M. L. (1992}, Clinicallnteraction and the Analysis of Meaning. Hillsdale, NJ: The Analytic Press. Dreyfus, H. L. & Wakefield, J. (1988}, From depth psychology to breadth psychology: A phenomenological approach to psychopathology. In: Hermeneutics and Psychological Theory, ed. S. B. Messer, L.A. Sass & R. L. Woolfolk. New Brunswick, 1'{J: Rutgers University Press, pp. 272-288. Eissler, K R. (1953), Effect of the structure of the ego on psychoanalytic technique. J. Amer. Psychoanal. Assn., 1: 104-143. Gadamer, H. (1976), Philosophical Hermeneutics, trans. D. Linge. Berkeley: University of California Press. Goldberg, A. (1990), The Prisonhouse ofPsychoanalysis. Hillsdale, NJ: The Analytic Press. Heidegger, M. (1927), Being and Time, trans. J. Macquarrie & E. Robinson. New York: Harper &Row, 1962. Hoffman, I. ( 1992), Some practical implications of a social-constructivist view of the psychoanalytic situation. Psychoanal. Dial., 2:287-304. Hoit, M. (1994}, On the analyst's non-interpretive activities in the clinical situation. 'JheAnnual ofPsychoanalysis, 22:209-223. Hillsdale, 1'{J: The Analytic Press. Kohut, H. (1971), The Analysis of the Self. New York: IUP. Kovel, J. (1988), Commentary on Herbert L. Dreyfus and Jerome Wakefield. In: Hermeneutics and.Psychological Theory, ed. S. B. Messer, L. H. Sass & R. L. Woolfolk. New Brunswick, NJ: Rutgers University Press, pp. 289-294. Laplanche, J. (1992), Interpretation between determinism and hermeneutics: A restatement of the problem. Internat. J Psycho-Anal., 73:429-445. Laufer, M. & Laufer, M. E. (1984}, Adolescent and Developmental Breakdown. New Haven, CT: Yale University Press. Mitchell, S. A. ( 1988}, &lational Concepts in Psychoanalysis. Cambridge, MA: Harvard University Press. Ricoeur, P. ( 1977}, The question of proof in Freud's psychoanalytic writings.]. Amer. Psychoanal. Assn., 25:835-871. Schafer, R. (1983), The analysis ofresisting. In: The Analytic Attitude. New York: Basic Books. Stern, D. (1985), The Interpersonal World of the Infant. New York: Basic Books. St olorow, R., Brandchaft, B. & Atwood, G. (1987), Prychoanalytic Treatment: An Intersuhjective Approach. Hillsdale, NJ: The Analytic Press.

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Terman, D. M. (1988), Optimum frustration: StructuraJization and the therapeutic process. In: Learning From Kohut, ed. A. Goldberg. Hillsdale, NJ: The Analytic Press, pp. 113-125. Winnicott, D. W. {1960}, The theory of the parent-infant relationship. In: The Maturational ltocesses and the Facilitating Environment. New York: International Universities Press, 1965,

pp. 37-55. Woolfolk, R. L., Sass, L. A. & Messer, S. B. (1988), Introduction. In: Hermeneutics and Prychological Theory, ed. S. B. Messer, L. N. Sass & R. L. Woolfolk. New Brunswick, NJ: Rutgers University Press, pp. 2-26.

Technical Approach to Eating Disorders in Patients with Borderline Personality Organiza,tion OTTO F. KERNBERG

What follows is based on the clinical experiences gathered by the members of the borderline psychotherapy research project at the Westchester Division of the New York Hospital-Cornell Medical Center regarding the diagnostic assessment and psychotherapeutic approach to patients with borderline personality organization and associated eating disorders. Although the focus of our project is not on eating disorders per se, most patients with severe eating disorders suffer from significant character pathology, and the experience gained in the psychodynamic treatment of borderline patients has, we believe, relevance for treating patients with these disorders. In addition, our engagement with long-term psychodynamic psychotherapy with such patients, and the availability of a cognitive-behavioral inpatient service specializing in the treatment of eating-disorder patients provides us with the opportunity to compare and relate the experiences of these patients. Finally, my own clinical experience in the psychoanalytic and psychotherapeutic treatment of such patients has permitted me to study some of the dominant dynamic features described in the literature regarding this pathology.

Diagnostic Assessment The two principal eating disorders, anorexia nervosa and bulimia nervosa, occur mostly in females. Anorexia nervosa is characterized by body-weight reduction of at least 15 percent of normal and the patient's active refusal to ~chieve normal weight; these patients are afraid of gaining weight or becoming fat; they present significant disturbances in their body image and primary or secondary amenorrhea. Bulimia nervosa signals its presence by 33


Eating Disorders

uncontrolled binge eating, and efforts to control weight by vomiting, laxatives, dieting, and/or exercise. Characteristically, these patients have heightened concern with body weight and shape. Because perhaps up to 95 percent of these cases present in females, there is a tendency to neglect the possibility of this diagnosis in some male patients with severe personality disorders. In our experience, the type and severity of the personality disorder is the most important single factor determining overall prognosis for the broad range of treatments that have been attempted for patients with severe eating disorders. Several dimensions of personality disorders and particular categories along these dimensions have to be taken into consideration here. A first dimension includes what might be called the major affective personality disorders, including, from least severe to most severe, the depressive-masochistic personality disorder, the sadomasochistic personality disorder, primitive self-mutilating syndromes, and the hypomanic personality disorder. While depression is a prevalent symptom in patients with eating disorders, it is important to differentiate major affective disorders from characterological depression, and the degree of severity of the depression from the affective type of personality disorder. A second dimension is the hysterical-histrionic-borderline personality disorder, where the hysterical personality proper represents the healthiest (neurotic) pole of the continuum, with the histrionic or infantile personality as a less severe type of the borderline personality disorder in a narrow sense, and the borderline personality disorder proper. A third dimension is that of the narcissistic personality disorders, ranging from the narcissistic personality proper to the narcissistic personality with overt borderline features, to the syndrome of malignant narcissism, and finally the antisocial personality disorder. The more severe types of pathology on this continuum, particularly the syndrome of malignant narcissism and, of course, the antisocial personality proper, have a reserved prognosis for psychotherapeutic treatment. A final dimension is the obsessive-compulsive personality disorder; these patients, at a more severe level, shift into hypochondriacal, schizoid, and paranoid personality disorders, and, at the most severe extreme, the relatively rare cases of chronic anorexia nervosa with an underlying psychotic structure and schizophrenic episodes. In general, however, it is important to make the differential diagnosis between an eating disorder proper and the severe anorexia of major depression and of some delusional schizophrenic patients. The most frequent personality disorders found in patients with eating disorders are the hysterical, the histrionic or infantile, the borderline, and the narcissistic personality disorders, and characterological depression.



In general, the higher level personality disorders or patients with neurotic personality organization (the hysterical personality, the depressive-masochistic personality, and the obsessive-compulsive personality) have a much better prognosis and offer fewer treatment complications than patients with borderline personality organization. I should add that, by including personality disorders not spelled out in DSM-111-R or DSM-IV, I am pointing to clinical syndromes well known to the psychoanalyst that have not yet found their way into our official classification system. In each patient with an eating disorder it is important to evaluate, together with the particular constellation of predominant character pathology, the presence or absence of identity integration, the dominant defensive structures, the quality of object relations, and, particularly, the presence or absence of antisocial features: these two categories-quality of object relations and antisocial features-are prognostically fundamental across the entire spectrum of personality disorders. The first question in treating a patient with a significant eating disorder is whether the treatment can be carried out on an outpatient basis, or whether a preliminary period of hospitalization is required to stabilize the patient and/or increase motivation sufficiently for an outpatient treatment to proceed. In general, with a weight loss of 30 percent or more in anorexia nervosa, initial hospitalization to bring the weight back to normal is indicated. In bulimic patients, only those with sufficiently severe electrolyte imbalance, severe depression, or drug addiction may require hospitalization. A second step in diagnostic evaluation is the exploration of whether a psychoanalytic psychotherapy or psychoanalysis, in contrast to a supportive type of therapy, is indicated. Patients with neurotic personality organization have an indication for psychoanalysis proper, whereas for most patients with borderline personality organization psychoanalytic psychotherapy may be the treatment of choice (Kernberg, 1984). Patients with a combination of multiple, chronic, severe acting-out patterns, antisocial behavior, absence of motivation for treatment, remarkable lack of capacity for introspection, significant secondary gain of illness, and a well-documented history of negative therapeutic reactions with experienced psychotherapists may require either a preparatory period of long-term hospitalization (if that is still available), or supportive psychotherapy. For these cases a supportive psychotherapy combined with cognitive-behavioral models of treatment may he an optimal combination. There is also evidence from controlled studies that cognitive-behavioral treatment of bulimic patients with milder neurotic personality disorders may be helpful (Hoffman and Halmi, 1993). In addition, the patient's capacity to enter a psychoanalytic psychotherapy will


Eating Disorders

depend on the capacity to accept the kind of treatment contract that is a precondition for such treatment. Some patients, even among those who present themselves or who are brought by their family apparently for outpatient treatment, require hospitalization. These include anorectic patients with severe weight loss and who present hypotension, bradycardia, amenorrhea, hypothermia, anemia, growth failure, lanugo, and osteoporosis. At times, not only the patient but also the entire family may deny the obvious severity of the condition, a denial that applies to patients who, in addition to an eating disorder, present diabetes mellitus in poor control and patients with severe depression or a history of "double depression" (characterologic depression and major depressive illness) that makes differential diagnosis difficult. Finally, in some cases the possibility of an underlying schizophrenic illness may indicate a diagnostic hospitalization. At times, hospitalization may serve as the catalyst for an entire family to confront their denial of the severe illness of one of their members. A well-documented failure of outpatient treatments over an extended period of time may also justify a diagnostic hospitalization.

Initial Treatment Strategy

In the psychoanalytic psychotherapy of eating-disorder patients with borderline personality organization, the potential for severe acting out makes the setting up of an initial treatment contract indispensable {Kernberg et al., 1989). Patients with less severe personality disorders, with relatively intact ego strength, anxiety tolerance, impulse control, and capacity for maintaining the responsibility for daily life, may not require such particular treatment arrangements. For the patient with borderline personality organization, once the diagnostic study has been completed and the indication for psychoanalytic psychotherapy elected, we evaluate which aspects of the patient's eating disorder create dangers for the patient's survival and the survival of the treatment in the short run. That includes all anorectic patients who are demonstratedly incapable of maintaining their weight within 15 percent of normal weight, and bulimic patients whose frequency of vomiting (usually 10 to 15 times per day) threatens electrolyte imbalance. For anorectic patients, we define an optimal weight that the patient must maintain in order for outpatient psychotherapy to proceed, with the understanding that, should the patient not be able to maintain that weight, hospitalization would be indicated until the optimal weight is restored and outpatient psychotherapy may continue. If the patient is hospitalized in the same service where the psychotherapist works, psychotherapy can take place on



an inpatient basis, but otherwise psychotherapy is interrupted until the patient's normal weight conditions are restored. A regular system of control is advisable by which the anorectic patient has to come to the hospital once a week to be weighed. The idea is to avoid the patient's temptation to misrepresent her actual weight. The patient is told that anything below the agreed-upon weight would trigger hospitalization in order for psychotherapy to continue. Naturally, if the patient has a significant weight loss and the first task is to restore normal weight, hospitalization would be the first step in the treatment. In our experience, a relatively limited inpatient treatment of several months based on a cognitive-behavioral model has proven effective in restoring the patient's weight, but I shall not describe this particular aspect of the treatment approach further here. The objective is to provide the patient with a re-educative experience that gives an objective knowledge of a healthier pattern of eating, and what the demands will be for the patient's controlling eating after discharge from the hospital. If psychoanalytic psychotherapy starts concomitantly with such hospitalization (which is perfectly feasible), it does not include the discussion of food or weight control. The psychotherapist makes clear to the patient that he will not be involved in the behavioral management of the hospital program, but the psychotherapist establishes as his natural expectation that a patient in this kind of psychotherapy needs to be maintained at normal weight. Sometimes cognitivebehavioral re-education may be carried out on an outpatient basis while psychodynamic psychotherapy begins; in such cases it is helpful to maintain open communication among the staff involved, so that the psychological issues that emerge in the cognitive-behavioral treatment may be explored in the psychodynamic psychotherapy treatment sessions. To carry out the treatment on an outpatient basis, it is important that the patient be provided with a full rationale for the condition that she maintain an optimal weight. The same principle applies to the treatment of patients with severe characterologically suicidal tendencies, where the initial contract requires them either to commit themselves to control their suicidal behavior or to enter a hospital if and when they cannot do so. The patient thus takes responsibility for survival, and for not damaging his or her body further so as to give psychotherapy time to evolve. Such instructions, we have repeatedly found, can be very effective if and when they are accompanied by simultaneous discussion ofthe underlying dynamics as these emerge in the transference situation. In patients with severe anorexia, the therapist first explains why it is important that the patient accept the conditions for the treatment that the therapist establishes because they are considered essential for the patient's survival. This limit-setting is followed, immediately, by the analysis in the transference of the intense rage and resentment arising from what


Eating Disorders

the patient usually experiences as interference with what is an ego-syntonic, well-rationalized eating disturbance. An anorectic patient, following the setting up of such a treatment contract, immediately accused the therapist of the same invasive, controlling, sadistic behavior that she experienced her mother to have with her. The therapist, while maintaining the structure established by means of the treatment contract, gradually elaborated the patient's view of her as a replica of her mother. The therapist pointed out that naturally the patient could not avoid an intense hatred of such a terrible mother, who now appeared to her duplicated in the person of the therapist, and that one manifestation of this rage was the patient's effort to destroy by starvation her own body perceived as a property of mother and the therapist rather than of the patient herself. In other words, the therapist interpreted the transference meaning of the anorexia once the contract was in place, with the result that the patient's rage gradually became focused on the therapist, while the needs for hospitalization because of excessive weight loss gradually disappeared. A patient with borderline personality organization, a double depression, and severe bulimia vomited 10 to 12 times a day, had significant parotid gland swelling and significant erosion of her teeth. As a precondition for treatment I established that she be in consistent control by a gastroenterologist specializing in eating disorders who would inform me if and when he thought that her physical condition warranted the need for additional medical treatment or hospitalization. The patient experienced that demand as humiliating and perceived me as enjoying "parading her" before the medical profession as a distasteful person out of control, which brought us directly to similar experiences in her past of punishment in the form of public exposure by both parents. In short, the establishment of a treatment contract that controls any behavior that is life threatening (and, by implication, threatens the treatment as well}, combined with an immediate focus on the manifestations of the controlled behavior in the transference, represents a first approach in the psychoanalytic psychotherapy of these patients. When such acute danger does not exist-for example, in milder eating disorders in which the patient maintains a relatively normal weight or is moderately obese and the eating disorder does not manifest with electrolyte imbalance, there is no need for such a contract. A special case is presented by patients who suffer from severe exogenous obesity and who consult for treatment of this condition. Again, if the personality disorder is at a neurotic level, the treatment indication may be psychoanalysis, but for most patients with borderline personality organization it is most likely psychoanalytic psychotherapy. For these cases I do not set up a contract controlling the eating disturbance, because it is not acutely life



threatening. I am concerned, however, with analyzing magical expectations from the treatment in the sense that, for example, "psychoanalysis alone will make me lose weight," that is, a magical assumption that treatment will resolve the symptom without the long-term painful but indispensable regimen of dieting. This is an instance of differentiating treatment goals from life goals: the treatment may help the patient to mobilize the energy to carry out a radical change in eating habits but will not, by itself, assure that such a change will take place. Another major principle derived from our experience with patients with borderline personality organization applies particularly to patients with multiple symptoms, such as the combination of an eating disorder, suicidal or parasuicidal behavior, antisocial features {particularly kleptomania, which often goes hand in hand with bulimic patients' efforts to hoard food), alcohol and drug abuse, and a generally turbulent life. Such chaotic conditions may interfere with the therapist's consistent concentration on dominant issues in the transference and may seduce the therapist into combining an interpretive approach with supportive measures and/ or environmental interventions to keep the total treatment situation manageable. We have found several ways of avoiding this danger of the gradual transformation of the treatment, under the impact of transference acting out along such multiple channels, into a supportive psychotherapy in which consistent transference analysis can no longer be carried out. This danger may be avoided by keeping in mind the following set of priorities. Certain developments in the treatment represent automatic priorities for intervention in order to protect the psychotherapeutic frame: first, as mentioned earlier, when there is a danger to the patient's survival or to third parties threatened by the patient (including the therapist). Our response is to spell out the terms of the treatment that protect the treatment frame: limitsetting and interpretation of the behavior controlled by limit-setting as it influences the transference. A second priority is the acute danger of the disruption of the treatment, the "drop out" that is so frequent in the psychotherapy of patients with ~evere personality disorders. Now, the indication is for interpreting as rapidly and as much in depth as possible the risk of the potential forthcoming ~isruption to the treatment and all the meanings attached to that risk. At ti~es, the risk for treatment interruption emerges in the therapist's fantasy ~~out apparent concrete evidence for it in the patient's communication. It 18 important that the therapist, while expressing concern over the possibility of ~n end to the treatment, maintain a position of technical neutrality, that is, point to the danger that the patient might take such a step and the reasons for Such a step, without appearing unduly anxious to keep the patient in treatment. At all times, the patient should need the therapist more than the


Eating Disorders

therapist needs the patient; if that basic equilibrium is threatened, the therapist should recognize and work through countertransference contributions before interpreting the danger for treatment disruption to the patient. A third priority is the therapist's consistent sense of deceptiveness in the patient's communications. Because psychoanalytic psychotherapy is based upon the assumption of honest communication between patient and therapist, consistent deceptiveness has high priority for interpretation, which usually leads to the unmasking of a psychopathic transference. Psychopathic transferences are characterized by the patient's basic assumption that the treatment consists of mutual manipulation of two persons who wish to exploit the other in the relationship; the transference implications of such a fantasy enactment should be fully elaborated. The effect of such working through is, as I have pointed out in earlier work (1992), to transform psychopathic into paranoid transferences, which may then be explored more leisurely and over extended periods of time. A fourth priority is severe acting out, both inside and outside the session: bingeing and vomiting or weight loss, we interpret in light of the current transference meanings. A fifth priority is the analysis of chronic narcissistic resistances in patients with narcissistic personality disorder. The problem here is the extremely slow, long-term working through required; the therapist may often indeed despair of the apparent lack of change in the hours. However, when the patient's life outside the sessions shows steady, even dramatic improvements while nothing seems to change in the transference, and the patient attributes all these changes to himself, the therapist may confidently continue to elaborate the narcissistic transferences. It would be easy to misinterpret all these priorities as an artificial rigidification of a psychoanalytic approach. In practice, these measures help the therapist to deal with what initially appear as chaotic situations in multisymptomatic patients with severe personality disorders, and they protect the treatment frame that then permits the therapist to analyze the transference in an atmosphere of safety.

Dominant Dynamics in Patients with Severe Eating Disorders The dominant feature in all eating disorders is a relentless, sadistic attack on the patient's body, an attack symbolically representing four major issues. First is a general attack on pleasure. In the simplest terms, the pleasure of eating, incorporating something good and transforming it into a symbolically as well as physically good object for the body's and the selPs survival and enjoyment, are fundamentally attacked. This dynamic is related to the primary inhibition of the capacity for sensual enjoyment and sexual pleasure



in some severe borderline patients related to an early, severe aggressive infiltration of all physical as well as psychological interactions in the motherinfant situation, pointing to severe disturbances in the mother-infant and mother-child relationship. Second, and connected with this attack on pleasure, is the attack on mother, and in the dynamics of all anorectic borderline patients there are either profound conflicts around separation-individuation or even earlier conflicts around a pathological enmeshment related to a struggle against a threatening, aggressive symbiosis with a devouring mother. The dominance of a sadomasochistic relation with mother may play itself out in different ways. Many patients, as Hilde Bruch (1973, 1985) pointed out, have a history of long-term surface submission to mother, presenting a history of always having been the "good girl" while harboring a deep and growing resentment against mother's invasiveness or her narcissistic exploitation of the child. Eventually, the anorectic patient's effort at starvation represents a masochistic form of rebellion against mother and the assertion of autonomy under the cover of self-destruction. The situation, however, is usually more complex, and Chasseguet-Smirgel (personal communication) has convincingly pointed to anorectic patients' hatred of their body as a derivative of the hatred of mother, and their attempt to destroy their body as if it belonged to or represented mother. By the same token, behind the self-destructiveness of the anorectic behavior the patient appears divided. In one part, the transference reveals her identification with a primitive, sadistic maternal figure whose qualities of grandiose and destructive omnipotence relate this pathology to that of malignant narcissism. Another part of the patient's self, located in her body, is simultaneously designated as the helpless victim of this sadistic, destructive maternal image. In fact, in the course of psychoanalytic psychotherapy of patients with severe anorexia nervosa, one frequently finds in the transference the patient alternatively identifying with a grandiose, quasi-psychotic maternal introject while attacking the therapist as an equivalent of the patient's body; while at other times the patient experiences herself as the victim of such a relentless, invasive assault from the therapist perceived as the sadistic mother. A third major dynamic is the attack on the patient's femininity, intimately related to the fact that by far the majority of patients with severe eating disorders are women. But this attack on femininity derives from several developmental stages: first there is an attack on mother from a very early, preoedipal level, including first the mother of the experience of symbiosis and then the mother of separation-individuation. These dynamics differ from the submission and rebellion against mother of the advanced oedipal st age of development (in contrast to the archaic oedipal situation) and the


Eating Disorders

regressive, destructive anality expressed in the wish to destroy all differentiated relationships, highlighted by Chasseguet-Smirgel (1984). Boris (1984a, b) has stressed the patient's projection of her own oral needs onto mother and onto the analyst, in the sense that others who want the patient to eat thus signal their unfulfilled needs and not the patient's. The patient thus protects herself against envy and resentment of the mother who is needed for food and love but whose good qualities are envied because of the frustrations of these needs, the experience of mother's teasingly withholding what the baby needs from her. While the anorectic patient's ongoing struggle against mother may reflect both warding off symbiotic enmeshment and the pathology of separationindividuation, such conflicts often reflect not only intrapsychic distortion of early experience but the effects of actual, severely traumatic experiences with mother, particularly the combination of mother's actual invasiveness and her narcissistic callousness regarding the infant and child used as an extension of herself. One of our most severe anorectic patients, an aspiring musician, was taken out of the hospital against staff advice by her mother so that the patient could perform in a concert at a time when the patient was near cachectic. The bulimic patient with the double depression I referred to earlier had to be hospitalized at one point because of a major depression with severe suicidal tendencies. She managed to manipulate her mother into taking her out of the hospital against medical advice-in the staffs and my view she was at serious acute suicidal risk. This patient had fantasies, reaching an almost delusional quality, that her mother wanted to poison her; she demonstrated her identification with mother by manipulatively leaving the hospital when there was acute danger to her survival. In bulimic patients, one frequently finds secondary defenses against conflicts around separation-individuation by the use of bingeing sprees to deny their dependency on significant others, or to express their rage at fantasied or real abandonment. The greedy incorporation of food perceived as forcefully extracted from mother then leads to the spoiling of that ingested food, which becomes a poison and must be expelled, while simultaneously, as Chasseguet-Smirgel (1984) has pointed out, the transformation of such food into excrement symbolizes the aggressive deterioration of internalized object relations. But attacks on femininity also stem from an oedipal level, and it is in the relatively less severely disturbed patients that such advanced oedipal dynamics dominate. Here, both bingeing and vomiting and devaluing physical feminine appearance, as well as the radical effort in severely anorectic patients to prevent full feminine development to occur, reflect the fear and rejection of identification with the sexual mother and the oedipal couple. Paulina Kernberg



(personal communication) has ref~rred to the "Peter. P~" syndrome of anorectic adolescents who unconsc10usly attempt to mruntam themselves as latency age children without specific gender identification. This attack on femininity broadens into an attack on heterosexuality. The envy and hatred of mother are displaced onto father, with the consequence of intensification of penis envy and a resentment of men perceived as aggressive and exploitive. While severely anorectic patients present, in general, pervasive sexual inhibition that obscures the unconscious conflicts in relation to men, sadomasochistic sexual relations with men are quite frequent in women with bulimia, and, equally often, periods of binge eating and vomiting may alternate with periods of sadomasochistic interactions with men, when the eating disturbance recedes temporarily. Profound prohibitions against infantile sexuality are reactivated in early adolescence, provoking a regression to a preoedipal relation to mother and to the anorectic defense against sexual maturation. Additional dynamics have been suggested in recent years, pointing to the importance of cultural factors, the role of trauma, and the earliest relationship of the infant to mother's body. Several authors have attempted to relate the increase of eating disorders in advanced western cultures to the effects of certain cultural pressures, namely, an unrealistic overemphasis on the autonomy of women in contrast to their need for validation via interpersonal relationships, pointing to unconscious conflicts between their identification with maternity, mothering, and dependency, on the one hand, and the rejection of traditional female roles in a paternalist culture, on the other (Morris, Cooper, and Cooper, 1989; Boskind-Lodahl, 1976). Eating disorders have been included in the broad spectrum of psychopathology related to early trauma, sexual and physical abuse, together with borderline personality disorders, affective disorders, dissociative disorders, posttraumatic stress disorders, antisocial disorders, suicidality, and somatization disorders (Marziali, 1992; Paris, 1993). Meltzer (Meltzer and Williams, 1988), pointing to the splitting between early idealization of the surface of mother's body and the projection of aggression into the interior of mother's body, suggests the possibility that the infant's excessive aggression in the early mother-infant relation leads to unconscious fantasies of a destroyed maternal body that precludes normal identification with mother and, by projective fantasies of mother's retaliation, leads to the infant's introjective fears of the destroyed interior of her own body, and fear and hatred of her own body.

A Clinical Illustration Regarding the dynamics in eating disorders, I have mentioned the concerted attack on pleasure, on mother, on femininity, and on heterosexuality. In this set of dynamics there is always an aggressor and a victim, in the sense that


Eating Disorders

what appears to be the patient's relation with herself reflects, at a deeper level, the relationship between internalized representations of significant others and the self. The gradual transformation of these intrapsychic relationships, masked by the symptoms of the eating disorder into major transference paradigms, is the central task during extended periods of the psychoanalysis or psychoanalytic psychotherapy with these patients. Let me illustrate these developments by the case of a woman scientist in her early thirties treated with standard psychoanalysis, four sessions a week. The patient presented a borderline personality organization; an infantile personality with hysterical features, characterological depression, bulimia, and moderate obesity; she also abused drugs and had phobic fears of driving on highways and bridges. Her relationships with men were clearly masochistic in that she was only interested in men who were unavailable and unconsciously ruined opportunities with those who were potentially available. In the transference, there were long stretches during which she presented oedipal material, fears of and wishes of being seduced by me that gradually shifted into wishes to seduce me as a father figure, with a parallel uncovering of dissociated unconscious guilt over this seductiveness, expressed in selfdefeating patterns in her relationships with other men in her life. In fact her oedipal conflicts were manifest not in a dynamic equilibrium involving unconscious, repressed positive oedipal longings and guilt feelings over them, but in mutually dissociated or split-off acting out of unconscious guilt over good relations with men outside the sessions, simultaneously with direct expression of sexual seductiveness and fears of being rejected in the analytic situation itself. In the third year of her analysis, a new theme emerged that gradually took over significant periods in the transference. The patient developed, for the first time in her life, a homosexual attraction, to a woman who worked in the same laboratory in which she did, a woman the patient found extremely attractive and, at the same time, a potentially serious professional rival. Her sexual feelings toward her colleague increased together with intense fear that she was trying to steal the patient's ideas in order to advance her own career. The patient seemed to become increasingly paranoid about this woman, attributing unusual powers to her-that she wanted to destroy the patient by ruining her work, producing mischief in the office in many ways. At a certain point, I became confused about what in all of this was reality and what was fantasy. My patient then began to be suspicious of me as taking the side of the colleague, and a potential enemy in alliance with her. A severe regression in the transference developed; the patient experienced me as an enemy who was trying to destroy her confidence in herself, to such an extent that the other woman and I became practically identical.



At that stage of the treatment, her bulimic symptoms, which had been relatively minor and had not emerged as important issues in the transference before, now became more severe. In my mind, I raised the possibility of recommending a consultation with an internist along the lines outlined earlier. I was reluctant, however, to suggest this to the patient in the middle of the chaotic transference situation in which she suspected me of an invasive effort to control her in parallel ways to the woman she admired and feared was attempting to destroy her career. It was only now that very early memories came to mind in which my patient had perceived her mother as both intensively protective and yet invasive-controlling the patient and reading her mind. It became apparent that the patient had always felt that her body, her movements, her speech, her intentions, could not be trusted because they might really represent her mother's intentions. The patient had lived with the conviction that her mother could not tolerate her independence or autonomy during her childhood years. The fear of driving on highways or over bridges now became clarified as fear of being taken over by mother who would punish her with death for attempting to escape from mother by racing away from home on highways or over bridges. We were now able to explore how she was repeating her relationship with mother in her relationship with me, experiencing me as an invasive mother who was assaulting her simultaneously in the sessions and at her workplace while, at other times, without being aware of it, she was identifying with this invasive mother in an attempt to prevent me from contributing to her understanding and from thinking clearly. I suggested that the terrible confusion of whether her rival was indeed creating a gaslight situation at work or whether my patient only fantasized such a development were part of a pattern that also evolved in the analytic hours. While she felt controlled and inhibited by me, I, at times, felt controlled and inhibited by the combination of the patienf s consistent distortion of what I was saying in the sense of interpreting it as an attack, her confused narrative about what was going on in the laboratory, and her experience of my efforts to clarify that confusion as an invasive, sadistic effort at thought control. The patient also realized how she was binge eating as a replacement of her now dangerous dependency on me, while her vomiting permitted her not only to free herself from mother's poisonous food but from avoiding that in her obesity she become like her mother. The search for a dependent relationship from mother displaced onto the greedy incorporation of food, the vomiting as an effort to get rid of mother's poison as well as of her identification with her, the projection of mother onto me while enacting mother's invasive behavior in her confusing disassembling of my interpretations all seemed complementary facets of the same conflictual relationship With a primitive, invasive, and sadistic mother.


Eating Disorders

Gradually, the patient became able to think more freely about what was going on at work, and her communications became clearer in the sessions. These developments permitted us to discover in the course of a few weeks that, indeed, the patient's rival was actively attempting to undermine the patient's work, a fact confirmed by evidence from other co-workers, and that the patient's intense attraction to that woman (whom she had intuitively perceived as a potential enemy) reflected the masochistic submission to mother. The binge eating and vomiting disappeared as her internal submission to and conflictual identification with mother was worked through in the transference. In later stages of her analysis, it became apparent that the internal, unconscious submission to mother from whom she felt she could not differentiate herself also represented the acting out of oedipal guilt, the split-off counterpart to her conscious oedipal fantasies and wishes in the transference. The patient now became more inhibited in the expression of her sexual fantasies relating to me, and consciously more fearful in her sexual involvement with men. Her unconscious, self-defeating behavior with men changed into a sexual inhibition that reflected her oedipal guilt more directly, and could be worked through at that point. In the advanced stages of her treatment she was able to establish a satisfactory relationship with a man whom she eventually married, and with whom the relationship has remained very satisfactory over the years. In this case, binge eating spontaneously evolved as a major aspect of the transference relationship and thus facilitated the resolution of this symptom. In many cases, however, the dominant symptom-for example, severe anorexia-may be stubbornly split off from spontaneous communication in the transference, and an obsessive concern with "right" and "wrong'' foods occupies much time in the sessions in spite of efforts to analyze the unconscious dynamics of these obsessive concerns. Under these circumstances, the patient's very insistence in talking about food while the analyst is exploring the transference relationship may facilitate the analysis of the denial of the conflicts in the transference by the patient's focus on the symptom. One might say regarding the unconscious conflicts of patients with eating disorders in stating that, in all cases, the patients treat themselves badly, and the defensive split between their image of their body and their self concept masks the collusion of the self with the destructive internalized object representation. The analysis of the collusion of the healthy part of the self with such an internal enemy, a hostile introject seducing the patient to treat her body as not belonging to the self, is counterpart to the patient's attack on the analyst when the analyst threatens that collusion. Here object relations theory and ego psychology converge in the simultaneous analysis of a



conflict between impulse and defense that involves a conflictually internaliZed object relation, while, at the same time, in the patient's unconscious collusion with the internal enemy, the patient is denying her responsibility for herself and, in the end, for the attacks on herself carried out in the name of a sadistic internalized object. Finally, at such crucial points in the treatment when the patient is able to assume full responsibility for herself while still being aware of the identification processes involved in her previous collusion, it is also time for the analyst to explore with the patient the nature of the early treatment contract, the reasons for which the therapist had to "impose" conditions on the treatment in order to keep the patient alive and to preserve time for the analysis of her unconscious conflicts. One might say that, at such moments, an implicit split in the therapist's relation with the patient is also resolved, namely, that between the therapist protecting the frame of the treatment by measures that are usually experienced by the patient as invasive control, while, at bottom, these measures reflected the analyst's concern for the patient's survival and his realistic investment in conditions essential for carrying out the treatment. This analytic resolution of parameters of technique may help to consolidate the patient's full autonomy, while permitting him or her to realize fully that autonomy and mature dependency are not mutually contradictory.

References Boris, H. N. (1984a), On the treatment of anorexia nervosa. Internat. J Psycho-Anal., 65: 435-442. - - (1984b), The problem of anorexia nervosa. Internal. j. Psycho-Anal., 65:315-322. Boskind-Lodahl, M. (1976), Cinderella's stepsisters: A feminist perspective on anorexia nervosa and bulimia. Signs: J Women in Culture & Soc., 2:342-356. Bruch, H. (1973), Eating Disorders. New York: Basic Books. (1985), Four decades of eating disorders. In: Handbook ofPsychotherapy for Anorexia and Bulimia, ed. D. M. Garner & P. E. Garfinkel. New York: Guilford, pp. 7-18. Chasseguet-Smirgel, J. (1984), Creativity and Perversion. New York: Norton. Hoffman, L. & Halmi, K. (1993), Treatment of anorexia nervosa. In: Current Psychiatric Therapy, ed. D. Dunner. Philadelphia: Saunders, pp. 390-396. Kernberg, 0. F. (1984), Severe Personality Disorders. New Haven, CT: Yale University Press. (1992), Aggression in Personality Disorders and Perversions. New Haven, CT: Yale University Press. Selzer, M., Koenigsberg, H. W., Carr, A. & Appelbaum, A. (1989), Psychodynamic Psychotherapy of Borderline Patients. New York: Basic Books. Marziali, E. (1992), The etiology of borderline personality disorder: Developmental factors. In: Borderline Personality Disorder, ed. J. F. Clarkin, E. Marziali & H. MunroeBlum. New York: Guilford, pp. 27-44.


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Meltzer, D. & Williams, M. H. (1988}, The Apprehension of Beauty. Old Ballechin, Strath Toy, Scotland: Clunie. Morris, A., Cooper, T. & Cooper, P. J. (1989), The changing shape of female fashion models. Internal. J Eating Disorders, 8:593-596. Paris, J. {1993), Borderline Personality Disorder. Washington, DC: American Psychiatric Press.

Narcissism: A View from Infant Research ALICE ROSEN SOREF

Infant research of the last few decades provides an opportunity for a new look at psychoanalytic theory. This relatively new body of empirical data lends itself particularly well to a reassessment of etiological factors. In this essay, I will discuss the implications of infant research for the etiology and treatment of adult pathological narcissism. I will propose an empirically based revision of prevailing theory and will review and synthesize the infant data that supports that revision. Healthy psychological development depends upon the unimpeded maturation of two innate, preprogrammed motivational thrusts: one is attachment/love; the other, mastery. Both are highly interrelated, and both continue to evolve throughout the lifespan (subject to the limitations of physical and psychological perturbations). If relatively undisrupted by these perhlrbations, infants tend to proceed along a healthy developmental course, culminating in competence and mature object relating. There is a primary psychological base that underlies the success of these developments. The infant's experience of this base would be a rudimentary equivalent of the adult experience: "I love, I am loved, and I am effective." If this primary experience is facilitated by the infant's genetic endowment, by his intrauterine conditions, and by the fit with and sufficiency of his caregiving environment, the foundation is set for the individual to sense that he is valuable the way he is. He will also sense that the world is generally "good" as it is and that he fits in the world, as he is. This discussion will start with a look at love and mastery, move on to a Critique of the prevailing etiology of narcissistic pathology and a review of developmental research on love and mastery, and then culminate in an B I would like to acknowledge the generous critical assistance of Drs. Gerald Adler, David erkowitz, Dan Buie, Alexandra Harrison, Anton Kris, Karlen Lyons-Ruth, and Edward T ronick.




explication of psychoanalytic theory and integration of developmental research and theory, followed by a section on implications for treatment. "I love" refers to the infant's innate social proclivity to engage with other people. "I am loved" refers to the infant's psychic experience of the caregiver's generative holding, soothing, valuing, and respecting of the infant as he is. The experience of feeling valuable and good about oneself reflects the infant's composite registration of himself as loved, loving, and the agent of effective impact on the environment. These experiences, or functions, have a synergistic interrelationship. In particular, it is necessary for the infant to receive love in order to develop his innate interest in objects along the lines of loving. The aforementioned psychological base needs to be reiterated throughout the developmental course of childhood, and it also needs not to be seriously derailed in later development. The infant's sensations, registrations, and memories of his experiences of love and efficacy will eventually mature into an adult version of these experiences. Even though there are maturational discontinuities along the developmental route, much of the infant's and adult's experience in these two areas represents points along a developmental continuum. Bearing in mind that the degree of sophistication implied by terms like "love" and "mastery" will vary according to developmental level, I shall tend to employ such adult terms when referring to these continua, in the interests of simplicity and ease of communication. The definition of "love," as the term will be used here, includes what I would refer to as "primal" love and "object" love, that is, instinctive and individuated love. The caregiver's "primal" love is comparable to maternal love in the lower species. This love includes, in humans, the caregiver's natural subjectivity and biases. Primal love is essential to, but insufficient for, the promotion of normal human development, unless "object" love is added. The latter includes responses that recognize and value the infant's budding individuality and that are contingent upon his signals-responses that align with and promote his genuine being. The pathogenic alternative to object love is the caregiver's conscious or unconscious narrowing or altering of the infant's natural range of affects and signals by failure to respond to them, inappropriate responses, or overt rejection. The combination of primal and object love includes a delight and sustained interest in the infant as he is. Coping and mastery refer to the individual's capacities to organize, to selfregulate, to maintain equilibrium, and to create a discernible impact on the animate and inanimate environiment. Infant research sheds light on this psychological base and on its successful or disrupted early development. In concert with psychoanalytic theory, this research can aid us in identifying types of disruptions and their potential role in the genesis of adult character problems. This discussion will focus on



adult narcissism. Here an important caveat must be inserted: Human development is too complex for infant research to predict pathology or specific symptomatology. In fact, longitudinal research indicates that personality organization in infancy and childhood is subject to reorganization throughout development based on significant positive or negative influences. (The source of this observation is a personal communication with Virginia Demos based on unpublished conclusions drawn from the 1954 Boston University longitudinal study.) Research indicates, however, that these limitations are not thoroughgoing. An exception seems to be in the area of early attachment patterns. When environmental influences are stable over time, it has been found that early attachment patterns tend to prevail (Main, Kaplan, and Cassidy, 1985). These attachment patterns are demonstrated by a 12-month-old infant's response to a mother or father who has left the examining room and then returned. Securely attached infants seek contact and comfort when the parent returns and then resume playing with toys in the room. Insecure infants resist contact, are ambivalant about contact, or become disorganized. In this study, these infancy patterns correlated with behaviors on the mother's return following a brief separation when the child was 6 years old. The correlation also held up under other tests of attachment to the parents. There is also some suggestive evidence that attachment patterns prevail across generations (Ricks, 1985). Unfortunately, longitudinal research bridging two or more generations is lacking in this area, but there is a correlation between mother's retrospective reports of her attachment to her own mother and the security of her child in the above test of reunion behavior at 12 months. Infants who resisted contact tended to have mothers who had been rejected by their mothers. As Ricks (1985) points out, retrospective reports are less reliable than the prospective data of longitudinal research. Despite its predictive limitations, infant research can inform and extend our present armamentarium of etiological and theoretical formulations. While this new source of data may shed light on several diagnostic categories, I have chosen here to explore its potential relevance to adult pathological narcissism. The findings emerging from infant observational research point to a "competent infant" (Stone, Smith, and Murphy, 1973} from birth on. Research of the past three decades has revealed that the neonate is highly invested in relating to his caregivers and to objects in the inanimate environment. He possesses a sophisticated central nervous system, not radically different from that of the adult. He comes into the world preprogrammed and predirected on a path that will lead to the healthy development of both love and mastery. This view contrasts with the Freudian classical model, elaborated by Fenichel (1945) and extended by Mahler, Pine, and Bergman (1975), in which a much



more circuitous course of development has been postulated, involving thoroughgoing renunciations and transformations of innate proclivities. The "classical infant" has had to navigate a developmental "about-face," that is, to awaken from autism, to relinquish symbiotic bliss, to supplant fusion with self-object differentiation, and to transform pure instinctual gratification into civilized restraint. He has had to renounce primary narcissism and infantile omnipotence in favor of an interest in the external world, in reality, and in mutual relatedness. The presumed necessity for such pronounced change rests on an old picture of the infant as a nonorganized, insensate, stimulus-avoidant, asocial, or antisocial creature. Developmental research suggests that maturation is more a matter of facilitation rather than correction of the infant's basic path. The previously hypothesized necessity to reverse course in so many ways would greatly complicate the infant's achievement of a sense of being valuable (loved, loving, and competent) just as he is. The most thorough reviews of these findings and perspectives can be found in Lichtenberg {1983) and Stern (1985). In support of the notion of continuity of love and mastery, one of Stem's key contributions is that psychological issues tend to evolve throughout life, rather than appearing and resolving at certain phases of development. They take different form as neuropsychological maturation advances, but often they are the same issues. For example, self-esteem is a unitary phenomenon whether the 8-week-old succeeds in making a mobile tum by moving his leg or whether, as an older child, he solves the more sophisticated task of assigning a name to an object. Many psychological and psychophysiological capacities that had. previously been assigned to a more advanced point in development have now been found in a less evolved form early in life. A few examples are that the fundamental discrete affects of adult life are innate (Tompkins, 1968), that there are early signs of self-recognition by the fourth month (Trevarthen, 1990), that psychic structure begins to form within the first four months (Beebe and Lachmann, 1988), and that smiling is socially elicted by the first week of life (Wolff, 1963; Van Rees and de Leeuw, 1987; Fogel and Thelen, 1987). In many instances, the more sophisticated and creative the research design and methodology, the earlier various emergent developmental capacities are detected. Many developmental phenomena tend to evolve throughout the lifespan. Recent findings in infant development add momentum to a historical trend in psychoanalysis-a progression in the theoretical formulations of the ego and self. Increasingly the ego has been understood as effective and adaptive from the earliest time of life, as opposed to earlier paradigms of a weak or nonexistent ego deluged by instincts. In recent times, infant research has contributed to this trend. The trend can be seen in the chronological



progression of classical theory, ego psychology, object relations theory and self psychology, now illuminated further in developmental research. An jncreasing role for individuality has been formulated in contrast to the jnstinctual predestination of Freud's early thinking.

The Etiology of Narcissistic Pathology Originally conceptualized as a crucial step in the development of his drive theory, narcissism was initially defined by Freud (1914) in economic or energic terms as the libidinal investment of the ego. Since then, as Pulver (1970) has pointed out, the use of the term narcissism to describe so many different aspects of the self on so many different levels of abstraction has created considerable confusion. It has been used to refer to a sexual perversion, a stage of development, a type of object choice, a mode of relating to the environment, and various aspects of self-esteem (Pulver, 1970). Yet, as Pulver and others point out, common to all of these different usages is a concentration of psychological interest upon the self. Libidinal investment of the ego has shifted to the libidinal investment of the self or whole personality, and in current literature the term narcissism is mainly used to refer to issues of self-esteem (Moore and Fine, 1990). Initially faithful to Freud's drive theory of narcissism, Kohut gradually moved away from classical metapsychology and the economic point of view in which narcissism had been conceived, to a focus on what he felt was much closer to subjective experience. Working from his observations of his adult patients' narcissistic transferences, later called the selfobject transferences, Kohut (1968, 1971) postulated a theory of the self and its development in relation to crucial relationships with selfobjects. The person's need to establish a firm, cohesive self, in relationship to sustaining and responsive others, is seen as central. Optimal frustrations of the child's needs to be mirrored and to merge into an admired selfobject in the context of an attuned and emotionally supportive atmosphere facilitate the healthy growth and development of the self (Kohut and Wolf, 1978). Tolpin (1971) described the process by which the infant internalizes the mother's soothing and anxietyrelieving functions as crucial in providing a foundation for a cohesive and individuated self. As Kohut and Wolf (1978) describe, depending on the quality of the early relationships, the self may develop varying degrees of ~ohesion, vitality, vigor, and inner harmony, on the one hand, or vulnerability to fragmentation, depletion, and enfeeblement, on the other. The latter lack of cohesion may be manifested in the narcissistically vulnerable patient's tendency towards faulty self-esteem, empty depression, severe anxiety, narcissistic rage, hypochondriasis, and/or sexualization (Tolpin, 1978; Kohut



and Wolf, 1978). In the present discussion, narc1ss1sm will be defined in "self" terms rather than in the original drive theory context. In most theories that view narcissism in terms of self development, a cornerstone has been the premise that life begins with merger or near-total union, affording maximal protection from stress and/ or the experience of differentiation (Kohut, 1968; Mahler, Pine, and Bergman, 1975; Rothstein, 1984, Cooper, 1986). Closely linked to this thesis have been the models of primary narcissism and infantile omnipotence. We see this linkage in definitions of primary narcissism such as that offered by Laplanche and Pontalis (1973): "the term is taken to mean a strictly objectless ... undifferentiated state, implying no split between subject and external world" (p. 338). Traditional theory has posited an extended period of passive, non-agentic, self focused gratification and minimal capacity {Mahler, Pine, and Bergman, 1975). These circumstances were believed to prevail largely unchallenged throughout the early months of life. Despite significant revision of this position in the current psychoanalytic literature, it still has many adherents. For example Rothstein {1984) states this theory of the etiology of pathological narcissism: Perfection is originally perceived during the preindividuated era. In that era, prior to a more defined and firmly established representational world, the quality of narcissistic perfection is felt to be part of a self that includes within it qualities of an object narcissistically perceived as perfect. All adult experiences of narcissistic perfection are built on the core of these original experiences; (constituting a) fantasy based on the original perfection of the self-object bliss of the symbiotic phase" [p. 18, 22). Kohut (1968) offers a similar etiology:

It was suggested [in my earlier writings) that the child's original narcissistic balance, the perfection of his primary narcissism, is disturbed by the unavoidable shortcomings of maternal care, but that the child attempts to save the original experience of perfection by assigning it on the one hand to a grandiose and exhibitionistic image of the self: the grandiose self, and, on the other hand, to an admired you: the ideali;:,ed parent imago [p. 86]. And Cooper (1986) argues that, in optimal circumstances, the very young infant enjoys "omnipotence, autarchy, and perfect union ... " (p. 132). The infant and current psychoanalytic literature has, for the most part, repudiated the postulates of Mahler, Pine, and Bergman {1975) of autism in the first month followed by an extended period of self-object merger and symbiosis (Peterfreund, 1978; Klein, 1981; Emde, 1983; Lichtenberg 1983; Stem, 1985; Sander, 1987; Soref, 1992). These authors find evidence for very early or innate differentiation. Despite the current trend away from



traditional pictures of primary narc1ss1sm and infantile omnipotence, the empirical evidence against these theories has not, to my knowledge, been collected and articulated in any one place. It is hoped that doing so will contribute to the clarity of psychoanalytic thinking on the etiology of pathological narcissism. Although the concepts of primary narcissism and infantile omnipotence have not constituted specific foci of infant research, many developmentalists and much of their work implies a substantial revision of these constructs. The contributions of these developmentalists will be discussed below. With so many psychological tenets currently under review, a closer collaboration between clinicians and researchers in planning and interpreting infant research might permit us to assess these tenets in a more thorough and valid way. Although a few current researchers straddle the developmental and psychoanalytic worlds (Stern, Sander, and Emde are notable examples), most of the research is carried out by developmentalists who are not trained in psychoanalysis and who do not have a particular interest in testing psychoanalytic theories. Up until the mid-1960s and prior to the advent of advanced audio-visual recording technology, theories of infancy had relied on a combination of subjective infant observations, metapsychology, and retrospective inferences drawn from adult pathology. For a variety of reasons, young infants were not studied, or not rigorously studied, even by our most influential infant scholars. Mahler's and Winnicott's observations concerned later infancy, and both of these theoreticians based their concepts less on their infant observations than on inferences drawn from children, psychotics, adult borderlines, and metapsychology (Stern, 1985; Demos, 1993, personal communication). The world of normal infancy that has emerged from more recent developmental research is a more imperfect world than that portrayed by traditional theory, characterized by a balance of closeness and solitude, gratification and frustration. In essence, the infant cuts his teeth on imperfection rather than perfection. The infant is innately inclined toward experience by himself as well as interaction (Soref, 1992} and is equipped with the rudiments of coping and mastery. In fact one might claim that this imperfect world is the best of all possible worlds for fostering successful adaptation. While it is true that early caretaking tends to be prodigious in its service to the infant, the immaturity of the infant's internal resources and the magnitude of his needs outstrip even these most attentive provisions, resulting in affective states that are far from blissful and positions that are far from omnipotent. Tronick and Cohn (1989) have found that a significant proportion of the time, infants experience negative affects and that positive affects, such as joy, are experienced less frequently.



In light of these and other empirical findings, it is no longer tenable to assume that narcissistic pathology derives from a regression to, or fixation at, an idyllic era. This pathology more likely results from processes of a later stage of childhood, representing a constellation of defenses that substitute for the natural unfolding of healthy object relating and competence. Derailments in these fundamental areas suggest that the narcissistic adult's sense of worthlessness and insecurity contain a realistic component, in that key aspects of his functioning are actually deficient. The thwarting of the narcissistically vulnerable patient's innate trajectory curtails his success in those areas which Freud so aptly chose to define normal life: work and love. Since they are absent in infancy, we must conclude that the omnipotence and exclusive self-absorption that we have so long attributed to normal infancy actually characterize narcissism in later development. A tenable hypothesis would be that these positions are substitutes for {and, in fact, caricatures of) the natural acquisitions of love and competence. The onset of pathological narcissism has not been specified, but it has been described in latency age children, where "the aim of grandiosity is to protect the child from loneliness and helplessness" (Cohen, 1991, p. 316). Similar ideas have been set forth by Kemberg (1970) and Kohut {1971) regarding love, and Basch (1988) regarding competence. Although deficits in these two areas can be played out in any diagnostic entity, their role in narcissism will be my focus here, since narcissistic problems are so prevalent in an analytic practice. I am referring to narcissistic issues, whether they comprise the major diagnosis or are features of other types of pathology. Innate capacities for object relating, coping, and mastery begin to develop in the first days of life, with intrauterine precursors, as I will elaborate in the following section. The developmental fate of these capacities depends on several conditions, which I base on the work of Gianino and Tronick (1988): (1) The infant needs a caregiving environment that provides a balance of gratification and challenge. (2) He must not be alone too long to deal with stress. (3) He needs the caregiver's collaboration to manage and repair stress; a collaboration based on good-enough responses to the infant's actual, correctly perceived signals. (4) Stresses need to fall within a range of intensity that is tolerable, ideally in the infant's "proximal zone" (Stem, 1985, p. 43), that is, a challenge that requires him to stretch just beyond his prior level. (5) He needs a caregiver who is sensitive to and yet comfortable with tolerable, naturally occurring frustrations (Demos and Kaplan, 1986). These five conditions provide continuing opportunities to learn what stress feels like; that it can be endured, managed, and repaired; that stress tends to be ameliorated; and that there is competence, value, and reliability in both the self and the object world.



Derailments of love and mastery that persist through later childhood constitute a spawning ground for adult pathology that can result in narcissistic vulnerability. Although these early deficits cannot be used to predict narcissistic pathology, they align remarkably well with its major issues. Based on the pertinent infant literature and on the symptomatology of narcissism, it is my thesis that pathological narcissism is rooted not in primary narcissism or infantile omnipotence but rather represents a substitute for natural, innate proclivities for love -and competence. In challenging the tenets of both primary narcissism and infantile omnipotence, the most pertinent area of infant research is the documentation of an early, and probably innate, thrust toward mastery. Mastery is an active pursuit often undertaken when gratification is not forthcoming from the environment and must be attempted by the individual. White (1959), Harter (1978), and Yarrow et al. (1983) are some of the contributors who have identified mastery as an independent motivation. The developmental literature is rife with examples of mastery dating back to such an early stage of infancy as to imply that the motivation is innate. For these reasons, I will begin by reviewing the major findings in this area, then move to the data on reasonable challenge, and finally to evidence of the infant's nascent capacity for love.

Review of the Infant Literature MASTERY AND REASONABLE CHALLENGE

The importance of mastery or "effectance" as a central motivation was presaged by Hendrick (1942) and White (1959). Later research amplified their hypothesis. Many studies have documented a joy that attends control of some aspect of the inanimate environment in early infancy. For example, the connection of an apparatus that allowed 8-week-old infants to turn a mobile by a movement of their bodies elicited smiles, coos, relaxation, and laughter (Hunt and Uzgiris, 1964; Watson, 1972, Papousek and Papousek, 1975; and Bower, 1977). It is believed that these reactions are specific to mastery and not secondary to an interpersonal pleasure. Indeed, mastery smiles occur when the infant is alone as well as in company (Trevarthen, 1990). Mastery motivation often interdigitates with aspects of the caregiving relationship (Harter, 1978; Redding, Harmon and Morgan, 1990) yet it also operates as an independent, intrinsic motivation. More recently, mastery has been demonstrated in 2-day-old infants who could activate a recording of female singing by elongating their customary pauses between bursts of sucking (DeCasper and Carstens, 1981). The newborns learned to do this with ease. In the next



phase of the experiment, singing was produced randomly, that is, noncontingent upon their sucking pauses. This loss of the opportunity to control the stimulus produced negative affects including "grimacing" and "vigorous crying" (p. 32). Besides the positive affective response to mastery, effectance was associated with greater attention, recognition, and memory of the stimulus, so this motivation is evidently a compelling one for the neonate. Bruner (1968) characterizes such adaptations of sucking as "voluntarization," that is, substituting voluntarily controlled sucking for reflex sucking (p.18). He reports that, from birth, when you show a newborn a stimulus with optimal properties, he will stop sucking altogether in deference to his interest in exploration. Mastery is also a significant feature of the infant's early social interaction. It has been noted that a major feature of the infant's social experience is his sense of control over the caregiver's contingent responses (Watson, 1972; Trevarthen, 1989). Many researchers have noted that the infant is far from passive in the complex social exchanges between infant and mother (Brazelton, Kowslowski, and Main, 1974; Stern, 1974; Schaffer, 1977; Trevarthen, 1977; Beebe and Lachmann, 1988). He responds to mother's communications with clear affective signals that tell her to keep doing what she's doing, increase or decrease it, alter it, or stop it. Gianino and Tronick (1988) refer to reciprocal pursuit of social aims by parent and infant as a "mutual regulation model" (p. 47). Primary narcissism and infantile omnipotence are also challenged by Gianino & Tronick's (1988) findings on synchrony and affective matching. Even though these forms of joining are desired goals of the infant, the goals are in fact rarely met (Trevarthen, 1977; Gianino and Tronick, 1988). Specifically, Tronick and his associates have found that the ratio of miscoordinated states to coordinated, synchronous, or matched interchanges between infant and mother is 70 to 30. This finding represents a challenge to the earlier view that the infant is rather consistently gratified. This imperfect, 70-30 world of the infant is one in which he is not omnipotent~ however, what he loses in perfection is gained in learning about, coping with, and mastering his imperfect world (Tronick and Cohn, 1989). Tronick, as well as a host of psychoanalytic theorists, including especially Kohut (1971) and Tolpin (1971) have observed that imperfection, in this instance miscoordination, furnishes an opportunity for manageable challenge-the chance to address and repair circumstances that conflict with one's goals. The repeated experience of mismatch and repair, with its attendant transformation of negative into positive affect, is a strengthening, growth-inducing experience, provided the aforementioned conditions obtain, namely that the stress is not overly taxing, overly long, or beyond dyadic reparative competence, and that the mother and infant work together as



partners in the reparation. In these favorable conditions, mismatches tend to be fleeting, followed by the infant's commnnicating his distress and a rapid joint restoration of matching. 'When the mother does not collaborate in restoring coordination, the infant is thrown back on his own self-regulatory devices, which are inadequate to meet his goals. In terms of my thinking about the genesis of narcissism, he is trained to opt out of the object world in favor of a focus on himself. It is important to note that these matters are relative rather than absolute and that degrees of self focus are also present and necessary in healthy functioning. Demos's {1989) findings parallel Tronick's findings on disruption. In describing infants in the first two years of life from a Boston University longitudinal study begun in 1954, Demos (1989) describes affective sequences in which relations are at first good, then disrupted, and then followed by joint reparative actions in which the infant and caregiver restore good relations. She described sequences where the disruption consisted of an angry scolding or some form of distress in the infant: "[T]he child learns that positive affect can be reliably reestablished, that negative affect can be reliably endured or managed or gotten over, and that the child itself can be an active agent in causing these things to happen" (p. 17). His active participation in signaling his distress and engaging the mother's assistance led him to such feelings as "I can solve problems; I can endure frustration and discouragement because I know things will get better; (and] bad things don't last long" (p. 17). Many others have also found less gratification than we would associate with infantile omnipotence, as well as a readiness to use manageable challenge for growth. Malatesta et al. (1989) have reported that moderate degrees of contingent reponses are preferable to highly contingent responses. Similarly, Belsky, Ravine, and Taylor {1984) have found that intermediate levels of maternal involvement produced more secure infant attachment levels than did high interactive involvement. Murphy and Moriarty {1976) have reported that moderate "acceptance" of the infant-including such factors as interactive attention-is more beneficial to growth than total acceptance. Sander (1975) found that the "mismatch" which provides an optimal "error signal" furthers the interactive competence and growth of the infant-caregiver system (p. 149). Grolnick, Frodi, and Bridges {1984) discovered that overcontrolling mothers decrease mastery motivation in their children. Stechler and Kaplan {1980) outline a process in which challenges that fall within the capabilities of the infant spur the infant to a new solution to the problem in which the self is expanded. From both theoretical and experimental sources Deci and Ryan (1985) conclude that infants and children need the experience that they determine their own responses to the environment in order to develop a sense of competence. Murphy and Moriarty



(1976) similarly noted the great importance of the infant's and child's being allowed to struggle for himself in the effort to solve his own problems. Thus a considerable body of infant development studies strongly suggests that the infant actually requires for his growth the challenge, opportunity, and time to himself to draw on his own resources for development (Soref, 1992). When mothers are depressed, angry, withdrawn, intrusive, or neglectful, infants show abberant patterns, such as a reduction of interest in human and in inanimate objects as well as a reduction in attempts at mastery (Gianino and Tronick, 1988). Trevarthen (1989) echoes this theme: "In pathological situations, an infant's motives and emotions for both communication and cognitive mastery of impersonal objects tend to collapse, and the selfrelated, protective emotions predominate" (p. 21). This effect is demonstrated in an experimental condition in which an infant and mother face each other and the mother is instructed to keep her face impassive {Tronick et al., 1978). In Tronick's "still-face" paradigm, infants of depressed mothers make fewer efforts to garner their mother's attention than infants of nondepressed mothers. These infants have already learned that they cannot master such stress and have given up trying. At the same time that the infant is thrown back on his own resources, he is denied the chance to internalize adequate self-maintaining functions so that, while adopting a focus on himself, he will be largely dependent on the provisions of selfobjects in order to maintain states of coordination between himself and others or within himself. Demos and Kaplan (1986) offer contrasting descriptions of two of the infants from the 1954 Boston longitudinal study. One received a balance of gratification and frustration, receiving support and help with frustrations where the frustrations did not exceed competence; the other was too quickly rescued from experiencing frustration by nursing and other soothing activities while, at the same time, deprived of adequate loving atttention, being less favored than an older brother. By the end of the first year, they manifested quite different capacities for mastery and different interests. The latter infant may be a study of pathological narcissism in the making: she showed less interest in toys, more passivity, less interest in joint activities with a somewhat greater investment in solo experience; she was unable to sleep independently or be comfortable with a stranger and did not develop adequate capacites to signal distress and anger. The former infant was the opposite in all these regards and, by the end of the first year, showed this picture: "[She] is full of enthusiasm and zest ... the initiator of complex plans which she carries out with persistence and flexibility. She acts as if her wishes and feelings mattered and conveys a general air of confidence that she can cause things to happen and can solve problems" (p. 16). Depending on a combination of constitutional factors and future influences in her life,



the latter infant could be predisposed to certain narcissistic defenses. She has been pushed into a greater investment in self rather than in object relationships and toys while at the same time showing significant dependency on external objects in her difficulties sleeping or accepting a stranger. She has also been derailed in her capacity to signal need and in mastery. Some psychoanalytic theorists have also argued against the postulate of a perfect early environment. Erikson {1950) alludes to the need for manageable challenge in terms of "phase specific experiential nutrients." For Kohut (1984), "optimal frustration" is a cornerstone of both normal development and the mutative process in treatment (p. 98). According to Kohut (1971), minor nontraumatic failures in the responses of mirroring and idealized selfobjects provide the levels of frustration that are optimal, as opposed to overwhelming disappointment or frustration of selfobject needs. Optimal frustration provides the impetus for gradual and partial withdrawal of investment in the selfobject and certain of its functions, which are then replaced by internalization of these functions. This process is akin to the work of mourning. Those aspects of the image of the object that are internalized undergo a process of depersonalization. Concomitantly the selfobject and its functions are progressively replaced by a self and its functions (Kohut and Wolf, 1978) in a process of structure formation that Kohut (1971) conceptualized as "transmuting internalization." In her further elaboration of transmuting internalization and early development, Tolpin (1971) echoes the theme of reasonable challenge delineated by infant researchers: "I am postulating that the mother's anxiety-relieving responses to the infant's distress signals are ultimately preserved as psychic structure as long as the inevitable anxiety experiences ... are kept to minimal, manageable, bite-sized doses ... " (p. 337). "[R]epeated experiences of small amounts of distress [are] probably the infantile basis for the mature personality's capacity to respond to situations that provoke mild anxiety as a pleasurable challenge" (p. 340). Freud (1911) also speaks to a creative form of early mastery in his concept of the hallucinated breast deployed to cope with the experience of oral frustration. As noted above, it is critical to the success of reasonable challenge that it be balanced by sufficient gratification. Gratification itself, without frustration, is another key source of structurebuilding. Demos ( 1983) notes the development of the bulk of psychic structure when both the I and the We experiences of the infant are going well. For example the developmental literature is replete with descriptions of how the infant's behavior is enhanced in smooth interactions with a caregiver-interest is prolonged ... and the infant's repertoire is expanded. Ainsworth (1974) has described how, at slightly later ages, the securely attached infant explores and plays more freely in


Narcissism the presence of the attachment figure. Thus, structure building is going on during good, empathic ... experiences as well (p. 109].

I conceive of structure as built in positive times and tested and strengthened in times of challenge, similar to the role of exercise (challenge) in extending and building muscle strength. LOVE: THE INFANT'S INNATE CAPACITY FOR ATTACHMENT

Theoretical understanding of the relationship between narcissism and love, including self love, is complex, controversial, and not yet complete (Sandler, Person, and Fonagy, 1991). Nevertheless, clinical practice is often conducted on an assumption that narcissism and self love are closely related. Indeed, they are often equated such that the narcissistic patient is viewed as having not sufficiently developed away from an original "primitive" state of selfloving self-absorption. Freud's contributions, especially his "On Narcissism: An Introduction" (1914), are selectively quoted in support of this view. Assumption of this view of narcissism carries consequences for clinical practice in that the therapeutic task is seen as requiring the patient to recognize and understand his unrealistic self-involvement, and then turn to investing his love in other persons. Very often the result is disappointing. When it does seem useful, it is often on the basis of conformity rather than true structural change. Infant research promises to offer important contributions to understanding the relationships between self love, love of others, and narcissismcontributions that carry implications for how therapeutic development might be facilitated in the clinical situation. Central to these contributions is the emerging demonstration that a loving interest in the environment is the norm for the infant, provided the environment receives the natural unfolding of this innate proclivity in a facilitating way. The infant research literature attests that responsiveness to this innate capacity through acceptance and validation of the infant's nascent self is crucially important in fostering his self-confident relatedness. When that responsivity from the environment is chronically not forthcoming, or even noxious, the infant's spontaneous capacity for loving others may be seriously derailed. Although the selfabsorption that results is secondary, being the consequence of developmental derailment, in clinical practice it is often mistaken as persistence of a primary state. Infant research points the clinician in a different direction, one in which the therapeutic task is oriented toward the patient's retrieving his original state of loving interest in his environment rather than having to inaugurate such a state. The human infant's engagement with his caregiver has precursors as early as intrauterine life. We see the fetus entrain to his mother's physiological



regulatory cycles such as her sleep-wake cycle in studies of vertebrates (Reppert and Weaver, 1988).We also see fetal responsivity to extrauterine sound (Truby, 1975) and a familiarity with and learning of the sound (Fifer and Moon, 1988) and content (DeCasper and Spence, 1986) of mother's voice. This interest in the caregiving object is elaborated and extended after birth. A striking finding reveals that newborns as early as 18 hours old show a precursor of empathy in their response to the crying of other infants (Simner, 1971; Sagi and Hoffman, 1976; Martin and Clark, 1982). Sagi and Hoffman (1976) cite this finding as evidence of an "inborn empathic distress reaction" (p. 175). A calm infant cries at the sound of other newborns crying. Interestingly enough, infants do not cry in response to a synthetically produced newborn cry nor that of a chimpanzee or an older child. They also do not cry to the sound of their own tape-recorded cry. There is also evidence of the newborn's engagement in the affects of adults, as shown in his capacity to imitate them (Field et al., 1982). An adult model displayed three different facial expressions, (happy, sad, and surprised) to newborns at the age of 36 hours. The newborns were able to discriminate and reproduce these affects. Imitation of adults has also been found in facial gestures (Meltzoff and Moore, 1977). We do not know the psychophysiologica.l mechanism behind such imitation, but, taken together with the finding on empathy, it indicates an early, active interest in the affective world of peers and adults. We also have evidence of the neonate's investment in his specific caregiving object. At 2 days he prefers to see his mother's face to that of another woman (Field et al., 1984). Additionally, 3-day-old infants prefer the smell of their own mother's breast milk to that of other mothers (Macfarlane, 1975). This was shown by placing breast pads scented with the mother's milk and a random woman's milk on either side of a reclining infant's head and finding that he consistently turned his head in the direction of his mother's breast pad. The neonate can also disciminate his mother's voice from that of another woman (DeCasper and Fifer, 1980). Smiles in response to an appropriate stimulus of the caregiver have been found as early as the seventh month in premature infants (Van Rees and de Leeuw, 1987} as well as at one week of age (Wolff, 1963; Fogel and Thelen, 1987). We are also finding that the infant has an inborn predisposition to communicative engagement with his caregivers, the facilitation of which is Vital to both emotional well-being and normal brain development (Trevarthen, 1990). Trevarthen (1990) has found evidence of "protoconversations" (Bateson, 1975) in newborns a few hours old in which emotions are communicated back and forth and a close mental contact regulates distress and need. This contact is essentially similar to adult-to-adult communication, developing



in further differentiation rather than in essential form and purpose (Bateson, 1975). Observational research has shown that these "conversations" are elaborately synchronized. "[T]he mother makes short ... utterances on a pulse of every .75 seconds ... leaving a rest on alternate beats. After a few seconds of watching and listening, the infant picks up the same beat and makes a 'reply' ... precisely on one of the rests of the mother, between her vocalizations" (Trevarthen, 1990, p. 100). The study of the early origins of a reciprocal infant-mother relationship burgeoned in the 1970s. Mother-infant head movements were synchronized (Peery, 1980), and Sander (1980) found that mothers' and infants' sleep-wake rhythms came into coordination by the fourth to sixth day of life. Several researchers studied the face-to-face engagement of mothers and infants by focusing a camera on each of them and then showing the second-to-second details of each one's reactions to the other on a split screen. A reciprocal engagement moving from closeness to distance was found in the mothers' and infants' vocal, facial, sensory, motor, and affective signals (Brazelton, Kowslowski, and Main, 1974; Stern, 1974; Trevarthen, 1977; Schaffer, 1977; Beebe and Stern, 1977; Tronick et al., 1979). As has been stated, Gianino and Tronick (1988), who analyzed the engagement more closely, discovered that synchrony, or matching, was present only one third of the time. Rhythmic cycling between infant and mother has also been traced back to birth (Censullo, Lester, and Hoffman, 1985) and has been charted through its development into the richly detailed games played from 3 months on. Early interaction also furnished examples of the importance of the presence of individuated "object love" in addition to "primal" or instinctive love. Communicative contact is preferred from the earliest moments of life, according to Trevarthen (1989): "A baby outside the womb for only a few hours, even one born two-to-three months premature, can engage with the caresses, vocalizations and body displacements given by a person who is providing support in a gentle way. Conversely such a very immature human being will withdraw and attempt to defend his (sic) or herself against unsympathetic or insensitive handling" (p. 8). Sander's work has particularly emphasized the recognition of the uniqueness of the infant's self as key to his normal self development. He speaks of the importance of the mother's "viewing [the infant) as an individual apart from her own projections and displacements" (1976, p. 132). Sander {1985) summarizes the manner in which the acceptance of the infant's self is the key to his use of himself as a center of initiative and importance: The emergence of infant-as-agent must be granted by the system.... it means a reorganization of the system to admit the newcomer. If the system



is such that it can permit the entrance of a new agent within it, it provides the conditions which establish not only the capacity for self-awareness, but conditions which ensure the use of such inner awareness by the infant as a frame of reference in organizing his own adaptive behavior [p. 9). The use of self as barometer and guide is also at the heart of Winnicott's concept of the "true self" (1960, p. 140). Steele (1983) also stresses the importance of validation of self without which the self is experienced as "irrelevant [or] erroneous, [remaining) persistently oriented toward the outside world for cues and guidance, disregarding ... its own internal sensations, needs, and wishes" (p. 241}. Demos {1989) demonstrates these principles in two cases in the 1954 Boston longitudinal study in which the parents encouraged only those behaviors in their infants that gratified the parents, discouraging or ignoring other spontaneous behaviors. The children "gave up trying to pursue their own initiatives in exchange for winning their mother's approval" (p. 12). One mother generally ignored her child but responded when he was "cute" or "entertaining." "This child gradually developed skills as a clown, a mimic, and a flirt ... but gave up trying to develop a whole range of other skills that were not responded to" (p. 12). There is much research on the deleterious effects of thwarting the infant's spontaneous interests'in loving and being loved. Tronick and Gianino (1986) trace the course of the infant's engagement with a depressed mother who: fails to respond to her infant's other-directed regulatory signals ... causing the infant to experience negative affect consistently and repeatedly. For a time, the infant may persist in attempting to repair the interactions but with each ... failure ... the infant turns inward, away from social engagement [the repetition of which will] have a structural effect. ... In addition, the infant will develop a representation of self as ineffective and of the mother as unreliable [p. 9]. For Stern (1985) it is the mother's attunement that is essential to " ... the infant's coming to recognize that internal feeling states are forms of human experience that are shareable .... The converse is also true: feeling states that are never attuned to will be experienced only alone" (p. 151}. Malatesta (1989) has found that failure to respond positively to infants' affects in the first 6 months led infants to the later suppression and ignoring of their own affects. She reports that, besides general negative affect suppression, rates of smiling diminished over 2 1/2 to 7 months of age, and by the second half of the first year these infants showed markedly diminished tendencies to smile. Lyons-Ruth (1992) reports the suppression of anger and distress in infants whose mothers were intrusive and covertly



rejecting of negative affects. It has been found that misattunements in early social interaction become structuralized prior to the advent of symbolic capacity (Stern, 1985; Main, Kaplan, and Cassidy, 1985; Beebe and Lachmann, 1988; Lyons-Ruth, 1992).

Developmental Research and Psychoanalytic Theory: An Integration The derailed infant and the narcissistic adult share many of the same deficits. In both of them, innate proclivities to tolerate and repair stress have been compromised. In addition, their experience of loving relationships has been curtailed to the extent that loving and being loved have been impeded, and the characteristics of their caregiving relationship have been generalized to others. Finally, to the extent that their particular nature has been ignored, devalued, or assaulted, individuality and the self as a center of authorship, influence, and importance have eroded. In order for the self to matter, it needs to be honored by others. Here, in the area of agency, narcissism diverges from an etiology based on "primary narcissism." For example, existing theory has been served by the metaphor of Narcissus staring admiringly at his reflection in the water. A more likely interpretation, based on infant research, would be that he was staring in search of his reflection. The mirroring concepts of Winnicott and Kohut offer an approach that fits this existential deficit. When there has been a dearth of human reflection, the need is for an inauguration, rather than a celebration, of existence. In this connection, the more appropriate metaphor of the proverbial tree that may or may not be heard without a human witness is more apt. As has been stated, there is no linear connection between derailments in infancy and narcissistic pathology in adults. Intervening development presents a host of new issues, notably the post-infancy matters of conflict and guilt (which first appear in the second year and develop more fully in latency and adolescence (Zahn-Waxler and Kochanska, 1988]). We do, however, see some striking similarities between narcissistic deficits and infant derailments of love and mastery. While these derailments can be manifested in the full spectrum of adult adaptation from health to schizophrenia, when we see narcissistic issues (whether primary to the character or as secondary to other types of pathology) we also see adults who mobilize certain characteristic defenses against their deficits in love and competence. The infant's response to these derailments is sadness and/ or anger (Weinberg and Tronick, in press). The adult has the task of using his more sophisticated resources to defend against these affects, a task that is frequently accomplished by narcissistic defenses. Interestingly, the therapeutic work with these defenses, if



successful, results in a return to the more direct reactions of the infant in the form of grief and rage. Another argument for drawing parallels between these infant deficits and adult narcissistic pathology is that narcissism is a near-ubiquitous feature of adult pathology (either as the primary diagnosis or a feature of other diagnoses). Problems in love and mastery are also nearly ubiquitous in infants who have suffered inadequate caregiving, so it is plausible to postulate that the two are related. I will turn now to two cardinal narcissistic defenses and link these to the infant research that has been reviewed. The first of these is the narcissistically vulnerable patient's well-known pursuit of perfection and specialness in self, in the inanimate world, and in the object world (Reich, 1960; Kohut, 1971; Rothstein 1984). One dynamic behind these pursuits is a poignant effort to reclaim the sanctitude of his lost individuality. Specialness, perfection, stardom, and glory are all apt symbols for the aborted flowering of one's unique and true nature. They are also efforts to compensate for the lack of appropriate expressions of love in the primary caregiver. Examples of this lack were illustrated in affect-suppression (Lyons-Ruth, 1992) and caregiver responses that derail attempts at mastery (Demos and Kaplan, 1986). Another reason that perfection is sought is simply because of a deficiency in negotiating imperfection. Perhaps in the infancy and childhood of adult patients who are narcissistically vulnerable, there has been too little experience with appropriate levels of challenge, stress has been toxic, one was too alone with stress, and one's budding efforts at coping and repair were compromised. In part, the need for perfection arises to assuage the pain of being confronted with genuine inadequacy. When this pain is intense and when self-esteem is minimal, adequacy or value are insufficient to fill the gap. Only the superlative of being perfect or "the best" can offer hope. The goal of perfection creates a vicious cycle, increasing the pain it is intended to relieve. This impossibly high standard insures a failure to meet it, setting up a perpetual sequence of ambition/failure/self-loathing/ambition. Compounding this sequence is the inability to use realistic strategies for achieving success, such as objectively acknowledging and developing from one's limitations. Similarly, the narcissistically vulnerable person frequently abhors the beginning and middle phases of a project, needing to begin a journey of a thousand steps with the last step. Only the conclusion can feel like perfection. Added to this frustrating sequence, the narcissistically vulnerable patient is often acutely aware that others would do better-that his approaches to the challenge are abberant and out of step with the more optimistic, effective, and confident approaches of others. Furthermore, the stressor tends not to be perceived as part of the law of averages but is equated with early pain, becoming a harsh confirmation of early parental rejection or devaluation.



John Murray (personal communication} spoke of this phenomenon in relation to physical illnesses experienced as the body rejecting the self, as a derivative of parental rejection. The relative failure to learn to deal effectively with imperfection can produce a zealous pursuit of the perfect life, characterized by success, wealth, beauty, an ideal climate, first-rate treatment, universal acclaim, and so on. Some narcissistically vulnerable patients embark on a perfectionistic pursuit of these goals that can result in vastly superior abilities along with the copious admiration they crave. Despite their success, they unfortunately cannot use their accomplishments nor the admiration they garner to support the belief that they are effective. Positive feedback cannot register as believable unless there is an inner sense of one's worth that roughly corresponds to the feedback. One needs some knowledge of one's worth in order to believe its validation; otherwise the pursuit of external affirmation remains ineffectual. A second major attribute of narcissism is self-orientation or self-absorption. The natural interest that infants display in things that relate to themselves, once frustrated, may get perverted into an adult attitude that "only I am important." Being not sufficiently thought of would yield the extreme version of the need: "Think only of me." The patient with significant narcissistic pathology with these characteristics shows varying degrees of intolerance and rage when objects evince characteristics or interests that deviate from his own predelictions. This reality can produce a near-constant level of tension during interpersonal encounters. Another parallel between derailed infants and narcissistic adults can be found in the maladaptive lessons of the infant and child who was forced to rely on his own regulatory strategies. Perhaps the narcissistically vulnerable person's early experience was to rely only on himself and to distrust and disdain the potential resources of external objects. In addition, he has to disavow the good qualities in objects because they detract from his need to perceive himself as the best and only source of value. Even though he may thrive on other people's sustenance, other people's value cannot be acknowledged as it would compete with his monopolistic sense of self-perfection. Value in others has also been described by Kernberg (1970} and Klein (1975) as the trigger for intense and painful envy that can be endured only by attempting to destroy the good qualities of others or proclaim them to be worthless. The self thus becomes the object of choice, reminiscent of the infants who must rely on self-regulatory devices when they cannot rely on caregivers. Second, when caregiving relationships are not facilitating, infants withdraw from other potential caregivers. They learn to renounce their innate predisposition to seek out relationships and, by default, tum to themselves



instead of to objects. However, as growth proceeds, individuals cannot use self as a center to evaluate, guide, and animate their lives without having been positively evaluated, guided, and animated by caregivers. They are therefore thrown upon the mercy of the resources of the very objects that are associated with disappointment and disdain. In this sense, they are like a hemophiliac in a razor factory. The resulting series of real and imagined injuries serves to confirm and reconfirm the malevolence of the object world, redoubling the intensity of the need to be "out for oneself." The "badness" of the object world would be compounded by the narcissistically vulnerable patient's inability to believe good feedback. Since he can only screen out affirmation, lacking an inner repository for it, he is limited to the negative portion of the range of people's responses to him. The original caregiver's rejections that inspired this negative sense of the object world spawns yet another vicious circle. Intense self-orientation, based on infant and childhood rejection, also elicits current rejection, which then reinforces the retreat into mistrust of the object world and self-orientation. A particular trigger for rejection is the narcissistic propensity to turn on objects whom they love when they perceive these objects as disappointing or inconvenient. The object's reactive rage is then perceived as confirmation of the malevolence of the object world. Finally, the combination of intense need yet disdain and disappointment in selfobjects results in the kind of intense self-reproach described by Anton Kris (1990). The narcissistically vulnerable individual's dearth of loving relationships and competence both contribute to an intense level of need that is felt as an entitled demand that external objects fill the gap of what is lacking. This demandingness and the rage when it is frustrated, to which I would add the primary counterassaultive rage at parental rejection, yields guilt and self-reproach that heighten both the attributes discussed. One feels unworthy of and alienated from the object world by virtue of one's guilt and shame, and one pursues perfection as a rescue operation from self-loathing.

Treatment Implications An aspect of the theoretical shift outlined here is the view that both caretaking of infants and treatment of adults are directed at a facilitation rather than a correction of the innate trajectory toward love and competence. Since these motivations were initially in place, having been derailed by early caregiving relationships, the task of psychoanalytic treatment is to restore natural growth proclivities rather than effect a transformation of fixated primary narcissism. Keeping this perspective in mind helps the therapist spot and capitalize on the ways in which original healthy growth motivations are still in evidence and to use these to enlist the patient's partnership in renouncing



current narcissistic gratifications. This perspective also offers a more encouraging and less daunting perspective on treatment than seeing the patient as mired in a primary narcissistic position that is in fundamental conflict with healthy growth. There is clearly no one-to-one correlation between infant caregiving and adult treatment. However, in working with deficits in the development of the self, some of the principles that guide infant caregiving become relevant to the adult, particularly when it is necessary for the patient to build capacities for mutual love and mastery that have been lacking. I refer here to the reparative function of analysis as discussed by Balint (1968), Dewald (1976), and Fleming (1975), and, like these authors, I am not referring to the manipulation of a "corrective emotional experience" (Alexander and French, 1946). One of the principles relevant to both infants and adults lies in the five conditions for growth. One of these conditions is that frustration not be overwhelming. Older analytic models prescribed an atmosphere that burdened many patients with too much frustration, particularly in strict adherence to abstinence, neutrality, and anonymity. Reasonable challenge, as we saw, involves small increments of challenge in the proximal zone of competence. Large doses of frustration in the treatment situation are counterproductive and can even be iatrogenic (Wolf, 1976; Stolorow, Brandchaft, and Atwood, 1987). Moreover the treatment situation is rife with frustration without the addition of unnecessary technically dictated frustrations. The narcissistic patient's deficits subject him to a level and quality of need that is in some ways com parable to that of a child or infant. Childhood wishes for a round-the-clock analyst who ministers exclusively and without remuneration to the patient run afoul of the 50-minute time limit, the fee, and the realities of other patients and the therapist's personal life. These are massive frustrations unavoidably built into the treatment situation. Also, the narcissistic patient usually faces mammoth frustration in his personal life. For these reasons, opportunities for reasonable challenge generally require a leavening of technical frustration, while of course walking the line to avoid infantilization, seduction, or intrusion into the patient's life and autonomy. Empathic lapses can register as overwhelming traumata rather than mastery opportunities. The therapist needs to cushion these with appropriate and reality-based support. It is important to note that gratification is also important to structure building. Many of the kinds of facilitation of natural growth that were not offered by parents need to be furnished by the therapist, again always mindful of the potential for infantilization or seduction. The narcissistic patient can generally not commence a meaningful existence as a genuine self until his analyst mirrors and actively validates his existence and worth. Kohut's "optimal frustration" (1984, p. 98) is insufficient for transmuting



internalizations because it does not include the gratifying kind of interchanges and "protoconversations" needed by both infant and narcissistic adult. There needs to be a give-and-take in which the analyst is personally invested in and enjoys the qualities of his narcissistic patient in order to provide the patient with experiences of contingent responsiveness and of loving and being loved. "When such experience was inadequate or absent in infancy and childhood, it needs to be offered in the analytic situation. Narcissistic patients have an inordinate experience of failure in their lives, as discussed. The experience of failure may go up exponentially in treatment where one is daily confronted with one's incapacities while in the company of the analyst whose functioning usually is at a much higher level. When the patient's sense of failure joins with his sense of envy of his analyst, paralyzing degrees of shame and rage may ensue. Treatment may reach an impasse when these feelings are too intense, particularly when the patient lacks the support of a circle of friends who are also involved in therapy. This challenge to treatment requires the analyst's creativity and freedom to move beyond technical constraints that might end the treatment while maintaining the boundaries inherent in the analytic frame. Copious support is necessary along with efforts to teach the patient that he has strengths, talents, and worth. It may also be helpful to share with some patients a perspective on the long developmental road that the analyst had to traverse before arriving at his current level of integration to disabuse them of a prevalent misconception that their analyst and others were si_ngled out by fate for a good life that is forever beyond their grasp. The patient may not be able to believe that his analyst is not a God and that he himself possesses intrinsic value. It is particularly difficult for the narcissistic patient to assign currency to qualities of himself that arise without effort, since, historically it has taken massive effort to transcend his actual deficits. Being just who he was was unrewarded or assaulted by his caregiving environment. Dan Buie (personal communication 1994) deals with this problem by giving such patients the task of not resting their selfassessment on how they feel but rather on what they think. He advises patients to carefully review the positive feedback they receive and to try not to dismiss it because it doesn't feel correct but turn it over to their cognitive powers to attend to and to assess its validity. Under the topic of self-orientation, several problems in engaging the object world were outlined. These are all brought into the analytic relationship, posing obstacles that are in some cases insuperable. To restate, the patient is intolerant of characteristics of his analyst that deviate from his own; he distrusts and may try to destroy any supplies that are not his own out of Kleinian envy and a need to disavow the good in others as it conflicts With his need to be "the best." He needs to be "out for number onet resents



his dependency on his analyst, and is apt to tum on his analyst destructively when he finds him disappointing. First, differences in the analyst do not need to be made manifest until a strong enough relationship has been built that the patient will be able to report his difficulty with these differences so it can be worked on. The interventions of choice with these areas are confrontation and interpretive work. Inevitable countertransferences of rage and even moralizing can be tempered partly by an understanding that, for a time, the narcissistic patient has no choice but to take these defensive measures against his failures to develop competence and loving relatedness. Owing to these deficits, he suffers a loss of pride and alienation from the community of those who were permitted to develop these enviable capacities. Finally, psychoanalytic treatment needs to inculcate the sense of loving as much as the sense of being loved, as both of these are innate and lifelong needs. It is usually the sense of being a loving person that is harder to incorporate into standard analytic treatment, as needs must by and large emanate from the patient. However, patients do often care for their analysts with both a primal and object love, and it is important to validate that this love is registered and valued. Gifts, notes, prompt bill payments, and sympathy for illness are common opportunities to acknowledge and value the patient's love and the aptness of its expressions. It is important to avoid the easy pitfall of presenting an analytic situation of pure giving devoid of opportunities for a give-and-take of mutual caring and concern. The patient's caring is a vital resource that needs to be recovered from defensive layers of self-involvement and distrust of the object world.

Conclusion Prevailing psychoanalytic theory of the etiology of narcissistic pathology was assessed and a revision was offered in light of the developmental research on infants of the last three decades. In particular, postulates of primary narcissism and infantile omnipotence were critiqued as contrary to empirical findings of an innate trajectory toward the development of mastery and attachment/love. It was shown that, from his earliest days, the infant actively pursues these goals in an environment that is more imperfect than blissful and more humbling than omnipotent. Narcissistic attributes such as the need for perfection and extreme self-absorption are not found in infancy but rather arise as substitutes for the normal achievements of mastery and mutual love when the environment thwarts these acquisitions. Some of the implications of this revision for analytic treatment were discussed, including the need to provide conditions of reasonable challenge and gratification that parallel normal infant learning and ways to deal with



the narcissistically vulnerable patient's inordinate experience of failure visa-vis the analyst

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interactive regulation and coping and defensive capacities. In: Stress and Coping Across Development, ed. T. Field, P. McCabe & N. Schneiderman, pp. 47-68. Grolnick, W., Frodi, A. & Bridges, L. (1984), Maternal control style and the mastery motivation of one-year-olds. Infant Mental Health]., 5(2):72-78. Harter, S. (1978), Effectance motivation reconsidered. Human Devel., 21 :34-64. Hendrick, I. (1942), Instinct and the ego during infancy. Psychoanal. @art., 11:33-58. Hunt, J. McV. & Uzgiris, I. C. {1964), Cathexis from recognitive familiarity: An exploratory study. Presented at the Convention of the American Psychological Association, Los Angeles. Kernberg, 0. F. {1970), Factors in the psychoanalytic treatment of narcissistic personalities.]. Amer. Psychoanal. Assn., 18:51-85. Klein, Melanie (1957), Envy and gratitude. In: Envy and Gratitude &Other Works 1946-7963. London: Hogarth Press, 1975, pp. 176-235. Klein, Milton (1981), On Mahler's autistic and symbiotic phases. Psychoanal. Contemp. Thought, 4:69-105. Kohut, H. (1968), The psychoanalytic treatment of narcissistic personality disorders. The Psychoanalytic Study of the Child, 23: 86-11. New York: International Universities Press. - - (1971), The Analysis of the Self. New York: International Universities Press. - - - (1984), How Does Analysis Cure?ed. A. Goldberg & P. Stepansky. Chicago: University of Chicago Press. - - - & Wolf, E. S. (1978), The disorders of the self and their treatment: An outline. Internat. j. Psycho-Anal., 59:413-425. Kris, A. 0. (1990). Helping patients by analyzing self-criticism. j. Amer. Psychoanal. Assn., 38:605-636. Laplanche, J. & Pontalis, J.B. (1973), The Language ofPsycho-Analysis. New York: Norton.



Lichtenberg, J. D. (1983), Psychoanalysis and Infant Research. Hillsdale, NJ: The Analytic Press. Lyons-Ruth, K. (1992), Qualities of the holding environment and patterns of conflict and defense in infancy. Presentation at Scientific Meeting, Massachusetts Association for Psychoanalytic Psychology, Cambridge. Macfarlane, J. (1975), Olfaction in the development of social preferences in the human neonate. Parent-Infant Interaction, ed. M. Hofer. Amsterdam: Elsevier. Mahler, M. S., Pine, F. & Bergman, A. (1975), The Prychological Birth of tlu Human Infant. New York: Basic Books. Main, M., Kaplan, N. & Cassidy, J. (1985), Security in infancy, childhood, and adulthood: A move to the level of representation. Monographs of the Society for Research in Child Development, 50(1-2): Serial No. 209, pp. 66-104. Malatesta, C. Z., Culver, C., Tesman, J. R. & Shepard, B. (1989), The development of emotional expression during the first two years oflife. Monographs ofthe Society for Research in Child Development, 54(1-2): Serial No. 219, pp. 1-104. Martin, G. B. & Clark, R. D. (1982), Distress crying in neonates: Species and peer specificity. Dev. Psycho[., 18:3-9. Meltzoff, A. N. & Moore, M. K. (1977), Imitation of facial and manual gestures by human neonates. Science, 198:75-78. Moore, B. E. & Fine, B., eds. (1990), Psychoanalytic Terms and Concepts. New Haven, CT: Yale University Press. Murphy, L. G. & Moriarity, A. E. (1976), Vulnerability, Coping, and Growth. New Haven, CT: Yale University Press. Papousek, H. & Papousek, M. (1975), Cognitive aspects of preverbal social interaction between human infants and adults. In: Parent-Infant lnt,eraction, Ciba Foundation Symposium 33. New York: Elsevier, pp. 241-260. Peery, J. C. (1980), Neonate-adult head movement: No and yes revisited. Devel. Psycho[., 16:245-250. Peterfreund, E. (1978), Some critical comments on psychoanalytic conceptualizations of infancy. Internal. J Psycho-Anal., 59:427-441. Pulver, S. E. (1970), Narcissism: The term and conceplj. Amer. Psychoanal. Assn., 18:319-341. Redding, R. E., Harmon, R. J. & Morgan, G. A. (1990}, Maternal depression and infants' mastery behaviors. Infant Beha.v. Devel., 13:391-395. Reich, A. (1960), Pathologic forms of self-esteem regulation. The Psychoanalytic Study of the Child, 15:215-232. New York: International Universities Press. Reppert, S. M. & Weaver, D.R. (1988), Maternal transduction of light-dark information for the fetus. In: Behavior of the Fetus, ed. W. P. Smotherman & S. R. Robinson. Caldwell, NJ: Telford, pp. 119-227. Ricks, M. H. (1985), The social transmission of parental behavior: Attachment across generations. In: Monographs of the Sociity for Research in Child Development, 50(1-2): Serial No. 209, pp. 211-227. Rothstein, A. (1984), The Narcissistic Pursuit ofPerfection. New York: International Universities Press. Sagi, A & Hoffman, M. L. (1976), Empathic distress in the newborn. Devel Prychol, 12:175-176. Sander, L. W. (1975), Infant and caretaking environment. In: Explorations in Child Psychiatry. New York: Plenum, pp. 129-166. (1976), Issues in early mother-child interaction. In: Infant Psychiatry, ed. E. N. Rexford, L. W. Sander & T. Shapiro. New Haven, CT: Yale University Press, pp. 127-147.



- - - (1980), New knowledge about the infant from current research: Implications for psychoanalysis.]. Amer. Psychoanal. Asm., 28:181-198. - - - (1985), Toward a logic of organization in psychobiological development. Monograph of the Amer. PsychoanaL Assn., Jan. 4. - - - (1987), Awareness of inner experience: A systems perspective on self-regulatory process in early development. Child Abuse & Neglect, 2:339-346. Sandler, J ., Person, E. S. & Fonagy, P., eds. (1991 ), Freud's "On Narcissism: An Introduction. "New Haven, CT: Yale University Press. Schaffer, H. R. (1977), Studies in Mother-Infant Interaction. London: Academic Press. Simner, M. L. (1971), Newborn's response to the cry of another infant. Devel. Psycho/., 5:136-150. Soref, A. R. (1992), The self in and out of relatedness. The Annual ofPsychoanalysis, 20:25-48. Hillsdale, NJ: The Analytic Press. Stechler, G. & Kaplan, S. (1980), The development of the self: A psychoanalytic perspective. The Psychoanalytic Study ofthe Child, 35:85-105. New Haven, CT: Yale University Press. Steele, B. F. (1983), The effect of abuse and neglect on psychological development. In Frontiers of Infant Psychiatry, Vol 1, ed. J. D. Call & E. Schneiderman. Hillsdale, NJ: Lawrence Erlbaum Associates, pp. 47-68. Stern, D. N. (1974), The goal and structure of mother-infant play, j. Acad. Child Psychiat., 13:402-421. - - (1985), The Interpersonal World oftlu Infant. New York: Basic Books. Stolorow, RD., Brandchaft, B. & Atwood, G. E. (1987), .Aychoanalytic Treatment: Anlntersuhjective Approach. Hillsdale, NJ: The Analytic Press. Stone, L. J., Smith, H. T. &Murphy, L.B. (1973), The Competent Infant. New York: Basic Books. Tolpin, M. (1971), On the beginnings of a cohesive self. The Psychoanalytic Study of the Child, 26:316-352. - - - (1978), Self-objects and oedipal objects: A crucial developmental distinction. The Psychoanalytic Study of the Child, 33: 167-184. New Haven, CT: Yale University Press. Tompkins, S.S. (1968), Affects-Primary motives of man. Humanitas, III: 321-345. - - - (1978), Script theory: Differential magnification of affects. Nebraska Symposium on Motivation, Lincoln, pp. 201-236. Trevarthen, C. (1977), Descriptive analyses of infant communicative behavior. In: Studies in Mother-Infant Interaction, ed. H. Schaffer. New York: Academic Press, pp. 227-270. - - - (1989), Intuitive emotions: Their changing role in communication between mother and infant. In: Affetti: Natura e Sviluppo delle Rela,zione Interpersonali, ed. M. Ammaniti & N. Dazzi. Rome: Laterza, pp. 97-139. Tronick, E. Z., Als, H. & Adamson, L. (1979), Structure of early face-to-face communicative interactions. In: Before Speech, ed. M. Bullowa. Cambridge: Cambridge University Press, pp. 349-372. - - - - - - - - - Wise, S. & Brazelton, T. B. (1978), The infanes response to entrapment between contradictory messages in face-to-face interaction. j. Amer. Academy Child Psychiat., 17: 1-13. - - - & Cohn, J. F. (1989), Infant-mother face-to-face interaction: Age and gender differences in coordination and the occurrence of miscoordination. Child Devel., 60:85-92. - - - & Gianino, A. F. (1986), The transmission of maternal disturbance to the infant. In: Maurnal Depression and Infant Disturbance, ed. E. Z. Tronick & T. Field. San Francisco: Jossey-Bass, pp. 5-11. Truby, H. M. (1975), Prenatal and neonatal speech, pre-speech and an infantile lexicon. In: Child Language, a special issue of Word, The J. Internal. Linguistic Assn., 2 7: 1-3.



Van Rees, S. & de Leeuw, R. {1987), Born too early: The kangaroo method with premature babies. Video by Stichting Lichaamstaal, Scheyvenhofweg 12, 6092 Nk Leveroy, The Netherlands. Watson, J. S. (1972), Smiling, cooing and "The Game." Mm'ill-Palmer Q.gart., 18:323-339. Weinberg, M. K. & Tronick, E. Z. (in press). Maternal depression and infant maladjustment: A failure of mutual regulation. In: The Handbook of Child and Adolescent Psychiatry, ed. J. Noshpitz. New York: Wiley. White, R. W. (1959), Motivation reconsidered: The concept of competence. Psycho[. Reu., 66:297-333. Winnicott, D. W. (1960), Ego distortion in terms of true and false self. In: The Maturational Processes and the Facilitating Environment. New York: International Universities Press, 1965, pp. 140-152. Wolf, E. (1976), Ambience and abstinence. The Annual ofPsychoanalysis, 4:101-115. New York: International Universities Press. Wolff, P. (1963), Observations on the early development of smiling. In: Detmninants ofinfant Behavior, ed. B. M. Foss. London: Methuen. Yarrow, L. J., McQµiston, S., MacTurk, R.H., McCarthy, M. R, Klein, R. P. & Vietze, P. M. (1983), Assessment of mastery motivation during the first year of life: Contemporaneous and cross-age relationships. Devel. Prychol., 19: 159-171. Zahn-Waxler, C. & Kochanska, G. (1988), The origins of guilt. Nebraska Symposium on Motivation (NIMH), pp. 183-258.

On the Resistance to Child Analysis: Problems of the Parent and the Analyst SAMUEL WEISS

As a child analyst and as a supervisor in child analysis and child psychiatry I have had an opportunity, over many years, to witness what I consider a ubiquitous phenomenon. Parents bring their children for help and most of the time deny them that help. These are children who are in need of help, sometimes desperately so. Although many of these parents come as a result of the pressures or recommendations of outside sources, like schools, other physicians, or clinics, many times it is the parents themselves who express concern about their children and are thus self-referred. Yet, when it comes to the actual recommendation for treatment, they balk. These same adults often do not hesitate to get help for themselves. But they find excuses to back away from treatment for their children. A 12-year-old girl was referred because she had a learning disability problem, asthma, low self-esteem, and her spirit had dried up, the parents said. If I were pretty, she had said, the boys would like me. She actually was pretty. But she was cautious, and she gave up too easily on her interests, like dance, piano, and Sunday school. Her father, who was the motive force in bringing her, seemed to suffer her pain, he was so tuned in to her. But when it came time to follow through on the child analyst's recommendation for treatment, he balked and said that he had been in treatment for the past 15 years and it had not helped him. His own analyst continued to encourage him to get help for the girl, since the father kept on reporting to him on how poorly she was doing. But after several years, nothing had been done. An 11 1/2-year-old boy was brought by his parents because he had become physically aggressive, a bully. Schoolmates were afraid of him. He had a learning disability problem and an exotic but not life-threatening genetic disorder. He was interested in children who were ill and was afraid he would die young. In consideration of the distance the patient and family 79


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had to travel, the analyst agreed to twice-a-week therapy. The aggressive behavior disappeared almost immediately. The patient was clearly a very hungry boy. But he also revealed himself to be a bright, creative person, totally unexpected by this family. Academically he had always been a failure. After 2 months of treatment, the mother announced one day that this would be his last appointment. The father had said that the treatment was driving them all crazy, and therapy stopped. Three months later, his maternal grandparents came to see the child analyst. They felt their grandson had improved during treatment and that he had partially slid back since he had stopped. They wondered what they could do to help get him back into treatment. But nothing further was heard from this family. Two siblings, a girl age 8 and a boy age 6, were brought for urgent help. Four years before, their parents had been killed in an auto accident. They were then placed with the father's brother and his family for 3 years. Following a disagreement between the grandparents and the surrogate parents, the children were summarily removed. They were then placed with the father's sister and her family in a distant city. It was these surrogate parents who came to see the child analyst with some urgency about these children. They were fearful the boy might grow up to be a killer. They felt they could hardly make contact with him; he did not listen to them. He was imitative. The girl was felt to lack self-esteem. She was aggressive and had been diagnosed previously as hyperactive. She was also seen as a liar and malicious. Both children were evaluated. A recommendation was made for intensive treatment for both, hoping to avoid the need for residential treatment. Although these new surrogate parents had come originally about the boy, they quickly insisted on help for the girl as well. The analyst agreed to treat the boy and found another analyst to treat the girl. The parents felt this was impossible, since the mother would have to transport both children as well as look after her own child. After some soul searching and consultation, the first child analyst agreed to treat both children, back to back, at a frequency of three times a week, which was all the parents felt they could manage. After four appointments, the father pressured to cut back to twice a week because of construction going on in their new apartment, which required the mother's attention. After one more appointment, the father called to say they were discontinuing the treatment. They felt that the children needed more time in a social situation, like after-school activities rather than in treatment. He agreed to let them come one more time to say goodbye. The next morning he called to say that they had decided that that was not necessary. So for the third time, these children were suddenly and without warning abandoned.



A 9-year-old girl came into analysis after having been sexually molested repeatedly from age 5 to 6 by her 13-year-old male babysitter. The child was able to tell the analyst what she had not been able to tell her parents. They had been led to believe there had been only a single incident. In addition, there was a nightly bedtime routine between father and daughter that excluded the mother. Father said to the analyst, "She is developing breasts now. She is not my little girl anymore. She wanted it too much," he said, meaning their nightly routine, but it -sounded very much like a sexual statement. Just before the analysis began, the father expressed considerable ambivalence about therapy. He reported that his psychiatrist had said, "Why analysis, why not antidepressants? These things happen all the time." The parents fought over the issue of analysis and the child then decided that she did not want it. Thinking of coming to the analytic sessions disturbed her, she said. Father then mentioned that mother had been molested as a child, which she confirmed. After 2 months of analysis, the family went on a 2-month summer vacation, with the analyst's agreement. At the first scheduled appointment following their return, there was no show. The analyst called and mother said they had decided on the previous night not to continue the analysis. Mother at first presented a picture of the child being adamant against resuming the analysis, but later acknowledged this to have been an exaggeration. It became clear that it was the mother, not the father or child, who was opposing the analysis. Mother asked, "Is it possible that a lot of frantic activity may be warding off a depression?" The analyst said yes. "Then we made a mistake," said the mother, but she did not offer to have the analysis resume. A mother brought her 12-year-old son for help. He had been very unhappy and had talked about killing himself by jumping from the balcony of their high-rise apartment. In the second grade the teacher had been concerned that he was depressed, but nothing was done then. The mother had come from a very impoverished background, was seriously phobic and had been anorectic. Most of her own help had come from a woman friend who had been analyzed, and who became her support. This woman had died 2 years before this referral. As she was dying she said to this mother, "Who will love you when I am gone?" One thought about the referral was that the mother was now looking for some kind of help for herself. The father was a very constricted person. He emphasized that there was nothing wrong with his son, that he did not want there to be anything wrong with his son, and that he felt his son did not need professional help. "You'll reassure my wife," he said. "That's my wish." The father's older sister, before he was born, fell from a high rise apartment window at age 2, survived but with brain damage and had been institutionalized ever since. This information had come from


Resistance to Child Analysis

the mother. The analyst's recommendation, based on a clinical evaluation and on projective tests, for intensive treatment for this child was perceived by the parents as a great threat and they sought another opinion, preferably from a non-Freudian. They ended up seeing another child analyst, who made the same recommendation that the first one had made. The patient entered analysis with the second analyst despite great reluctance on the father's part. This analyst was never told about the father's sister. Now, after a period of treatment, the analysis is moving very slowly but the mother is now worried that the father may be becoming suicidal. Is there a relationship between the neglect of children's needs for therapy and the historical neglect and abuse of children? Are they on some kind of continuum, with similar explanations? In recent years the seemingly universal abuse of children has been uncovered. Miller (1983) has detailed in her books the psychological abuse of children, usually under the guise of good child-rearing. She feels that as adults we experience the need to rid ourselves as quickly as possible of the child within us and that when we encounter this creature in our own children, we then persecute it with the same measures once used on us. Miller cites many references on child rearing that support efforts at intimidating the child, humiliating the child, physically abusing the child, all justified in the service of so-called good child rearing. Ross (1982), perhaps reflecting our increasing awareness of parental ambivalence and even villainy against their offspring, has focused on Laius, Oedipus's father, as the true villain of the Oedipus myth, not Oedipus. He notes that Freud (1905), in concentrating on Oedipus, had totally neglected Laius. Ross emphasizes that Oedipus was a good king, a good husband to his wife, and a good father to his children. In contrast, Laius was a bad person. "Taken as analytic allegory, the chronicle portrays the Oedipus complex not merely as a 4-year-old's psychic fiction but also as an outcome of generations of bad parenting" (p. 175). Laius himself had been abandoned as a child. He later kidnapped and raped Chrysippus, the beautiful son of King Pelops. A curse was put upon Laius for this. He was condemned to be childless or to have a son who would murder him and take his place in bed with his wife. Thebes, the seat of his kingdom, was put under a cloud. The Sphinx was sent to terrorize its inhabitants. Later, when Oedipus was born, Laius had the infant's ankles pierced with a spike and he was then abandoned on a mountain to die. Freud's discovery of the Oedipus complex and his abandoning his "seduction" theory seem to have been very much related to the death of his own father and to the anniversary of that death. At age 55, Freud acknowledged having hostile envy toward his own son, then extended it to a theory of the old envying the young. But as Ross ( 1982) emphasized, "Psychoanalytic



developmental theory ... remained essentially a psychology of sons and their filial conflicts" (p. 175). It is quite fascinating, given this apparent ill will towards children, that these same children have a need to idealize their parents, even in the face of the cruelty or neglect. They will often even take on the externalizations of the parent to help the parent in his own coping. In one case of the analysis of an 8-year-old girl, the father brought her for analysis because he was worried she would grow up to be like his brother, after whom she had been named, who in a depression had killed himself. At the diagnostic, the girl played out a story in which a girl was in a coma and a doctor operated on her and saved her. Three years later the father was in a coma, having attempted suicide. The patient came in to her analytic session saying, "Isn't it amazing that my father is dying of a heart attack at the same age that my uncle died of a heart attack?" She was not accurate as to the details but her unconscious did make an appropriate connection. It then turned out that the grandfather had also committed suicide when the father was a small child. It had apparently become the destiny of males in this family to kill themselves. The father, apparently in an attempt to save himself, had designated this child to carry his own destiny. He had named her after his dead brother. She grew up wanting to be a boy, acting in a manner that impressed the parents as retarded. The enactment of a girl in a coma in the diagnostic was of course overdetermined. The analyst did not know then of the destiny issue. He had understood this behavior as the girl's oedipal wish, to be operated on by the doctor-father, while she herself disowned such a wish. In the course of the analysis, many aspects of her masculine identification, partly connected with the mother's uncertainty about her own femininity, were analyzed. The matter of her school failure was also addressed in terms of oedipal issues. Gradually, enough of a shift took place in these issues so that she became a good student and became interested in being a girl. She became quite attractive as a girl. The father was confronted with his daughter no longer being available for the externalization of his own unconscious needs. He could have sabotaged the analysis. He could have tried to shift to his other child. Or he could have taken this burden of destiny back onto himself, which he did. The same seems to be happening to the father of the 12-year-old boy, alluded to earlier, who had threatened to kill himself by jumping off the balcony of his high-rise apartment. Why had these children been willing to sacrifice themselves for their fathers? Mahler ( 1965) has described infants adapting to the unconscious and even pathological needs of the mother, presumably to maintain the contact. In the Oedipus myth, Laius was so clearly the villain and Thebes Was being terrorized because of a curse on him. Oedipus, in effect, rescued


Resistance to Child Analysis

his father. He answered the question of the Sphinx and thus lifted the curse. The father's cloud was then replaced by the son's cloud. Oedipus sacrificed himself for his father. Sophocles and Freud chose to ignore the Laius story and made it the story of the son. As I have noted in another context (Weiss, 1988), "The father's impulse to harm the son Freud constructed as a projection. It was the son's own fantasy, which then got externalized onto the father and aimed back at him. And then it was generalized to the status of archetype. He could in this way avoid blaming first his father and then himself" (p. 379). The girl and boy mentioned above were prepared to stand in for their fathers. Oedipus was prepared to stand in for his father and accept the guilt for the father's terrible misdeeds. There is considerable evidence that Freud likewise protected his own father. When he spoke of the sexual exploitation that parents make of their children, he wrote to Fliess, "Then there was the astonishing thing that in every case, not excluding my own, the father had to be accused of perversion" (Krull, 1986, p. 54). Later, when his father died, Freud said the death of a father is "the most important event, the most poignant loss, of a man's life" (Schorske, 1981, p. 186). He then became paralyzed in his work and could not write, until he renounced the seduction theory. Again, the protection by the child of the parent. The Oedipus complex is a theory about a child. There is little evidence of any theories that Freud had about adults as parents rather than about adults as children in their relationship to their parents. It is the unique situation, with our adult patients, that we conceptualize ourselves in a son or daughter transference. The older patient might in fact experience us as their child. In the past we solved that problem by suggesting that older people are not analyzable. It is still uncommon for anyone over age 50 to be in analysis, but less so than in the past. Our conceptual outlook is almost always in terms of the patient as child and the analyst as parent. Sometimes we can see ourselves as siblings. We have reinforced this view with our theories, which emphasize that transference refers to issues of the distant, repressed past and therefore to the childhood of our patients. We can also guard against our own regressive tendencies and thus emphasize our role as parent in relation to the patient. There are important reasons that we need to avoid the child in ourselves and that parents need to avoid the child in themselves. So a very important source of a powerful resistance to child analysis, stemmming from both parent and analyst, is laid down. Parents face an opportunity and challenge of reworking their own childhood at each developmental stage of their child, as Benedek (1970) emphasized many years ago. But this may also mean reopening many of the actual



and imagined terrors and traumas of childhood. These repressed and distorted memories have often acted as important organizers of the parents' personality and. helped to_ shape their histo~ical narrativ~, their mytholo~, if you will, of their own childhood. All of tlus can potentially be brought mto question by their own child's development. The cited references above give us just a glimmer of what we need to defend against. Externalization and projection are frequent mechanisms that are used by parents to deal with the onslaught of feelings that threaten their repression. An 11-year-old boy in analysis was preoccupied with aggression, building pretend bombs, bringing in knives, even a plugged-up gun. He was always about to visit destruction on the world. His drawer in the consulting room housed his "fecal" aggression. It was a mess of papers, candy wrappers, and junk, to a point where periodically he could not open the drawer, it had become so filled. At certain times he would clean out the drawer. What had contained his anal aggression was thus released. But invariably, he would then do something that would end up as an attack on himself, not on others. His stepmother, who had just had a baby of her own, became terrified that this boy was going to harm her baby. The analyst felt quite secure in reassuring the parents that he would not harm their baby, that any aggression that emerged was always turned on himself. This stepmother was subsequently hospitalized for medical reasons. During the hospitalization, she was given projective tests, which showed her to be strongly infanticidal. The patient was an almost perfect target for her externalizations. In the case of the suicidal destiny, there too the father was able to externalize his own destiny onto his daughter, such daughter being designated by being born shortly after the uncle had committed suicide and by her having been named for him. Another, older daughter was not the target of the father's attempted externalization. In the case of the boy who had thoughts about jumping from the balcony of his high-rise, there too the father's unresolved issues regarding his older sister, who had fallen from a high window, were somehow being externalized onto his son. Externalization, be it of affects or id-derivative expression, are possible only if the object of the projection supports it. It is a common defense mechanism most prominent in childhood. An important criterion of externalization is that the environment must accept the externalization for it to Work. Brodey (1965), in a paper on narcissism, used an example of its failure. A mother on the verge of a psychotic break tried to externalize her illness onto her infant to rid herself of her own illness. She worried that he was the one who was terribly sick. She rushed him to the pediatrician, who examined him and said there was nothing wrong with the child. The mother's


Resistance to Child Analysis

externalization defense, an attempt to put her illness outside of herself and onto her child, failed and the woman then had a psychotic break. Children need the attachment to their parents and remarkably are quite willing to accept the externalizations onto them, to protect the parent even in the face of their own suffering. Parents are rarely willing to make the same sacrifice for their children. To a remarkable degree, we all need to repress or disavow our own affective childhood experiences. We need to falsify, idealize, or otherwise change the event, the figures, or the affects into something other than what they were or how we had experienced them at the time. We need to create a myth of our childhood to avoid being overwhelmed; in order, I think, to maintain the support of our internalized introjects without feeling persecuted by them. These introjects, perhaps part of the fabric of our false selves that Winnicott {1960) alluded to, are part of our illusory good past which forms the basis of our personal historical narrative. The degree to which these introjects are crucial to our internal stability, to our soothing and selfregulating functions, to that degree will they be more or less fiercely defended. These internalized introjects very likely derive both from actual experiences as well as from the experiences that get distorted by the infantile magical theories that dominate young children's thinking. In some adult patients, coming into analysis, the initial presentation may in fact include a hostile view of the parent. This initial presentation, which often forms the basis of a defense transference, would seem to go against the idea of the child's need for the idealization of the parent. But I have often found that the hostile or negative view of the parent is fairly close to the surface and is not hard to uncover. It is often at the level of the preconscious rather than the unconscious. But this view often covers over the idealization. And it is only when the idealization is analyzed that the deeper underlying hostile view can emerge. And this then has to be analyzed to reach the hostile parental introject rather than the hostility to the parent. The analyst, in analyzing the adult patient, is generally satisfied in reconstructing a kind of fictionalized version of the past. It is at best an attenuated version of reality, but one that satisfies the patient and the analyst and leaves relatively intact the repression of their respective childhoods. Freud, faced with this dilemma, solved the problem by saying that his seduction theory was wrong; it was all fantasy. It had nothing to do with reality, often a reality that stared him in the face, as in the case of Dora. Another important defense mechanism used by the child to preserve the relationship with the parent is identification with the aggressor. A 7-yearold boy, in analysis for depression and encopresis, would order the analyst around. He was the king and the analyst was his slave. Or he was the master



and the analyst the servant Or he would insist that the analyst copy himmitror him-exactly. The analyst could rarely have a will of his own. He was able to relate this to the child's many congenital illnesses, in which he was at the mercy of other forces, in which he felt helpless, just like the analyst did in the analysis. Outside the analysis, he was also trying to be the boss, but only with children. Some children would complain or not play with him. But at a Passover seder, as the story of the exodus from Egypt unfolded, he went over to his mother and said, You are the pharaoh and I am the slave. The mother was embarrassed when she recounted this story to the analyst. She felt guilty for being overly bossy with her son. In his analytic sessions and in society at large, it was rare that he exhibited the slave view of himself. Rather, he was the boss, the king, the master. Thus, his own sense of helplessness in relation to his mother, his congenital illnesses, and his encopresis was defended against. And thus the potential for a characterological revision of his history was in the making. A child needs to cope with his smallness and sense of helplessness in relation to the adult world on the one hand and also deal with his own grandiose and often destructive impulses on the other. Perhaps it is only through the concept of a complementary series that we can understand that these two forces operate in tandem, with one position being a defense against the other position in a circular fashion. The child's grandiosity becomes a defense against his helplessness in the face of the evil forces in reality and in his imagination. Simultaneously, his own hostile impulses are projected onto that world. Part of this is a projection and part of it is a reprojection of the internalized evil of the outside. This then gives some urgency to the need to protect against the real and projected hostile world. Grandiosity helps to make the child immune to the dangers. Idealization of the environment also is his attempt to protect himself. The grandiosity, however, in protecting him, also makes the aggressive and/or sexual impulses potentially more realizable. A retreat then to a small, helpless state protects the child against his own impulses but once again subjects him to the outside real and imaginary evil. Freud himself shifted his position to look upon this issue in only one way. From a belief in the noxious influence of the environment, he finally concluded that it was the child's projection of his own wishes, whether of aggressive or of sexual intent, that had to be dealt with. Reality therefore had to be perceived as benign or noncontributory. The child, in the face of this dilemma, where no solution is satisfactory, will attempt disavowal of the internal state, denial of the external state, and repression, if that is possible. All of this suggests the potential for an unstable situation. One major threat to this stability is the child's development, especially as he becomes a


Resistance to Child Analysis

parent, with his child going through the same developmental states that created the stresses on him when he was a child. If the parent is confronted with a hostile introject of his own parent, regardless of whether this derives from actual traumata or perceived and imagined ones, then there is danger of a persecutory anxiety and a conse• quent urgency to remove that threat, a threat that can range from castration fear to annihilation anxiety. The parent will now use a variety of defenses to protect himself. One major defense would be externalization, a revival of a major defense of childhood, in which the unacceptable impulse, affect, superego attitude, and even constellation of earlier events are now seen to reside in the child and not in the parent. As I have suggested, the child will often accept this externalization as a way of protecting not only his reality parent but, more importantly, the internalized parent. One can postulate that the building blocks of the personality, which provide cohesion, stability, soothing, and regulation, originate with the internalization of a relatively unambivalent introject. If the introject is perceived as persecutory, then the situation is dangerous and further emergency defenses will have to be erected. One solution could be the elaboration of a false self, in Winnicotes sense. That false self would be the falsification of the introject as benign and unambivalent, a forerunner of idealization. If the parent is threatened by the presence of the child and his develop· ment, if the parent is threatened by the revival of his own ambivalent relationship to his own parent, then the idea of therapy for the child becomes an additional threat. It also offers the dangerous possibility of interfering with the parent's defenses. Yet, the idea of analysis or therapy is also initially appealing to the parent. It offers the possibility of some rapprochement and restitution between the self and object introjects. It provides an opportunity therefore of a reworking of old conflicts and old solutions. Analysis is not, of course, the only opportunity for structural revision. The impact of one's own development and then the impact of one's child's development provide such additional opportunities. From a narcissistic standpoint, the therapy given to the child also accrues to the parent. But from the object standpoint, therapy for the child requires a greater balance of love and protection of the child than a self-protection of the parent and may even require a personal sacrifice on the part of the parent, as in the example of the suiciding parent. Many parents do make the initial effort, bringing their children for analysis. But only a few remain beyond the diagnostic. And many treatments are interrupted as the child starts to improve. Brodey (1965) notes that "in the narcissistic predicament, the therapist of a child who has begun to improve knows the danger-the child will be withdrawn from treatment if his illness does not continue to externalize the parents' conflict" (p. 181182). It is dangerous for parents if their own repressions become undone.



The analyst faces the same dilemma as the parent. But the analyst and the adult patient face each other with the same constellation of defenses and coping mechanisms. The danger of a significant regression is thus minixnized. They are both largely well defended against experiencing the intensities of their respective childhoods. And they can thus agree on a historical narrative that is acceptable to both. The child analyst or child therapist is confronted with a structural organization in his child patient that is different from his own. The potential then for a reawakening of his own affective past is much stronger. The child is less prepared to collaborate with or corroborate the analyst's narrative. The child analyst thus has to institute protective measures for himself. He may subtly support a parental flight from the analysis. This is especially visible when the child starts improving and the analyst will then often support the parent's wish to withdraw. Or he may take on the role of parent with the child and/or parent. In that role he becomes more education-and guidanceoriented and thus supports identificatory processes in both child and parent, which favors covering over much more than uncovering. Or he may regress with the child. There are parents who have achieved a balance between their narcissistic love and object love for the child. They likely can tolerate the changes in the child and the possible reawakening for them of their own childhood experiences. It may even afford them a positive opportunity for a reworking of their own past. Other parents, like the suiciding father, are willing to make a sacrifice for the child. It may be a blend of their need for some kind of restitution as well as a stronger object love than a narcissistic one. It seems to me that a major path that we, as analysts, need to take is that of attempting to address the childhood that is reawakened in us as we face the child. As a result of our own analyses and our being more in touch with the child in us, we have, it is hoped, used this as an important empathic road to understanding and experiencing the child and his past. Is it possible that we can use that experience to put us in empathic touch with the parent as well? In the past, we have often looked upon parents as the enemy. In that context, only orphans could be analyzed. Can our empathic understanding of the parents help them overcome the hurdle in dealing with their own childhood revivals and introjects and the intense defenses against them? But they are also not the patient and we cannot treat them. This makes for difficulty. Empathy in itself is surely not enough. And analysis of the parent by another analyst does not necessarily lead to less resistance, as in the example of the 12-year-old girl. Yet, we need to form an alliance with the parents so that they will support the analysis. That alliance is essential. Yet it also is fraught With danger, because a strong positive transference that the parent develops


Resistance to Child Analysis

towards the analyst, which initially helps to support the child's analysis, may ultimately undermine that analysis. It may be much later, years later, for example, that one discovers that the parent's hidden possessiveness of the child's analyst prevents the child's later access to the analyst. But perhaps even more importantly, it may interfere with the access of the analyst as an introject. The suiciding father fired his own therapist fairly quickly after his medical resuscitation. He insisted that the child's analyst had saved the whole family. At termination, the mother burst into tears, somehow assuming that the parents would continue with the analyst. Ten years later, the girl returned for a visit and told the analyst that she had felt, after her termination, that the analyst now belonged to the parents. That possessiveness had clearly blocked the girl's return. Sometimes an unconscious drama may be enacted in which the analyst needs to be cathected by the former patient in a covert way, perhaps duplicating the original incestuous fantasies, so that the previous analyst becomes the desired incestuous parent of childhood, while the real parent takes on the role of hated competitor. At some level, we have to meet some needs of the parents. It is difficult to titrate the intensity of their transference, and we cannot analyze it. How we try to achieve an optimal situation with the parents varies with each situation, based on their personality organization and needs and also on our own. It is this issue of the parents, how we fit them into the picture in a way that supports the child's analysis, that constitutes one of the challenging but occasionally rewarding experiences of child analysis. I would like to illustrate two approaches to the problem of dealing with parents during the course of the child's analysis. Clearly they represent different theoretical ways of coping with this problem. At one international child analytic meeting, a clinical presentation was made in which the analyst's bringing the parent into the analysis had become a real possibility. The patient wanted the analyst to intervene with a sexually seductive father who was making her uncomfortable. The mother of this teenage girl had refused to intervene. The analyst, with many misgivings, decided to maintain an analytic stance and not see the father. This analyst made out an impressive case for the position that she took. The subsequent analysis, as she reported it, supported her maintaining this stance. The analysis was seemingly successful and progressed to an analytic termination. At another, similar meeting, in contrast, the child analysts took an opposite position: they saw the parent's introduction into the analysis as aiding the analysis or even making an unanalyzable situation analyzable. These analysts also justified their own stance.



What are the compromises that we have to make in order to do child analysis? Although we have to be aware of the danger of our need to defend and rationalize whatever theoretical and technical position we might elect to take or have been thrown into, there is also clearly a need to be creative in doing child analysis and there may be many models that can be pursued, although likely each with its own consequences. We have to ask ourselves, What are the consequences for the child's analysis, both at the time of the intervention and for the future, of including or excluding a parent from the analytic situation? We often can't know. And we need to live with our uncertainties and the need to tolerate the knowledge that there may be a number of routes to so-called analytic cure. But is analysis ever complete? Or do we have to accept that under certain conditions, in a given time and place, some analytic work was done and there were limitations imposed on the analytic process by the child, the parent and the analyst. Some things could get analyzed now and other things could not. At another time and another place, often even with the same analyst but perhaps with a different one, other aspects of the personality might get analyzed. All three participants-the child, the parent, and the analyst-are usually then in a different place maturationally, developmentally, and psychologically, which might allow for additional aspects of the personality to be approached analytically.

References Benedek, T. (1970), The family as a psychologic field. In: Parenthood. Its Psychology and Psychopathology, ed. by E. J. Anthony, & T. Benedek. Boston: Little, Brown, pp. 109-136. Brodey, W. (1965), On the dynamics of narcissism: I. Externalization and early ego development. The Psychoanalytic Study of the Child, 20: 181-182. New York: International Universities Press. Freud, S. (1905). Fragment of an analysis of a case of hysteria. Standard Edition, 7:7-122. London: Hogarth Press, 1953. Krull, M. (1979), Freud and His Father, trans. A. J. Pomerans. New York: Norton, 1986. Mahler, M. {1965), Mother-child interaction during separation-individuation. In: The Selected Papers of Margaret S. Mahler, Vol. 2: Separation-Individuation. New York: Aronson, 1979, pp. 35-48. Miller, A. ( 1983), For Your Own Good: Hidden Cruelty in Child-Rearing and the Roots o/Violence. New York: Farrar Straus Giroux. Ross, J. M.(1982), Oedipus revisited; Laius and the "Laius Complex." The Psychoanalytic Study of the Child, 37:169-200. New Haven, CT: Yale University Press. Schorske, C. {1981), Fin-de-Siecle Vienna. Politics and Culture. New York: Vintage. Weiss, S. (1988), How culture influences the interpretation of the Oedipus myth. In: The Oedipus Papers, ed. G. H. Pollock & J.M. Ross. Madison, CT: International Universities Press. Winnicott, D. W. (1960), The theory of the parent-infant relationship. In: The Maturational Processes and the Facilitating Environment. New York: International Universities Press, 1965, pp. 37-55.



Psychoanalysis and Knowledge: Part 1. The Problem ofRepresentation and Alternative Approaches to Learning FRED M. LEVIN

This essay and its companion essays 1 are conceptualized as a sketch of some of the issues involved in a psychoanalyst's thinking about knowledge in relationship to two things: the workings of mind and brain, and the clinical situation of psychoanalysis. In particular, I start with a discussion of the problems inherent in conceptualizing mind/brain activity in terms of internal "representations." In its place I propose a more complex understanding of interrelated mind/brain processes that involve learning. Such learning is the result of brain plasticity and depends upon neural systems that change in relation to experience. Any psychoanalytic theory of learning or personality must be consonant with what is known about learning, memory, and knowledge formation from neuroscience (Cloninger, 1991; also see companion essay, Part 2 of this essay). Of course, it will simultaneously take into account such psychological variables as the fate of the psychoanalytic transference. In what follows I consider specific recommendations that one can expect to facilitate learning in general by creating or properly exploiting learning readiness. The argument is made that these general strategies are usefully

Part of this paper was presented October 12, 1994, to the Houston Psychoanalytic Society, Houston, Texas. The author wishes to thank Drs. Robert Galatzer-Levy, Charles Jaffe, and George Klumpner for their input on an early version of this paper. 1 The first companion essay, Psychoanalysis and Knowledge: Part 2, deals with the special relationship between the psychoanalytic transference, the judging of similarity and transfer of knowledge, and the priming of memory. The second companion essay, Part 3, examines some complex philosophical questions that enter into our psychoanalytic theories and affect the analyst's neutrality and interventions. 95


Psychoanalysis and Knowledge: Part 1

employed in the specific psychoanalytic clinical situation for the creation of "learning windows.,, Each generation of theoreticians must ponder difficult questions regarding the nature of knowing and thinking, squaring their scientific theorizing with their religious/cultural beliefs. Since Kant's concentration on these issues two centuries ago we have advanced in our understanding of the material universe, including many details about our brain and behavior; yet in terms of sorting out which are the most useful "categories" to facilitate further scientific progress we still and always will face substantial challenges (discussed in the companion essay, Part 3). For example, consider the category designated by the word "representation," which is popular within neuroscience, cognitive psychology, and psychoanalysis. One can ask if we really understand the precise meaning of this term, or whether any substantial or useful part of its meaning is actually shared by these three disciplines. Neurologically the body is conceptualized as being "represented" within the brain in various feature maps based upon the different sensory modalities. This is a relatively concrete, physiological meaning of the term "representation" in which the word indicates that some experience is coded in memory. This neurological meaning appears to make sense, since there is evidence that at times our reasoning proceeds by way of a process of internal "imaging" and the manipulation of visual, perceptually near experience. Consider, for example, the circumstance of being asked to look at a geometrical figure and judge if it is the same or different from another figure drawn from a different perspective. The reaction time to accomplish this task seems to depend upon how much mental rotation is required of an assumed internal image. However, although this concrete physiological definition of "representation" seems clear enough, the exact meaning in terms of brain function is not altogether unambiguous. For example, in his On Aphasia {1891) Freud carefully describes how during the imaging process what one ends up with is not likely to be an exact point-for-point correspondence at the brain's cortical level, but rather a looser "representation" ( Vorstellun~ of the origina] sensory input, which has been transferred across numerous synapses and finally becomes part of a rich network of meaningful associations (Rizzuto, 1990; see also Reiser, 1980). As I have noted with Vuckovich (1983), Freud's neurological speculations on language disturbance become a significant precursor to his later psychoanalytic conceptualizing. And, as Rizzuto (1990) points out in elegant detail, Freud's views on the nature of brain "representation" are a cornerstone of his On Aphasia. In any event, one can only conclude that even within neurology "representation" has a set of meanings rather than any single referent, although most of these are principally tied to



the remembering and imaging processes, that is, to aspects of working I11emory. The problem of defining representation becomes more complex, however, when imprecise neurological concepts such as self- and object representation are amalgamated with even vaguer psychological constructs such as "self' and "object," and imported into psychoanalysis, for example, by Sandler and Rosenblatt {1962). Although these scholars are careful in their evocation of a helpful metaphor, nevertheless, all subsequent theoreticians run the risk of working such original ideas into a reified web, seemingly explaining and contrasting in the process certain core psychoanalytic phenomena of even greater abstraction such as those subsumed under the rubrics of "introjection," "identification," and so-called "psychic structure." An aside may help, since the reader will appreciate that in criticizing the use of the word "representation" in psychoanalysis I in no way intend to denigrate the efforts to understand and delineate such core psychoanalytic concepts as are covered by such terms as "introjection" and identification." In fact, I personally hold these ideas to be prescient psychological constructs on the road toward a meaningful interdisciplinary theory of knowledge acquisition. This I try to spell out later in this text, where I remind the reader of the pioneering work of Rapaport who integrates the insights of Freud, Hartmann, and Piaget. Rather, I am addressing the danger of overusing the ambiguous term 'representation' and thereby avoiding acknowledgment of our general ignorance of how mind/brain actually works. A second example of this linguistic trend in modern psychoanalytic conceptualizing is the work of Bucci (1985, 1992), who describes essentially three elements as internally represented:· the nonverbal, the verbal, and correlations between the two (which she calls the referential). 2 Not unlike Bucci, I myself have written repeatedly of how the mind/brain represents different aspects of mentation, which can then be either isolated or integrated with various purposes in mind. For example, I have speculated that


Bucci (1985) describes four models of representation: (1) verbal mediation, in which memories are coded verbally, (2) a modal common code, in which all inputs into long-term memory are coded in an abstract, common code (whether the data coded is verbal or nonverbal, (3) perceptual dominance, in which coding is a function of the perceptual-sensory modality involved, and (4) dual coding, where two distinctly different codes each participate, one for verbal and the other for nonverbal experience. Bucci favors the last system, claiming the support of experimental psychology research, pointing out the ready application of this dual coding model to psychoanalysis. Interpretations are understood to facilitate a "referential" system that bridges verbal and nonverbal worlds. I personally find Bucci's interest in a referential system attractive but I think it has no bearing on the question, which I believe is not really answered yet, as to which system of coding is actually employed by the mind/brain. Readers interested in this particular debate may wish to consult Levin (1991, especially pp. l[n)42, 145[n] 164, 193, and 201[n]218).


Psychoanalysis and Knowledge: Part 1

over the course of development we build a self-in-the-world model, the manipulation of which allows us to think without recourse to obvious sensory experience (that is, without apparent manipulation of the real world). In so doing I would seem to have obviously cast my lot with those within psychoanalysis who believe in "internal representations." Yet the more I have pondered over such terminology the more I have concluded that the very conceptualization of "internal representation" within psychoanalysis has lost its precision and utility, although the perspective may yet be important as a handy image to manipulate (that is, rather than anything correlatable with objective reality in the mind/brain). The problem, as I see it, is that we are most unclear whether psychoanalytic internal "representations" are concrete sensory (reference) images for the brain to manipulate, the memory of such images, epiphenomena associated with remembering and/or information processing and working memory, mere metaphors (for "gedanken" experiments), each of these, or something else! Unfortunately, the ambiguity of the terminology leads to considerable confusion and the mere illusion of insight. Most critically, the vagueness of the idea of representation sets an arbitrary conceptual limit on the amount of insight we are ever likely to achieve about mind/brain correlative mechanisms. It also reinforces our failure to look for the details of how mind/brain accomplishes its activities, because one does not look for what one believes one already has in his possession! But cognitive psychology's conceptualizations of "representation" appear equally ambiguous; moreover they are primarily based upon a rapidly aging analogy between mind/brain and computer. Worse still, the psychological meanings of representation seem not only concrete but also subtly different from the meanings of "representation" as used in neurology and in psychoanalysis. First of all, computer memories are real, mechanical devices for storing and processing data. That they must actually function in ways unlike the brain/mind is not always appreciated. According to this view the computer has various types of memory (RAM, ROM, working memory, floppy and hard disk drives) and presumably such mechanical "memory" bears a relationship (albeit unspecified) to biological memory processes (sensory, short- and long-term, including long-term potentiations). To add to the confusion, psychology has its own set of meanings for "representation," as is the case of such "representational constructs" as semantic nets, frames, and scripts. These abstract categories have been proposed and have their own attraction as theoretical tools, partly because, as noted, these words also refer to concrete, computer-related software with utility in its own right. But a danger remains: Because these borrowed computer concepts are the basis for useful mechanical devices, the unwary are lulled into believing that this is how mind/brain actually works. That is,



because we respect computer technology we get drawn into believing the authority of neuroscientific and cognitive psychological pronouncement.s! 3 yet neuroscience and cognitive psychology are no more authori'tatative on the workings of mind/brain than are many other fields that study the same phenomena and no one in either neuroscience, cognitive psychology, or psychoanalysis knows definitively how information is actually coded in the mind/brain! Moreover, even experts within artificial intelligence note that "complete theories of knowledge representation [either for computer or human intelligence} do not exist noul' [emphasis mine] (Salton, 1991, p. 977). In summary, one must conclude that a major problem with the simultaneous reference to "representation" 4 (without further clarification) within neuroscience, psychology, and psychoanalysis is that these are three different sets of conceptions. Even if one argues that these meanings overlap, the net result of their combined usage can only be to obfuscate rather than to clarify. In a nutshell, the brain remains "a consummate piece of combinatorial mathematics" (Max Born, quoted in Eisley, 1975, p. 258). Where then do we go if representational terminology no longer enlighten us about mind/ brain?

Connectionism and Psychoanalysis Before proceeding, a word about neural networks. Some may object that in my discussion to this point I have not highlighted a connectionist description of brain function, and this may alter the apparent value of "representation." Connectionism, or neural net theory, poses a set of paradigms that are at times useful to our understanding of the brain. For example, Olds (1994) points out how such theories describe brain ·as "less dependent on [the concept of] a central processor" (p. 581). While this statement is technically correct, the situation in the brain is actually more complicated. According to the research of Posner (1993) and Lassen (1994), cognition involves the tying

3The artificial network structures (artificial intelligence) created by interdisciplinary teams are interesting and important models, but they do not answer the question as to how our mind/ brain accomplishes its specific tasks, that is, identify what subprocess are involved and which pathways of the brain support these activities. In this regard, some such experts have proposed that "representation" best refers to "patterns of activation" that comprise a particular neural network's response to a particular stimulus (Cohen and Servan-Schreiber, 1992). In such computer models nodes may represent concepts (ideas), directional arrows between nodes stand for relationships, and specified rules for inference govern the movement within the network, thus '.'1lowing for such things as computer diagnosis of complex problems. These ideas are interesting, but they are only half of the work: the remainder involves the more difficult project of making psychological-neurological correlations. 4 One might say that the idea of "representation is a bit like the natural sciences themselves: fallible, not indubitable ... and never entirely free of ambiguity or the possibility of error or oversight" (Davis and Hirsh, 1981, p. 347).


Psychoanalysis and Knowledge: Part 1

together of zones or brain cell collections that are both dispersed (i.e., function as neural networks) and highly specialized functionally (i.e., quite different from neural networks). The key, apparently, is how specialized populations connect in time and space in order to accomplish given cognitive tasks in assembly-line fashion. This anatomical-physiological wrinkle renders ordinary forms of neural network theory or neural connectionism limited in their human application, since the idiosyncracies of specific brain architecture are rarely referenced. For the purposes of this essay, however, the differences between a pure (i.e., simplified) connectionist approach and the more complex approach I suggest do not necessarily alter my conclusions about the problems inherent in the idea of internal representations. Actually, in fact, had I chosen to highlight a connectionist approach it would make my argument against internal representation even stronger (also see Forrest, 1987; Anderson and Rosenfeld, 1989; Spruiell, 1993). This is because representation, in the sense of its usual meanings, has virtually no fixed relationship to how any task is accomplished by the network. In a nutshell, the task is to understand how things work in mind or brain, and simplified neural network theory lacks the ability to clarify the "representational" process in any manner that convincingly mimics real minds and brains. In order to obviate the problems inherent in the conception of "representation" this essay therefore presents an alternative approach. The remainder of the essay is organized as follows. First the question of expert knowledge is introduced. This leads to two important considerations: cognitive psychological research on judging similarity and transferring knowledge between content domains, and a discussion of what is known about the varieties of knowledge, their acquisition and retrieval. We shall see that Rapaport's ideas of integrating Freud, Hartmann, and Piaget became the basis for the first systematic thinking of a psychoanalytic theory of learning, and how this was subsequently used as the foundation for outlining a modern learning theory and a hierarchical developmental model based upon integrating psychoanalytic and neuroscientific knowledge. Finally, there is a discussion of how these nonrepresentational conceptions and insights about the phenomenology of learning can be fashioned into practical means of evoking "learning windows" within the clinical psychoanalytic situation.

Comparing Experts and Novices: A Step Toward a Psychoanalytic Theory of Learning In Mapping the Mind (Levin, 1991) I suggest that the essence of memory is that each quantum of human experience infinitesimally changes the mind/ brain; in other words, memory involves tapping the brain's plasticity to



build databases of knowledge. Therefore, the process of remembering would seem to involve (exactly as Freud [1891] argues in On Aphasia) the recreation of the mental/neural events connected with the original experience itself. Our best approach to understanding how learning works would thus appear to be to steer clear of older theories of representation and instead concern ourselves with how the mind/brain organizes knowledge. Let us consider asking, for example, the following kind of question: What is it that makes experts tend to solve problems more efficiently than novices? Experts have the edge presumably because they are "more likely to have explicit, accessible [knowledge] of the relational structures of the content domain" (Gentner and Ratterman, 199 la, p. 36). Stated differently, experts are better able to recognize "similarity" between current and old problems and "transfer" the relevant knowledge (that is, apply the old solutions) to the current situation. What is especially useful about such a perspective is that is shifts attention from the ambiguous concept of "representation" to more precisely definable process categories (such as judging "similarity" and "transferring" knowledge), which can more easily become the subject of specific experimental manipulation and investigation. In addition, although this may not appear obvious, it seems possible that

what neuroscientists call priming and what psychoanalysts call transference might coincide with what cognitive psychologists label judging similarity and transferring knowledge. (See Part 2 of this essay.) If this proves correct, then to appreciate the phenomenon of priming mentioned earlier we need to study how we judge similarity, and how we transfer knowledge between content domains and in the psychoanalytic situation as well. Let me elaborate. Gentner and Ratterman point out (1991a; in press) that research on very young children, infants, and primates shows that innate mechanisms allow for the apprehension of relational similarity. Moreover, if one examines language, "the possession of names for relations, including [the words] same and different [as examples] may be [particularly] important for the appreciation of analogical similarity. This in turn suggests that the changes in knowledge that drive [the recognition of] changes in similarity do not simply consist of accretion of domain facts, but also include the deepening and systematization of the [individual's) knowledge base" (1991b, p. 227; see also the companion essay, Part 2, for an elaboration of some of these points). This could mean that when in a psychoanalysis a patient's out-ofawareness feelings are named and correspondences (subtle similarities and differences) noted between specific episodic experiences, then there is likely a simultaneous deepening and systemization of the patient's knowledge bases. Further, there is reason to wonder if this cognitive reorganization and consolidation of knowledge based upon judgments of "same/ different" might not coincide with what analysts call increasing self-definition and/ or


Psychoanalysis and Knowledge: Part 1

cohesion. Clearly, psychoanalysis constitutes a virtual laboratory for learning about learning in individuals.

Varieties of Knowing: Some N euroscientific Observations Before presenting Rapaport's approach to learning theory, a few additional remarks seem in order on the mind/brain's systems or ways of knowing, each of which constitutes (to a degree) its own variety of intelligence, its own mode of using that intelligence, and its own worldview (or its own contribution to any overreaching worldview the brain can assemble as a whole). That humans have two cerebral hemispheres suggests we have no less than two different kinds of knowledge or knowing, just as Aristotle posited. The contribution of the 1eft hemisphere appears to be via syntactical language and logic, references to famous people (i.e., appeals to authority), insight by means of temporal sequences, and a tendency to synthesize and explain. In contrast the right hemisphere seems to have a logic all its own, and operate more "timelessly," emotionally, socially, and intuitively (like Einstein and Poincare did at certain points in the discovery phase of their work, say, on relativity theory; or perhaps more like a Zen mystic than a taxi driver). The consensus is that although knowledge usually refers to the category of learning depicted by the operation of the left hemisphere {formally called "declarative" or "explicit" knowledge), the right hemisphere's intuitive/ emotional/personal system also constitutes knowledge (formally called either "procedural," "implicit," or "episodic"). The left hemisphere is capable of rapidly searching through associative linkages or decision trees; the right contributes in a similarly rapid style that is both holistic and, perhaps more importantly, intelligently guided by feelings. But one might consider other kinds of knowledge as well, based upon the contribution of integrating subsystems of the brain, for example, the cerebellum, the striatum, the amygdala(s), hippocampus(es) and/or the thalamus (each of which contributes to so-called "procedural" knowledge in its own unique way, much like dialects uniquely reflect a mother tongue). 5 Space does not permit an elaboration of how the qualities of these subsystems might differ, but one such example might be the interesting distinction Hadley {1992) makes between the hippocampuses as a knowledge system versus the amygdala as a belief system. According to Hadley, only a belief system has the power to impel action. The distinction between knowing and

5 Gentner as quoted above describes how judging similarity at a deep level seems to be innate in humans and primates. This implies that the subcortical structures noted are probably critical parts not only for neural control but also for the judging of similarity and knowledge transfer.



believing thus becomes important; although a full discussion of Hadley's distinction is beyond the scope of this brief essay, there is a possibility that "the hippocampus subserves the coding of the external context ([i.e.,] of sensory, temporal, spatial, and somatic response attributes [of experience]), while the amygdala subserves the coding of internal environmental context {(i.e.,] sensory, temporal, affect, and autonomic response attributes}" {Kesner, 1984, p. 112). Obviously, the brain operates as a whole, combining the unique contributions of all of its parts. The major effort remains in specifying exactly how coordination and synthesis between the various parts obtains and influences the results. One final comment. For the distinction between "declarative" ("book learning'') and "procedural" ("habits and behaviors") credit is due Aristotle as well as Endel Tulving and the late Gilbert Ryle. Tulving does the most to differentiate these patterns in terms of cognitive psychology; but Ryle, as early as a 1945 address to the Aristotelian Society, and later {Ryle, 1949), notes the cardinal difference between "knowing that" (something is so) and "knowing how" (to do something) (White, 1982, p. 14). Specialists in other disciplines also employ this ancient differentiation, as in the distinction between physics and engineering: the former is said to deal with descriptions of how things "really are," the latter with the practical problems related to "how to do things" {Channel, 1991, pp. 573-574). Certainly there must be many other useful categories of knowing that have simply not yet been identified as such or named. Their specification will undoubtedly also involve "judging similarity" and "transferring knowledge" within and between domains.

Rapaport's Contribution to a Theory of Knowledge Acquisition: The Integration of Nature and Nurture The earliest integrated theory within psychoanalysis of how it is possible for humans to acquire knowledge is that of Rapaport (1951} and can be summarized briefly. The theory synthesizes the ideas of many philosophers (see Gedo's discussion of Rapaport in Gedo, 1986, especially pp. 63-81), as well as contributions of Freud, Hartmann, and Piaget, and has been updated by modern researchers {Gedo and Goldberg, 1973; Gedo, 1986, 1989; Levin, 1991, pp. 43-82, 105-120, 195-200) into a hierarchical, developmental model. Such a model is much to be preferred over a representational schema approach, which fails to examine the details of how any such model works (for example, how progressive and regressive developmental steps relate to each other}.


Psychoanalysis and Knowledge: Part 1

According to Rapaport the biological roots of humans involve the innate drive towards caregiving objects who are never given up in our unconscious life. Freud's primary contributions to a theory of learning are his descriptions of the dynamic unconscious and infantile sexuality (i.e., drive theory), phenomena which guarantee that all of our loving attachments will recapitulate our earliest love relationships, and that abandoned object cathexes will crystallize as internal structure. From Hartmann we add the notion that our egos are relatively autonomous from the drives on the one hand, and from the human environment on the other. This guarantees that learning is possible, but invariably difficult. Finally, from Piaget we have the description of hierarchical, developmental phases that are biologically determined, yet environmentally released. The philosophical implications of the Rapaport model will not be discussed here but in Part 3 of this essay. As Rapaport puts these component theories together, learning occurs from the viewpoint of psychoanalysis in three crucial steps: the first involves "introjection," which he defines as that step in which the lost or unavailable object is recathected in memory (versus in perception). This step basically states that the individual subject involved is incipiently aware that someone exists in memory who is, or was felt to be, worth knowing. The second step is "identification," which means that the ego or self is now altered by its knowledge of and feelings about the introject. The experiencing subject is now in a stage of encapsulating the qualities and knowledge identified with their relationship to the loved or revered person, but will initially do so en bloc. What remains is a third (unnamed) step 6 in which the knowledge connected with the identified but unavailable person becomes organized as one's own, so it can be thought about without thinking of the lost object per se, but rather by means of some identificatory "tags" that categorize the knowledge, for example, on the basis of similarities. The sequence is thus of investing in or loving someone, feeling oneself "losing" them in some way, remembering the experience of them, and finally making specifically chosen, perceived qualities associated with our relationship with them our own. Although many subtle details have been added by modern psychoanalysts, this sequence remains basically the best answer we have to Aristotle's question about how humankind transforms perception into knowledge (the agent of change for which he called psyche). The reader is referred to part 3 of this essay for further details. What we need to do, however, is to fill in the scientific details regarding each step of

6 "Remodeling" might describe this step well, since final modifications are probably involved to make what is internalized apt for the rest of the self organization. Once again, judgments and tolerances regarding "same/different" would seem to be involved,



knowledge acquisition, and this is increasingly complex for several reasons.

For one, knowledge is no longer seen as a human monopoly!7 A second complication in understanding knowledge acquisition is that cognitive development does not invariably proceed in a standard manner. For example, the neurocognitively impaired and multiply handicapped, including the blind, the deaf, the autistic, and the learning disabled, have much to tell us about normal development. In each of these cases there are practical reasons why special modes of learning are at times required before an individual can proceed with learning in general. For instance, the deaf need first to learn sign language before they can optimally learn any other language; that is, they first need exposure to a language modality they can use and learn naturally. Similarly, the learning disabled often suffer from "imprisoned intelligence" unless properly helped to learn how to learn (Pompian and Thum, 1988; Orenstein, 1992). The point is that all of us require optimal exposure to such things as our native language in order to develop properly such traits as the ability to use syntactical language correctly. Optimal development of personality also seems to require exposure to and immersion in a normative cultural milieu.

"Learning Windows": Their Importance and Creation Optimal timing of input during development bears a direct relation to what are sometimes referred to as "learning windows," and would seem to involve

'Pamela McCorduck in Machines Who Think (1979) and Ernest W. Kent in The Minds of Men and Machines (1981} help clarify that problem-solving systems exist which are neither human nor alive, Robots and computers are knowledgeable; that is, they share with virtually all life on earth the capacity to transduce input into complex output. This is true as much of DNA molecules, bacteria, viruses, mycobacteria, and simple unicellular creatures as it is of all of us eukaryotes. Therefore, we should not be so arrogant as to believe that we are the only "intelligent" creatures, since humans are just one more form of life on earth. Moreover, even the lowly fly and cockroach are smart enough to outwit us most of the time! And there is hardly any debate about the vast intelligence of whales, porpoises, and the great apes. Humans, of course, give themselves special credit for inventing such things as syntactical language and empathy, believing that this proves our superiority. But of course we also invented the bomb! One can only conclude that we have a lot to learn from other specialists about knowledge in nonhuman systems, just as experts in other fields involving inorganic knowledge need to compare what they discover with what is understood about the human varieties of knowledge. Incidentally, if it is difficult to define knowledge, it is no less easy to delineate intelligence. For example, there is a story told by a researcher who uses mice to study intelligence. What he finds interesting is that the mice who are most successful in getting through complex mazes quickly are also the easiest to induce to put their head into a guillotine, so they can be sacrificed '.111d their brains examined, On the other hand, the so-called stupid or dull mice fight Intensively to avoid having their heads chopped off!


Psychoanalysis and Knowledge: Part 7

priming of the nervous system. So far, not much is understood about what controls the timing of these critical periods of learning readiness. This knowledge would seem crucial, however, if we are to alter these windows or reestablish them in the here-and-now for the benefit of sensorily deprived or emotionally traumatized (nonoptimally exposed) individuals. It seems to me that psychoanalysis (in collaboration with other fields) might play a significant role in this challenging task of discovering the control mechanisms for "windows," since analysts habitually concern themselves with remediating situations where learning has become arrested and behavior repetitive-that is, with the creation of learning readiness. In Mapping the Mind (1991} I discuss what is known about the relationship between learning and brain plasticity. In this section I wish to speculate on some possible means of creating learning readiness and their possible mechanisms of action. Traditionally analysts have motivated learning by the proper timing of their interventions. First, they center their attention upon what the patient wants help with at any given moment, as compared to what we as psychoanalysts might judge to be important {see Schwaber, 1983); this {patientcentered) orientation has a powerful impact on enhancing nuclear trust and confidence, but it also has more specific effects in facilitating learning (see below}. Second, we have learned the importance of communicating our tentative understandings to patients in terms that are experience-near. Third, by respecting the patient's learning initiatives we help the patient build cognitive "bridges" upon the stronger foundation of what he already feels relatively successful at In other words, learning "bridges" are best extended to new territory only after they are anchored, as it were, in something the patient comfortably "owns" or has a sense of mastery of. Fourth, spontaneous activity on the patient's part usually expresses his intuitive understanding of what he needs to learn first, what second, and so on; that is, an appreciation of his own knowledge of how he learns best. Finally, my impression is that there is yet another reason for carefully respecting the patient's sense of what is important. The gentle introduction to new information and the gentle testing of new abilities may be required to help the mind/brain deal with the special kind of anxiety relating to the effort to learn something new. Let me explain this particular "novelty anxiety" reminding the reader briefly of neglect syndromes in which previously mastered brain functions are lost owing to illness or injury. When a brain-injured patient encounters the existence of a lost function he becomes alarmed and may refuse or be unable to recognize the new perceptual reality. In a similar way, when new functions are activated that have not yet been encountered and mastered, a normal individual learner may respond with anxiety to the novelty of the



situation that resembles that of the brain-injured. During the period of practicing the new function it has been proven important not to misinterpret the patient's hesitations as either resistance or defensiveness, in the traditional psychoanalytic sense of these terms. I am convinced that this understanding is an important part of what has led some experienced psychoanalysts, such as George Moraitis and Lou Shapiro, to emphasize in their teaching the importance of generally not interpreting resistances and defenses directly, but rather to focus instead primarily upon engaging the hesitant or anxious patient in a process of gentle analytic inquiry {see Smaller, 1993), and learning. Such a perspective would seem to respect the patient's vulnerable feelings about what is novel and unknown, as well as what is known about knowledge acquisition from psychoanalysis, psychology, and neuroscience. A slightly different way of summarizing some of the points made about learning is to relate learning in psychoanalysis to two elements: (1) Freud's free associative method, and (2) neuroscientific research visualizing cognition. This will make it possible to understand simply why free association is decisive in creating learning "windows." The key lies in the research of Lassen {1994) and Posner (1993), which shows decisively that when people are spontaneous in their associating, they activate working memory for the associated material. This means that the patient's free associations are the place to start in learning, for learning requires working-memory activation (Levin, 1994). This approach, typical of analysis, is quite different from approaches that begin intervention at a point distant from what is central to a patient's current free association, for then we can be sure working memory will not be activated, and consequently learning will necessarily increase in difficulty by several orders of magnitude. The learning model employed, like that of Rapaport mentioned above, involves releasing functional capacities within the mind/brain on the basis of extending the patient's spontaneous outputs in a loop through the external world (meaning especially the world of the patient-analyst interaction), with input then returning to the patient. From an information-processing perspective, what appears particularly crucial to learning facilitation in this mode is that the output is from one part of the patient's brain, and the input that returns (from the loop through the world) comes back to a different part of the same mind/brain. In this manner psychoanalysts facilitate a deepening and broadening of mind/brain communications and connections. It is argued that when novelty anxiety occurs, the information outputted returns, but to the same rather than to a different part of the mind/brain. Another way of saying the same thing is that for learning to occur optimally a functionally enlarged neural circuit is required, and this probably requires that the level of anxiety be kept to a minimum, or at least be under the patient's control.


Psychoanalysis and Knowledge: Part 1

A Final Word on the Retrieval of Knowledge and the Psychoanalytic Model of Leaming Each form of knowledge would seem to have its own method for coding and its own mechanisms for reading and writing such codes. There is reason to believe that within the brain the coding process is related to multisensory mixing or integration phenomena involving the same critical parts of the major learning subsystems mentioned above. For example, the amygdala and hippocampus located on each side of the brain are a portion of the cortical hemispheric systems for knowledge acquisition. Most recently Squire and Zola-Morgan (1991) have further demonstrated that the medial temporal lobe memory system itself functions "to bind together the distributed storage sites in neocortex that represent a whole [declarative] memory" (p. 1380). Only after an initial processing period does a memory apparently become independent of this medial temporal lobe system, further explaining what Rapaport speculates about years ago when describing learning stages (see above). This new set of observations is particularly exciting because the temporal lobe system includes the parahippocampal cortex, which has already been implicated in panic attack syndrome. Also, I have just noted the crucial importance for learning of maintaining anxiety within tolerable levels. Thus there is a possibility that panic attacks might themselves he a consequence of the brain's anticipation of danger in association with its own perceived failure to store useful (adaptive) information because of a disturbance in the (temporal lobe) memoryfixing system. It is also possible that what anxiety accomplishes is the prevention of certain long-term storage of experience. We conclude that many brain systems are important in long-term memory and the recall of knowledge: the cerebellum, the central parietal cortex, the gyrus cinguli, the corpus striatum, the thalamus, the amygdalas, and hippocampuses. Not surprisingly, those areas of the brain involved in sensory integration also appear to be those most involved in memory and general synthetic activity (Levin, 1991). In other words, remembering is not a function of any single subsystem, but rather a system property of very large arrays of neurons, working together in a particular and intricate manner. Remembering (the gerund) is a more evocative word than memory {the noun), since the verb form implies a process in which something that happened within the brain is now happening again. Recalling past events is possible because the brain has changed infinitesimally by each experience. Remembering is thus more like recreating a file than finding and opening a file that abstracts experience. The proof resides in the various neglect syndromes. For example, when the visual subsystem for color V 4 is damaged the subject not only can no longer see color (only shades of gray) but cannot even



remember having previously seen color, nor even understand the concept of "color" (Zeki, 1992)! As I suggested at the outset, psychoanalysis can play a decisive role in the timely recovery of useful but seemingly unavailable information and/or skills. The revolution in facilitating the retrieval of lost memories is of course created by Freud with his monumental discovery that human beings have a tendency to repeat rather than to remember. (Or put differently, both repeating and remembering are really aspects of the same tendency of the brain to express itself through the recurrence of previous patterns of excitation.) Thus we do not need to know consciously about the knowledge we have in order for us to use it. This utilization of unconscious and unknown knowledge is at the core of the so-called "repetition compulsion," as Freud (1920) discusses (see also Bornstein and Pittman, 1992, on perception without awareness). The psychoanalyst, because he knows the patient and has his confidence, is in a preferred position to comment constructively about possible novel meanings of such complex, recurrent mental patterns. The additional useful strategy psychoanalysts have discovered is to concentrate on the patient's nonverbal experience and communication. In contrast to verbal experience, which is easier to code and therefore tends to be either conscious or preconscious, nonverbal experience can coincide with decisive, unconscious feelings. Only the total communication (Levin, 1991) carries the complete message. And the nonverbal component of the total communication is particularly overlooked, in my opinion, except by experienced therapists and intuitive beginners, because it is ineffable (that is, seemingly indescribable in words). But the major general approach to facilitating the recall of affective experience is for the psychoanalyst not to be afraid at times to allow himself some liberty in "priming" the patient's memories, as noted at the beginning. This means that, based upon our understanding of so-called "procedural knowledge" (see above), if we allow ourselves to not just to be a blank screen, but rather to manifest unobtrusively the compassion that we feel in resonance (attunement) with our patient (meaning reflecting back to him, verbally or otherwise, our own reactions to what he is communicating), then some patients (those who cannot proceed otherwise) will find that the analyst's free associations, spontaneously given, will stimulate their own associations; that is, they will prime patients' procedural memories. Among these memories may be included some of the patients' most obscure but relevant nonverbal experiences. At times such experience may only be retrieved through the reexperience of something akin to the initial state in which the experience first occurred (as a consequence of being primed) and cannot be remembered by any questioning of a logical sort. Such is the case When, for example, the analyst whistles an interpretation to a patient in the


Psychoanalysis and Knowledge: Part 1

form of a particular, precisely chosen classical tune. "When this opens floodgates of memory in the patient, one cannot fail to wonder if such recall could have been tapped so richly by any other means. Of course I am suggesting a fundamental change in psychoanalytic technique, but only so far as it is usually described formally. I am convinced, however, that what I am advocating is not only Freud's strategy but that of most experienced analysts, whether they say so in writing or not. For example, Roy Grinker, Sr. (1940), notes that during his analysis with Freud, Freud made periodic spontaneous remarks about such things as the reaction of Freud's dog's to Grinker's associations! (Freud's dog was frequently in Freud's office during his analytic work with patients.) When the dog scratched to go out, Freud might say: The dog is very disappointed with you today! And when the dog returned, Freud commented: She has decided to give you another chance! The reason why Freud never mentions such priming comments as a matter of technique would seem to be that he took this kind of creative playfulness for granted. Freud's real technique thus involves not only learning from "arheiten und liehen" (work and love) hut also from "spielen" (that is, play). The key is that play is spontaneous, that is, self-initiated, and as such is associated with the activation of working memory (see above). The point of the foregoing discussion is to clarify the importance of positively valenced affective involvement for learning phenomena, since affect is often most available when people are playfully involved. Vuckovich and I struggle repeatedly with the question of how a psychoanalyst might best facilitate the optimal internal communications between the various knowledge subsystems of the patient's brain (Levin, 1991, chapters 2 and 3). Of course, such communication optimalization is what free association accomplishes par excellence. In our papers Vuckovich and I first speculate that the cerebellum plays a major role in learning in general and not merely in motor learning. Since 1983 the occasional role of cerebellar pathology in infantile autism, schizophrenia, and other conditions has been reported upon, supporting our speculations about a cerebellar role (Decety et al., 1990). The clinical significance of these comments is that the analyst must tap his own playfulness; that is, that priming is required at times for the patients's learning process to occur. Of course it goes without saying that by playfulness here one does not mean anything that would lack tact or sensitivity to the patient's feelings. Rather, the emphasis should be on the importance of the analyst not forgetting his own spontaneity and humanity. Optimal learning thus appears to require active interventions on the patient's part. Jeannerod (1985) suggests that every spontaneous action is also a test of an hypothesis about the world. Actions lead to continual modification of a putative model in our brain (possibly in the cerebellum



and/or the basal ganglia) that has been designated the self-in-the-world model (Levin,1991). Analysts might note that here I am talking about at least two kinds of nonconscious activity: one is the psychoanalytic "unconscious," and relates to conflicts; the other deals with the normal out-of-awareness utilization of knowledge (see Bornstein and Pittman, 1992). To be more precise about the hypothetical learning mode I am employing, it seems that the major difference between children and adults regarding their behavior in exploring the world is that children appear to need sensory stimulation to think about things: they must mouth, look at, touch, smell, and taste their world, presumably because they are still building up the internal schema which they will later manipulate cognitively in lieu of active physical contact with things. Adults appear to make use of knowledge without the obvious manipulation of concrete objects. However, personal observations have led me to conclude recently that this difference between adults and children is more apparent than real. 8 Two final qualifications. First, I am not arguing that all thinking occurs by means of either the manipulation of concrete objects (the paradigmatic case of children) or the manipulation of concrete internal images as parts of models (the case of adults). I am merely suggesting that problem-solving and exploratory behaviors appear to stimulate our need for strong sensory experience (that is, for "priming"), which is similarly required for the recall of learned information in both children and adults. Unfortunately, we do not yet have sufficient information about learning and recall to appreciate what machinery the brain uses for such cuing (Gabriel et al., 1991) and the resulting provision of refined neural control. One thing we can say, however, is that the insights of William James so long ago seem particularly apt: James surmised that the judging of similarity constitutes possibly the central element in mental organization (Leavy, 1992). Second, it should be stated explicitly that some new knowledge results not from a new combination of the recall of old information, but from the facilitation of new operations altogether. In this sense, some colorful interpretative metaphors invite activity in sensory-integrative systems of the mind/brain for the 8

Writing this essay has been an arduous task, during which I observed the following that led me to the above conclusion. I noted that I was able to effectively make use of my word processor only during the initial phase of writing. Once the writing advanced to the stage of a final draft, however, I found that I needed to have a periodic printout of the manuscript, which I then would hold in my hand while reading it and making final corrections. That is, I needed to make the final corrections with real pen on real paper, not on the word processor. I believe this is because I needed particular kinesthetic, tactile, and visual experience to optimally retrieve my knowledge of editing. I would further speculate that this might be necessary because this comes closer to the original sensory experience involved in my learning how to edit. In this manner it became obvious to me that even adults require subtle forms of sensory priming to facilitate thinking in specific problem domains.


Psychoanalysis and Knowledge: Part 1

first time, making it possible to experience certain perspectives that are either

intrinsically insightful or catalytic ofsynthetic activity. Conclusion Armed with the certainty that our knowledge and theories of mind and brain are incomplete and likely to remain so, we are in the best position to interact with our patients as human beings and to frame experimental approaches that will eventually improve psychoanalytic knowledge, theory, and practice. New learning in treatment is most likely to occur through a combination of the following (all of which are the legacy of Freud): aiming at investigating rather than being therapeutic; collaborating (working and playing) with patients in a partnership of mutual respect; staying attuned to what the patient is curious and associating about, and why; and being precise in our theoretical thinking about such psychoanalytic constructs as "representation," which may otherwise tend to be too ambiguous or misleading to be useful. This essay has considered some of the neuroscientific reasons these approaches make sense, while focusing particularly on problems inherent in the idea of "representations." Regarding psychoanalytic practice I have further described how remembering of unconscious elements is facilitated by free association, attention to "total communication" {especially its easily overlooked nonverbal component), and allowance for "priming." I have speculated that what neuroscientists call priming is the same phenomenon that psychoanalysts call transference and cognitive psychologists label judging similarity and transferring knowledge. In addition I have wondered if the process of deepening and systematization of such personal knowledge bases might not coincide with what analysts consider movement towards cohesion of the self. In this way I have tried to show the advantage of nonrepresentational models of learning. Most importantly I have suggested why anxiety is antithetical to learning. All the strategies to facilitate learning readiness would seem to be effective because of their impact on the creation of enlarged circuits within the brain, and the consolidation of these circuits. Eventually we will better understand what determines "learning windows" for certain kinds of learning and improve our ability to facilitate the acquisition of genuine knowledge. For the moment, however, there is a strong suspicion that the creation and recreation of concrete, sensory experiences within the context of a flexible psychoanalytic setting is not only important for the patient's discovery and experience of the phenomenon of transference and for feeling supported and/or understood, but also a decisive part of the mind/brain's method of tapping its knowledge and capacities for particular conceptual tasks. Learning always requires the activation



of working memory. The psychoanalytic technique of free association greatly favors this activation. of working memory. Such learning and development within psychoanalysis clearly also involves "judging similarity" and "transferring knowledge," mental processes we need to better understand if our problem-solving techniques are ever to improve. This last area is discussed more fully in a companion essay, Part 2. The underlying philosophical questions raised in creating a psychoanalytic theory of learning are taken up in Part 3 of this essay.

References Anderson, J. A. & Rosenfeld, E., eds. (1989), Neurocomputing: Foundations of Research, Cambridge, MA: MIT Press. Bornstein, R. F. & Pittman, T. S. (1992), Perception Without Awareness. New York: Guilford. Bucci, W. (1985), Dual Coding: A cognitive model for psychoanalytic research, Amer. Psychoanal. Assn., 53:571-608. - - {1992), The development of emotional meaning in free association. In: Hierarchic Conceptions in Psychoanalysis, ed. A. Wilson & J. Gedo. Psychological Issues. New York: Guilford, pp. 3-47. Channel, D. F. {1991), Special kinds of knowledge. Science, 253:573-574. Cloninger, C.R. (1991), Brain networks underlying personality development. In: Prychopathology and the Brain, ed. B. J. Carroll & J.E. Barrett. New York: Raven Press, pp. 183-204, Cohen, J. & Servan-Schreiber, D. ( 1992), Introduction to neural network models. Psychiat. Ann., 22:3. Davis, P. J. & Hersh, R. {1981), The Mathematical Experience. Boston: Houghton Mifflin. Decety, J., Sjohlm, H., Ryding, E., Stenberg, G. & Ingvar, D. H. (1990), The cerebellum participates in mental activity: Tomographic measurements of regional cerebral blood flow. Brain Research, 535(2) :313-317. Eisley, L. (1975), All the Strange Hours: The Excavation of a Life. New York: Charles Scribner's Sons. Forrest, D. V. (1987), Dream of the rarebit fiend: N euromedical synthesis of unconscious meaning. J. Acad. Psychoanal., 15: 331-363. Freud, S. (1891), On Aphasia, trans. E. Stengel. New York: International Universities Press. - - (1920), Beyond the pleasure principle. Standard Edition, 18:7-64. London: Hogarth Press, 1955. Gabriel, M., Vogt, B. A., Kubota, Y., Poremba, A. & Kang, E. (1991), Training-stage related neuronal plasticity in limbic thalamus and cingulate cortex during learning: A possible key to mnemonic retrieval. Beho.v. Brain R£s., 46: 175-185. Gedo, J. (1986), Conceptual Issues in Psychoanalysis. Hillsdale, NJ: The Analytic Press. (1988), The Mind in Disorder. Hillsdale, NJ: The Analytic Press. (1989), Self psychology: A post Kohutian view. In: Self Psychology: Impressions and Contrasts, ed. D. Detrick & S. Detrick. Hillsdale, NJ: The Analytic Press, pp. 415-428. & Goldberg, A. (1973), Modelr of the Mind. Chicago: University of Chicago Press. Gentner, D. & Ratterman, J.J. (1991a), The roles of similarity in transfer: Determinants of similarity based reminding and mapping. Cognitive Science Technical Report CS-91-12. Beckman Institute, The University of Illinos.


Psychoanalysis and Knowledge: Part 7

J. (1991b), Language and the career of similarity. In: Perspectives on Language and Thought: Interrelations in Development, ed. S. A. Gelman & J. P. Byrnes.

- - & Ratterman, M.

London: Cambridge University Press, pp. 225-284. - - & Markman, A. B. (in press), Similarity is like analogy: Structural alignment in comparison. Similarity, ed. C. Cacciari. Brussels: Brepols. Goldman, A. I. (1986), Epistemology and Cognition. Cambridge, MA: Harvard University Press. Grinker, R. R., Sr. (1940), Sigmund Freud: A few reminiscences of a personal contact. J. Orthopsychiatry, 10:850. ---(1953), Prychosomatic Restarch. New York: Norton. Hadley, J. (1992), The neurobiology of motivational systems. In: Psychoanalysis and Motivation, ed. J. Lichtenberg. Hillsdale, NJ: The Analytic Press, pp. 337-372. Jeannerod, J. (1985), 17zeBrainMachine, trans. D. Urion. Cambridge, MA: Harvard University Press. Keller, J. D. & Lehman, F. K. (1991), Complex concepts. Cognitive Science Technical Report CS-91-07 (Language Series), The Beckman Institute, University of Illinois. Kent, E. (1981), The Minds ofMen and Machines. Peterborough, NH: BYTE Books. Kesner, R P. (1984), The neurobiology of memory: Implicit and explicit assumptions. In: Neurobiology ofLearning and Memory, ed. G. Lynch, J. L. McGaugh & N. M. Weinberger. New York: Guilford, pp. 111-118. Knudsen, E. I. & Brainerd, M. S. (1991), Visual instruction of the neural map of auditory space in the developing optic tectum. Science, 253:85-87. Lassen, N. A. (1994), Where do thoughts occur. Ugeskrifl for Laeger, 156(27): 4004-4005 [Dutch). Leavy, D. E. (1992), William James and the art of human understanding. The American Psychologist, 47:152-160. Levin, F. M. ( 1991), Mapping the Mind: The Intersection ofPsychoanalysis and Neuroscience. Hillsdale, l"{J: The Analytic Press. - - - (1994), The relationship between Freud's free associative method and the creation of "windows11 (i.e., learning readiness). Presented to the Houston Psychoanalytic Society, Houston, Texas. - - - & Vuckovich, D. M. (1983), Psychoanalysis and the two cerebral hemispheres. The Annual ofPsychoanalysis, 11 :171-197. Hillsdale, l"{J: The Analytic Press. McCorduck, P. (1979), Machines Mo Think. San Francisco: W. H. Freeman. Olds, D. D. (1994), Connectionism and psychoanalysis. j. Amer. Psychoanal. Assn., 42(2): 581-611. Orenstein, M. (1992), Imprisoned intelligence. Unpublished doctoral dissertation, The Institute for Clinical Social Work (Chicago). Pompian, N. W. & Thum, D. P. (1988), Dyslexic/learning disabled students at Dartmouth. Ann. Dyslexia, 38:278-286. Posner, M. I. (1993), Seeing the mind. Science, 262:673-674. Rapaport, D. (1951), Toward a theory of thinking. In: Organk/1,tion and Pathology of Thought, ed. & trans. D. Rapaport. New York: Columbia University Press, pp. 689-729. Reiser, M. F. (1980), Memory in Mind and Brain. New York: Basic Books. Rizzuto, A. M. (1990), The origins of Freud's concept of object representation ("Objektvorstellung") in his monograph "On Aphasia: its theoretical and technical importance." Internal. J Psycho-Anal., 71(2):241-248. Ryle, G. (1949), The Concept ofMind London: Hutchison's University Library. Salton, G. (1991), Developments in automated text retrieval. Science, 253:974-980. Sandler, J. & Rosenblatt, B. (1962), The concept of the representational world. The Psychoanalytic Study of tltt Child, 17:128-145. New Haven, CT: Yale University Press.



Schlessinger, N. & Robbins, F. B. (1983), A Developmental View of Psychoanalytic Process. New York: International Universities Press. Schwaher, E. (1983), A particular perspective on analytic listening. The Psychoanalytic Study ofthe Child, 38:519-546. New Haven, CT: Yale University Press. Smal1er, M. (1993}, Louis Shapiro: Dean of Chicago analysts. The American Psychoanalyst, 27( 1) :26-67. Spruiell, V. (1993), Deterministic chaos and the science of complexity: Psychoanalysis in the midst of a general scientific revolution.]. Amer. Psychoanal. Assn., 41(1):3-44. Squire, L. R. & Zola-Morgan, S. {1991}, The medial temporal memory system. Science, 253: 1380-1385. Walsh, W. H. {1971), "Kant,"s.v. EncyclopaediaBrita.nnica. Chicago: William Benton, Publisher. White, A. R. (1982), The Nature o[Knowledge. Totowa, NJ: Rowman and Littlefield. Zeki, S. (1992}, The visual image in mind and brain. Sci. Amer., 267(3):68-76.

Psychoanalysis andKnowledge: Part 2. The Special Relationship Between Psychoanalytic Transference, Similarity Judgment, and the Priming ofMemory FRED M. LEVIN ERNEST W. KENT

Humans create databases from experience that they deepen and enlarge over time. It is the product of this deepening and enlarging process that we call knowledge. Knowledge keeps us safe from danger and enhances our chances of reaching wished-for goals. Of course, some knowledge is wrong in that it leads to faulty conclusions or unsuccessful adaptation. For example, how much of the content of this essay is correct may be difficult to say at this time. This last observation points out the importance of continually testing and therefore updating our knowledge bases. Within the psychoanalytic situation the analyst and patient engage the patient's complexity, experiencing together crucial countertransference and transference states that become a major object of their study. Over the years psychoanalysts have learned how to tap this vital, conscious and unconscious dialectical stream of information about feeling states, behavior, and cognitive patterning. The resulting self-knowledge and working through of feelings greatly facilitate the mastery of conflict and emotional growth by means of updating and improving the key knowledge bases upon which our adaptive skills depend. Earlier versions of this paper were presented May 19, 1994, to the American Psychoanalytic Association in Philadelphia, PA, and October 7, 1994, to Psyche '94 International Symposium on Mind-Body Problems, Osaka,Japan. Thanks to Ors.John Gedo, Mark Gehrie, Dedre Gentner, Brenda Solomon, Harvey Strauss, andjerome Winer for their wise comments on this manuscript. The authors, however, not these consultants, assume full responsibility for the final product.



Psychoanalysis and Knowledge: Part 2

This essay attempts to explore more deeply the mystery of transference. It suggests that what analysts call transference involves the transfer of knowledge and the creation of expert systems. In a nutshell, the understanding of one's personal knowledge alters its organization, making it both more accurate and useful (i.e., more like an expert system). Clearly, psychoanalysis looks to psychology to help understand how knowledge is transferred between content domains (that is, to identify the governing principles involved). Similarly, psychoanalysis depends upon neuroscience to understand better the basic machinery and mechanisms by which knowledge bases are created, modified, and tapped. Yet psychology and neuroscience must depend upon psychoanalysis to better appreciate the significance of such covert human phenomena as transference, into which our affects are organized and which so significantly influences human knowledge organization and decision making. This is because psychology and neuroscience do not routinely include information about the highest level of man's psychological organization, as is manifest through transference. Cognitive psychology in particular has also had great difficulty integrating affect into its models. The core of this essay centers upon what appears to the authors to be a special relationship between psychoanalytic transference, the judgment of similarity, and the priming of memory. Our idea, briefly, is that these three processes use closely related machinery of mind and brain. Addressing the relationship between these three processes, therefore, should help us bridge psychoanalysis, cognitive psychology, and neuroscience, bringing us a step closer to a basic scientific understanding of how mind and brain work.

Definitions and Clarifications Some definitions and clarifications are in order. To begin with psychoanalysis, the central concept of transference traditionally refers to a tendency toward "displacement of patterns of feeling and behavior, originally expressed with significant figures of one's childhood, to individuals in one's current relationship," including of course one's analyst (Moore and Fine, 1968, p. 92). A number of qualifications are important: (1) transference always involves affects, and any affective gestalt or ego state can become a transference; (2) transference invariably arises in attunement or reaction to persons (in one's environment or in one's memory); (3) some psychoanalytic scholars no longer consider transference to be disintegration products of the drives, but rather modes of cognition (Gedo, personal communication, 1994; Modell, 1993); and (4) given the above descriptions of transference there can be no question that transference always involves judgment of similarity comparing past and present figures (or, put differently, that various real-life situations prime affects, which in turn lead to transference).



Turning now to psychology, judging similarity (and difference) can be based on superficial or deep structural correspondence (Gentner and Ratterman, 1991a, b) and has been considered "one of the most central theoretical constructs in psychology," pervading virtually all theories of cognition (Medin, Goldstone, and Gentner, 1993, p. 254). Later in this essay we shall introduce a model of mind that updates one introduced by one of the authors (Kent, 1981). In this new model we shall attempt to show how priming and similarity can be defined in terms of coactivation of elements in the model that relate to attentional and motivational states. However, for practical purposes at this point in our discussion the reader should merely consider that "transfer of learning is said to hinge crucially on the similarity of the transfer situation to the original training context. An important Gestalt principle of perceptual organization is that similar things will tend to be grouped together {Medin et al., 1993, p. 254)." Also, what seems to make experts better than novices is their familiarity with certain paradigms and their consequent advantage in judging similarity and transferring relevant knowledge between content domains. (By the way, we apologize for using similar sounding terminology to mean different things here: transferring knowledge means what it seems, transferring information from one content domain to another; and this is different from transference, which we always use to mean "psychoanalytic transference.") Finally, regarding neuroscience, the priming of memory generally refers to the effect of perception on recall within specific brain memory systems. Some memories are declarative {some say representational or explicit), whereas others are procedural {or implicit), and a characteristic of the latter is that "a substantial part of the information may be stored at a few discrete loci, e.g. synapses in the [neural] network. What is stored is the altered probability for a stimulus-evoked response, and retrieval is actually the readout of the information in the reflex" (Dudai, 1987, p. 403; also see Levin, 1991). In other words, some past events captured in the brain are principally retrieved only when part of the original experience creating them recurs. The evocation of such retrieval is called priming. Perhaps some examples will help. If I sing the beginning of a song, you may be able to remember the rest of it, even though it is long forgotten, because of the stimulating effect of your perceptual experience. Similarly, if you have a specific kind of brain injury and lose your ability to walk (having forgotten the engrams), if I place you in water you may, by virtue of reexperiencing the movement of your legs, begin a swimming movement and subsequently recover the ability to walk (Sacks, 1984). Declarative and procedural memories appear to involve different brain circuitry. Specifically, declarative knowledge " is affected by lesions of the limbic system, especially the hippocampus, amygdala, and mammillary


Psychoanalysis and Knowledge: Part 2

bodies. In contrast, the ... [procedural system] probably requires the par. ticipation of the basal ganglia and cerebellum" (Dudai, 1987, p. 404). Because transference likely involves both declarative (explicit) and procedural (im• plicit) memory, (which is our speculation) therefore cortico-limbic, cortico• striatal, and cortico·vestibulocerebellar circuits would each seem to be involved in its case. Detailed attempts to further buttress these claims have been made elsewhere (Levin, 1991). In what follows we shall compare and relate the three processes that are the principal subject of this essay from a number of perspectives. We shall also diagram, describe, and compare dynamic models of mind and brain in which these processes can be seen as parts. The reader may then judge for himself or herself if we have established a sufficient basis for further study of the interlocking nature of priming, transference, and judging similarity. Table 1 summarizes the points already made.

Models of Mind and Brain The reader will wonder how the three processes under examination might fit into current models of mind and brain. Of course, such efforts to systematically relate functions across disciplines are extremely rare (see Levin, 1991,

Table 1. Subprocesses and their properties subprocess at issue transference

judging similarity

priming memory



investigating discipline


defining characteristics

displacement of comparing patterns stim.·evoked feelings/behavior on basis of response, new from old to new superficial or reads out old figures deep structural pattern similarity

type of memory

declarative and procedural

declarative and procedural


brain structure involved

limbic (esp. hippo· campus, amygdala, mammilary bodies)


basal ganglia (incl. striatum), cingulate cortex, cerebellum, limbic thalamus



and Reiser, 1990, for a review of such efforts). We shall present and illustrate our ideas about how such a synthesis might begin. Figure la depicts an updated version of a model of mind/brain organization presented earlier by one of the authors (Kent, 1981). First some general remarks about the model. The model is simultaneously parallel and hierarchical, with four major divisions noted: an input (sensory/perceptual) system, and output {motor) system, a goal selection system, and a "world model." In addition, where in the system interaction occurs with the external world is made explicit. Proceeding upward one goes from large numbers of synthesizers to small numbers of integrators, from concrete to abstract, and

integration synthesis '

sensory analysis

goal selection


internal states

motion generation

world model


external world


Figure I a. A conceptual representation of the basic organization of the brain's architecture. The organization is both parallel and hierarchical. The four major functional systems {input, goal direction, world model, arid output) are shown. Each of the major systems is assumed to connect with each other at high, low, and intermediate levels of processing and interconnections with other systems at each level. Many data paths exist in the system. Square areas indicate data bases in which massive amounts of information are processed simultaneously, in parallel. Arrows indicate sites of major interactions between systems.


Psychoanalysis and Knowledge: Part 2

from spinal cord toward cortex. The arrows in Figure la show schematically the general direction of information flow or activity (which can be described as roughly clockwise). Because of the importance of this model it will be useful to describe its workings. The central goal-selection portion becomes an input to a "worldmodel" that represents the system's internal construction of hypotheses, models, belief, and so on, about the nature of the external world. At each level there are linkages as follows: a feedback loop would be established between the world-model and the sensory processing system in which input from the sensory processing system would be evaluated and used to update the world-model. Input from the world-model would also be used to present hypotheses about expected sensory input (based on world-model contents and current actions). On the other side (of the diagram), input to the world-model from the action-generating system would provide the modeling system with information concerning current actions which would allow it to predict states of the upcoming sensory input. In turn the world-model would return to the action-generating system hypothesized results to be worked on the world as the result of planned actions. In particular, it would use the input from the goal-selecting system to identify goal-relevant stimuli (by modeling anticipated sensory input) and generate appropriate attention directives to the sensory processing system, thus providing the action-generating system with the information on predicted consequences of planned actions with respect to goal-relevant stimuli. The question that seems important to us at this juncture is where would one place priming, similarity judgment, and transference within the updated model of Kent? An approximate answer appears in Figure 1b (a blowup of the goal selection system). Within Figure 1b, priming is depicted at the lower end of the model because of its known relationship to the perception of motor output activity. In contrast, transference and similarity judgment are diagrammed as running the entire length of the goal selection system because they are known to involve multiple levels of abstraction depending upon whether based upon superficial or deep comparisons. A more complex answer to the question of localization within the model of Figure la will be attempted in the next section. At this point, however, we shall move on to the work of June Hadley and Michael Gabriel, which we believe to be highly complementary to Kent's model. We shall then use these three models to further illuminate something that might be called motivation, discrimination, or simply thinking with the goal of solving problems. We shall begin with Hadley's perspective on the limbic system. The circuit {fig. 2) that is judged to be the crucial motivational machinery for






selection intemal


states priming

extemal world


Figure 1b. Blowup of goal selection systems. Shows range of applicability of transference, similarity, and priming.

mind and brain involves a cortico-hippocampal-amygdala-striatal-hypothalamic-cortical loop (Hadley, 1989; also see Cloninger, 1991). According to Hadley two basic organizing principles are involved in any such motivation or goal selection: ( 1) "the maintenance of familiarity of neural firing patterns" based especially on limbic (notably hippocampal) comparator mechanisms, and (2) the use of pleasure-unpleasure affect signals for steering behavioral choices through a matching/mismatching process" (p. 337). This motivational system, depicted schematically in Figure 2, shows the basic flow of information within the limbic circuit (p. 339). Hadley's description of comparator mechanisms and matching/mismatching processes clearly highlights the important role of comparing gestalts and judging similarity. We now move on to the research of Michael Gabriel of the Beckman Institute, The University of Illinois. Gabriel (1991) has been investigating the brain's patterns of excitation in association with discriminative learning in rabbits. The changing patterns of firing of individual brain cells and clusters of brain cells demonstrate the performance of two fundamental neural computations: (1) "motor priming (centered in the striatal motor areas}" and (2) "event-processing (centered in the cingulate cortex and limbic thalamus)" (p. 11). The former system primes motor patterns but cannot encode, recall, or interpret information. The latter system encodes, recalls, and interprets events but has no effect on motor priming. We will first describe Gabriel's experimental paradigm in our own terms, then in Gabriel's terms. In general the rabbits must make choices in matching to



Ventral Tegmental

Periaqueduc tal Grey

Area and

Nucleus Accumbens


[pleasure) Basal

[motor programs)


Hypothalamus [autonomic output]

Amygdala [segregation by affect]

To Memory Syste ms (Mam millary Bodies

into Thalamus)

I-I ippoca mpal


Highly processed sensory information from Entorhinal Cortex:

Activation by Reticular Activating System and Brainste m Nuclei From Memory Systems (Toala mus via Septa! System)

Figure 2. Flow of information through the limbic system. Adapted from Hadley, 1989.



sample, for which they can receive rewards (or avoid punishments) if they are successful. The key point to note is that, remarkably, Gabriel has been able to place the electrodes in the rabbits' brains so that the oscillographic patterns associated with learning can be identified and followed, from region to region. As Gabriel states: The predictive cue presented to a trained rabbit (first) elicits the established topographic retrieval pattern in the limbic thalamus [meaning, a pattern already identified as the oscillographic signature of a particular learned relationship between a perceptual event and a behavioral response]. The pattern is [next] projected to the posterior cingulate cortex, where it is compared to the "historical" mnemonic template [which is the pattern associated with past success]. [One the one hand] if the [current] pattern matches the [historical) template, [then] cells in the cingulate cortex send a command volley to the motor system. [On the other hand] if a match does not occur, the learned [motor) response is suppressed and [something called] the anterior cingulate cortical recency system is activated (the purpose of which is] to encode novel mismatch-generating events [p. 11]. By the way, as far as we understand it, Gabriel's reference to "historical mnemonic template" is something, namely a neural firing pattern, which he actually identifies experimentally, and not something that he merely hypothesizes the existence of. Figure 2 also illustrates how all levels of processing within the limbic circuit involve comparisons between goal states and intermediate states. In a manner similar to Hadley and Gabriel, Kent describes what he calls "the basic equipment of the brain for rational thought [meaning problem-solving, goal-directing thought processes]" (Kent, 1981, p. 203). From his viewpoint this involves the following: selective attention to goal-relevant features of both input and internal states, suppression of output to goal-relevant features of both input and internal states, suppression of output temporarily pending evaluation of the projected outcomes of possible actions, defining intermediate goal states on the basis of similarity to the desired goal states, and finally, targeting temporary goals on the basis of current and past associations with goal relevant stimuli. Now our conclusion: We perceive a close relationship between Hadley's, Gabriel's, and Kent's ideas. Kent's are the oldest, yet they neatly describe in operational terms the steps involved in discriminative (i.e., rational) thought and their temporal relationship. Hadley's and Gabriel's viewpoints cover much the same ground but take into account some of the latest neurophysiological research on goal selection, and also describe some of the functional anatomy involved. By combining the viewpoints of these three scholars we


Psychoanalysis and Knowledge: Part 2

can begin to appreciate how complexity gets built into the variety of cognition which we are c~ling judgments of similarity. Because input relative to needed judgments about similarity is likely to occur at multiple levels within the "information bus" of the limbic circuit (forgive the computer term "bus,, for the information highway within a computer program linking the various data flow paths), therefore similarity judgments will differ substantially, because some will be based on superficial characteristics, while others will be based on deep, structural similarity. In other words, we are hypothesizing that the differences in kinds of similarity judgment themselves result from the amount of information that gets included in the comparison; that is, quantitative differences create qualitative differences when critical thresholds are reached (compare with Galatzer-Levy, 1978).

How Similarity and Priming Might Be Conceptualized in the Revised Model of Kent Kent's revision of his earlier model provides a more sophisticated, plausible, and detailed depiction of mind and brain operation, and one that better lends itself to the task at hand of appreciating the relationship between a number of complex variables. Priming in such a scheme could be understood simply as a coactivation of certain elements in the model as follows: (1) by similarity to elements in the model with current sensory input and {2) in relation to input from motivational systems. Another way of stating this with precision mathematically is that within the model the recursive {i.e., reiterated) estimation evaluation in the sensory-input/world-model provides a feedback loop onto similar stimuli, the result being that the model will have a tendency to accept the input as relevant to the model of the target of the motivational state. In essence we are attempting to describe how relevance appears in the model, and how priming and similarity judgment neatly dovetail in the model's operation. The beauty of such a model, of course, is that it also corresponds with known patterns of functioning of mind and brain. We apologize for the mathematical language employed in this section, but we wish to describe accurately something that will allow a better appreciation of certain relationships, so we ask the reader to bear with us temporarily, and will try to make things clearer before long! In particular, what we are interested in here is a new way of understanding similarity judgment and priming in the revised model {of Kent) we are putting forward. We would suggest that the brain system we are describing might be modeled mathematically (conceptualized) as a system input space spanned by various primary sensory attributes (e.g., luminosity, color, retinal location, time of



occurrence, etc.). Technically this would include values for each point loc·ation within the so-called space together with all their partial derivatives to about fourth order. Such a space (termed technically a ''jet bundle") provides essentially a model of the local sensory input to fourth order (that is, to great detail), for each point in the theoretical input space. To this one can add a scale dimension so that the local neighborhood {or collection of input space points) is represented at various sizes but with decreasing resolution. In such a space, any stimulus will have some vector distance from any other. One could take this vector distance as a measure of similarity {and thus concretize the concept of similarity). If then we let the attention ftmction provided by the world-model project the vectors representing any two stimuli onto some relevant subspace of interest, this may well decrease the vector distance (in other words, increase the similarity) between any two stimuli relative to others, so the perception of similarity becomes a function not only of the stimuli themselves, but of the attention function, which in turn may be influenced by motivational states or planned actions. If our logic eludes some readers, we beg to suggest that what we have just stated is merely an attempt to describe how Kent's revised model can itself be used, with some mathematical strategies, to emulate mind and brain activity (as on a computer). In fact, it is the very ease of performing such an emulation that lends plausibility to the model itself.

The Criticality of Similarity Categorization for Organizing Databases of Mind/Brain Gentner's work on similarity posits a central importance for similarity judgment as a process at the core of human cognition. Yet similarity from her perspective actually seems to her decomposable into a number of kinds of similarity judgment, and these probably fall as well into a rough developmental sequence (Gentner and Ratterman, 1991a, b; Medin et al., 1993). It thus becomes possible for us to compare Gentner's view on the judging of similarity with our psychoanalytic conception of the transference phenomenon. First, like similarity judgments transference hypothetically expresses a variety of components. Second, the components in the case of both similarity judgment and transference probably reflect as well a developmental sequence or process. {We cannot prove this assertion, but it would seem plausible given the evolving nature of transference over the life-span.) Third, both transference and similarity judgment can be seen as serving the larger function of organizing and expanding the knowledge bases of mind and brain. For the purpose of this essay it thus becomes important to carry our comparison of transference and similarity judgment as far as possible to better understand how these processes might further connect. Let us explain.


Psychoanalysis and Knowledge: Part 2

Transference to others in our growing-up years, or to other adults including our analyst in our adulthood, involves bringing into alignment at least two sets of characteristics, that is, characteristics associated with interpersonal experience from different eras. Based upon Gentner's research, including her own attempts to emulate similarity judgments on computers, similarity judgment seems to proceed most easily by a two-step process. The first step seems likely to be a match according to superficial or surface features, which assumes that surface similarity is often correlated with deep or structural similarity. Gentner notes that such a method will inevitably result in errors, but it is computationally "cheap" (Gentner and Ratterman, 1991b, p. 41; also compare with Newell and Simon, 1985). The more costly similarity mapping computations are then only performed on the "winners" of the first, approximate matching process. Obviously, as experience gradually occurs in any particular content domain, a natural tendency to eliminate errors will appear based on the creation of "expert systems." Reasoning by analogy, one reasonable inference is that the psychoanalytic transference represents a critical early stage or "probe" in the initial surface-matching process, which might or might not be borne out by further, costly similarity-mapping computations. Thus transference allows us gradually to bring into focus deep structural similarities and thus gain in our understanding and appreciation of past and present experience by comparing them. In other words, transference results in the creation and deepening of expert systems. Levin makes a similar point when he speculates about the possible evolutionary value of the transference phenomenon itself (Levin, 1991, chapter 8, especially pp. 169-171).The exact details of the similarity-judging system, however, are not crucial to the argument introduced at the outset of this essay that similarity judgments are likely a core part of the goal selection system of mind and brain, and the major element from which psychoanalytic transference emerges on the basis of contextual clues and the priming of memory.

Conclusions Specifically we have noted that at the core of the transference are two general processes that would seem to characterize all goal-directed thinking, namely, the judging of similarity (and difference) and the priming of memory. In previous publications Levin (1991, especially chapter 1) has discussed the importance of allowing priming to generously invade the psychoanalytic situation. In this essay we are more specifically suggesting that priming in the form of transference facilitates not only the retrieval of information, but the deepening of our internal knowledge bases as well. This



would seem to be the consequence of repetitive cycles of pnmmg our memory for old solutions that are usable for new problems, and the judging of similarity sufficiently to apply solutions only to appropriate cases (i.e., the refining of such judgments). The core of the entire cognitive system of the brain would appear, therefore, to be the system for making various kinds of refined judgments of similarity and difference. Psychology is learning about similarity just as neuroscience is learning about priming. But the key to our understanding human behavior more comprehensively would seem to be appreciating the relationship between priming, similarity judgment, and the affectively meaningful psychoanalytic transference. This is because it is only the latter (namely the transference) that codes for the highest level of meaning within the human system of goal selection; moreover, only transference accounts for affects that undoubtedly organize memory along lines of similarity of feeling. Some will object to the juxtaposition of judging similarity, priming memory, and the psychoanalytic transference, believing that this contributes little or nothing to the difficult task of understanding any of these phenomena. However, along with Ricoeur {1981) we hold that "all new rapprochement runs against a previous categorization" (p. 234). Therefore, we assert that these three phenomena are closely enough related that they likely employ sufficiently similar brain machinery and exercise similar enough parts of mind to make studying them in tandem advantageous. To add to the plausibility of our speculations we have also taken the time to elaborate on earlier models of mind and brain, generate a new model, and describe how it can be used technically to emulate the kinds of similarity and priming activities that we believe are key parts of the mechanisms of such models. In our thinking, transference becomes less mysterious when it is broken down into subprocesses that can be studied and related to each other, such as we attempt to do in this essay. We have thus come full circle, to appreciate how transference functions as a critical means of keeping our knowledge updated, so as to function better as an expert system. We have also seen how this proceeds by means of steps that involve comparing past and present affective experiences, and transferring knowledge from one domain to another. Finally, we have presented a detailed model, capable of emulation by computer, of how mind and brain work with regard to the variables under discussion: judging similarity, priming memory, and the psychoanalytic transference. In our opinion this model is both sophisticated and supported by many facts about mind and brain operation culled from cognitive psychology, neuroscience, and psychoanalysis. Of course, this does not prove the model, but it does make it compelling.


Psychoanalysis and Knowledge: Part 2

References Cloninger, C. R. (1991), ·Brain networks underlying personality development. In: Psychopathology and tM Brain, ed. R. J. Carroll & J. E. Barrett New York: Raven Press, pp. 183-204. Dudai, Y. (1987), On neuronal assemblies and memories (reporter of Dahlem Conference). In: The Neural and Molecular Bases of Learning, ed. J. P. Changeux & M. Konishi. New York: John Wiley & Sons, pp. 339-410. Gabriel, M. ( 1991), Brain dynamic circuit interactions and learning, research perspective. Newsletter, Beckman Institute, The University of Illinois, 3(2):2, pp. 2, 10-11. Galatzer-Levy, R. (1978), Qualitative change from quantitative change: Mathematical catastrophe theory in relation to psychoanalysis.]. Amer. Psychoanal. Assn., 26:921-935. Gentner, D. & Ratterman, J. J. (1991 a), The roles of similarity in transfer: Determinants of similarity based reminding and mapping. Cognitive Science Technical Report CS-91-12, Beckman Institute, University of Illinois. - - - & Ratterman, J.J. {1991b), Language and the career of similarity. In: Perspectives on Language and Thought, ed. S. A. Gelman & J.P. Byrnes. Cambridge: Cambridge University Press, pp. 225-227. Hadley, J. (1989), The neurobiology of motivational systems. In: Psychoanalysis and Motivation, ed. J. Lichtenberg. Hillsdale, NJ: The Analytic Press, pp. 337-372. Kent, E. ( 1981 ), The Brains ofMen and Machines. Peterborough, NH: BYTE Books. Levin, F. M. (1991 ), Mapping the Mind: The Intersection ofPsychoanalysts and Neuroscience. Hillsdale, NJ: The Analytic Press. Medin, D. L., Goldstone, R. L. & Gentner, D. (1993), Respects for similarity. Psycho[. Rev., 100(2):254-278. Modell, A.H. (1993), The Private Self. Cambridge, MA: Harvard University Press. Moore, B. & Fine, B. (1968), A Glossary of Psychoanalytic Terms and Concepts. New York: The American Psychoanalytic Association. Newell, A. & Simon, H. A. (1985), Computer science as empirical inquiry: Symbols and search. In: Mind Design: Philosophy, Psychology, and Artificial Intelligence, ed. J. Haugeland. Cambridge, MA: MIT Press, pp. 35-66. Reiser, M. (1990), Memory in Mind and Brain. New York: Basic Books. Ricoeur, P. (1981), The metaphorical process as cognition, imagination, and feeling. In: Philosophical Perspectives on Metaphor, ed. M. Johnson. Minneapolis: University of Minnesota Press, pp. 228-247. Sacks, 0. (1984), A Leg to Stand On. New York: Summit Books.

Psychoanalysis and Knowledge: Part 3. Some Thoughts on a Line of Development of a Philosophy ofMind FRED M. LEVIN

In Part 1, a companion paper, I criticize the modern trend of conceptualizing mind/brain activity in terms of internal "representations." In its place I suggest nonrepresentational, interdisciplinary theories of learning such as those of Rapaport (1951) and Gedo (1991). Such learning theories reexamine how knowledge is acquired, an ancient epistemological question. In Part 2, a second companion paper, I examine, together with Ernest Kent, more details of such "expert systems," introducing an interdisciplinary perspective on the concept of psychoanalytic transference. Specifically, I suggest that transference plays an important role in the reorganization and deepening of core knowledge systems. In Part 3, the present essay, I explore some of the philosophical issues raised by Parts 1 and 2, concentrating on a line of development of philosophy of mind in which the major nodal points are the contributions of Aristotle, Kant, and Freud. Philosophy of mind impacts on several aspects of psychoanalytic concern. 1 One such area considered is how our philosophiAn early version of this paper was presented to the University of Illinois Medical School, Defiartment of Psychiatry, September 15, 1991, Chicago. Gilmore (1994) takes me to task in my theorizing for not (systematically) addressing specific questions within philosophy of science, an approach that obviously appeals to her. Part 3 is a step toward addressing this gap. However, the reader should appreciate that the border between psychoanalysis and philosophy is no more important than the borders with other disciplines, for example, with cognitive science or neuroscience. What is sophisticated from one perspective may well seem naive from another, so we must be careful not to privilege one perspective for personal reasons. In fact, this has been my reason for favoring interdisciplinary approaches to psychoanalytic theory in general: it tends to minimize bias. 131


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cal beliefs about such things as knowledge acquisition might influence psy~ choanalytic theorizing and our behavior in the analytic setting. A second area concerns creativity,2 which is conceptualized as depending foremost upon one's ability to temporarily suspend personal belief systems in favor of alternative beliefs. In tum the ability to suspend belief is assumed to vary directly with the extent to which such belief systems function as dispensable parts of one's self. 3 It is further assumed that mental health is associated with a cohesiveness of the self, and with personal belief systems that are relatively independent of each other. Of course, the topic of knowledge acquisition has a rich history in our field and analytic scholars have written often and insightfully about such matters, such as Rapaport {1951, especially pp. 721-723), Waelder (1962), Hartmann (1964), Holt (1967), Schlessinger et. al. (1967), George Klein (1968), Gill (1976), Basch {1976), Modell (1978, 1993), and Gedo (1986), to mention but a representative sample. There are also many excellent general works on the subject by nonanalysts, for example, R. White's monograph (1982, especially chapters 4 and 5), Kent (1981), and Eickelman's learned discussion of the interface between knowledge and culture (1985). This essay is organized in the following manner. The discussion begins with a definition of epistemology and a sample of three variations of the central epistemological question that is the subject of this paper. There follows a review of the decisive contributions of Aristotle, Kant, and Freud, in particular, examining how their work forms a developmental sequence. It is easier to comprehend the philosophical foundation of a psychoanalytic theory of learning when it is viewed in the larger context of a philosophy of

2 Creativity is such an exceedingly complex topic that a separate discussion is planned. Let me mention, however, Johnson-Laird's {1977) position, with which I agree, that creative thought contrasts with induction and deduction as a third variety of systematic thinking. 3 After coming to the conclusion that I do about the need for temporary suspension of belief for optimal learning to occur I discovered the following quotation: "Hegel observed that the [person} ... who is omnipotent cannot acquire knowledge from others. Psychoanalysis confirms that those individuals who cannot relinquish belief in their omnipotence cannot learn from the analyst" (Modell, 1993, p. I 03). I also recall reading a book by Paul Reps {1961) called Zen Flesh, Zen Bones during my teenage years in which a story is told about a professor who visits a Zen master in Japan. The master pours the visitor tea, but does not stop when the cup is filled. The startled visitor asks why. The master responds that just as you cannot fill up a cup of tea that is already filled, so even a master cannot teach a visitor anything; the visitor must first empty himself. Obviously my central thesis about one's willingness or ability to empty oneself has multiple roots.



mind. Along the way, case material is presented to illustrate the clinical relevance of some of the points discussed.

Epistemology: Background and Definition According to the dictionary (Random House, 1988, s.v.) epistemology is "a branch of philosophy that investigates the origin, nature, methods and limits of human knowledge." One of the major epistemological questions can be expressed variously: How do humans acquire knowledge from perception (Aristotle; from the fourth century B.C.E.)? Or, "How is it possible that reasoning arrives at conclusions which coincide with the outcome of processes occurring in reality?" (Rapaport's rephrasing of Leibniz's question, quoted in Gedo, 1986, p. 78; originating in the seventeenth century). Or, How can the apparatus regulated by the pleasure principle (drives) be also adapted to reality? (Rapaport, 1951, pp. 721-722, n. 6; from the mid twentieth century). Clearly, the historical perspective demonstrates how this question evolves over time, as various sciences (including psychoanalysis) differentiate themselves from philosophy. How the question about knowledge acquisition is posed necessarily influences whether and how it is answered. Knowledge can be operationally defined as that information which people can recall or demonstrate which is most valued by some subgroup within a given culture. Psychoanalysts do not usually think of themselves as being much concerned with knowledge in the abstract, but rather with the experience of an individual as he or she comes to know, believe, or feel something in particular to be true. In principle, however, analytic investigation sometimes is remarkably similar to the perspective of philosophers who ask general questions about the use of evidence. Moreover, there are times when analysts, like philosophers, collect evidence for the purpose of constructing generalized theories of human motivation. When, in Part 1, I present some of Rapaport's thinking about human development, showing how he integrates the views of Freud, Piaget, and Hartmann, I am essentially describing the classical psychoanalytic concepts of introjection, identification, and a structuralization process in which aspects of the selPs experience of another person who is loved and/or admired become enduring acquisitions in the form of mental functions. In Part 2, however, I end up deviating from the traditional analytical perspective when I describe similar mental activity from the point of view of databases of the mind/brain that can become progressively widened, deepened, and generally reorganized to suit an individual's needs. Obviously, each of these subjects deals


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with knowledge acquisition, but from a different perspective. The change in orientation between Part 1 and Part 2, which will be obvious to the reader represents my attempt to integrate the psychoanalytic with modern cogni: tive psychological and neuroscientific frameworks. It is my contention that such an interdisciplinary viewpoint will be decisive for any progress in our psychoanalytic theorizing, just as it is decisive for Rapaport's creation of a psychoanalytic theory of learning (or structuralization). One reason why interdisciplinary efforts succeed more than some other approaches is that by their vary nature as compromise formations they involve the temporarily suspension of old belief systems which favors the ascendancy of a new paradigm (see below). An important step in refining Rapaport's psychoanalytic learning theory occurs when Gedo and Goldberg create their hierarchical, developmental model (especially as modified most recently by Gedo, 1993). This model has considerable utility inasmuch as it is consistent with data from child development, neuroscience, and psychoanalytic studies; that is, the Gedo model, like Rapaport's, is rooted in an interdisciplinary framework. As such the latest Gedo model becomes the basis for a modern learning theory with broad applicability. Of course, many details of such a learning theory need to be filled in, but now there can be little doubt that the outlines of such a general conception are gradually coming within reach. But what are the implications for psychoanalysis of a general theory of learning (as is discussed in Part 1) or an updated theory of transference, with its reference to memory priming and to judging similarity (as is discussed in Part 2)? Still more specifically, under the influence of what theory of mind do we think and act with patients in the consulting room? It would be possible, were one versed broadly in the philosophy of psychoanalysis or of mind, to write in extensa about the various philosophical nuances of such theorizing. Rapaport (1951) in fact does so when he constructs his Ph.D. thesis on the subject of philosophical contributions to the idea of mental association, matters that are part of his personal preparation for thinking about thinking psychoanalytically. However, because of the obvious limitations of time, space, and my personal knowledge of philosophy, the following discussion can do no more than consider an idiosyncratic outline of the contributions of Aristotle, Kant, and Freud to the present discussion.

Aristotle: Curiosity About Psyche Sets the Stage for Empiricism Aristotle is important to our discussion about knowledge because he is arguably the first person we know of to employ an experimental/ empirical



approach to the study of novel human knowledge (Barnes, 1982). In fact Aristotle is the one who originates the idea of category without which we could not contemplate varieties of knowledge, and he also invents a vocabulary to describe logical thinking tersely. Perhaps even more important, however, is the fact that Aristotle also establishes the first general "rules of validity," thus making it possible for anyone after him to acquire scientific knowledge in the consensually validatahle sense (Grene, 1979, p. 69). Unfortunately, a portion of Aristotle's work seems to have been mistranslated from the original Greek into Latin by medieval religious scholars in a manner that has confused our appreciation of the man and his approach to novelty. Specifically, the word "psyche" is mistranslated as "soul" rather than in the way I believe Aristotle intends (Barnes, 1982, p. 65). Let me explain. Judging from the 12 volumes of Aristotle,s complete works (Ross, 19551962), a better translation of "psyche" would appear to be "mind" (Ross, 1955-1962, Analytica Posteriora, 99b36) in the following sense: "that agency, that is, that interior, localizable part of the human body (and the bodies of animals), that is capable of learning (i.e., acquiring knowledge) from sense perception" (Ross, 1955-1962, Analytica Posteriora, 100b05). Aristotle is an enormously curious man. He thus believes that "psyche" (meaning "mind" in the above sense) is the proper study of science, not religion, and that through such techniques as comparative anatomy and physiology it ought to be possible to understand (mental) activities and the life process itself (Ross, 1955-1962, De Partibus Animalium, 641a25-30). Aristotle's novel idea of "psyche" is what frees his mind to extend his observations beyond his personal religious beliefs. The major reason Aristotle does not make clear that his primary interest is in mind/brain as we presently understand these terms is because during his age no one understood the true role of the brain in mental activity. In fact, the brain in ancient Greece was believed to be merely an agent for cooling the blood, which was thought to be heated by the heart. Mental activity suffers when the brain fails in its presumed cooling function, and this is how damage from blows to the head was explained in ancient times! However, even though Aristotle's anatomy and physiology are wrong regarding the brain, there seems to be no doubt that he is writing about the nature of mind (and what will eventually be localizable as brain) from an experimental, biological perspective. Moreover, his approach at times involves dissections carried out by Aristotle himself. The fact that his father was a physician no doubt played a decisive role in Aristotle's pragmatic approach. Early in the twentieth century debates occur such as those between Russell and Poincare over whether knowledge is the product of logic or


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intuition. This debate, however, really begins 2,300 years ago when Aristotle introduces the concept of "category." For this purpose he borrows a Greek word that in the legal parlance of his day means "that of which a person is accused [that is, a type of crime]" and adapts this concrete word to designate abstract, logical kinds of "predication" (Ryle, 1971, p. 67). By predication he means the predicate of various sentences such as "Socrates is a man" or "Socrates is mortal." Aristotle lists 10 (sometimes fewer) general types (of predicate or "categories"): such things as "quality," "quantity," "relation," "substance," "state/condition," and so on (p. 67). It is hard to tell from Aristotle's work how universal or particular he believes such categories to be. It is virtually impossible for us to imagine mental life without a concept of "category" in the Aristotelian sense, so we may easily underestimate the revolutionary advance he creates by coining the term. Aristotle's contributions to epistemology are thus multiple: (1) at the same time that he creates a terminology he also (2) gives us a systematic analytical method for abstract notation (i.e., a symbolic logic) in which letters stand for premises (for example, "If A, then B"), and (3) he then uses these conceptual tools extensively to analyze the thinking of his time (i.e., he discovers "mind" as a subject of study in the scientific sense). Most crucial to our discussion (4) he asks how perception leads to knowledge, and (5) establishes rules of validity to apply to the answers to such questions. Each of these contributions is of course momentous; however, the fourth and fifth contributions seem decisive for epistemology, for without a question about mechanism we would remain hopelessly mired in religious belief; moreover, without rules of validity there could be no science as we know it, that is, in the sense of a discipline with empirical observations and reproducible results. The clarification of the mistranslation of the word "psyche" as "soul," to which I refer above, is extremely important historically, because this is what makes it possible to appreciate Aristotle's distinctive achievements. What is crucial would appear to be the distinction between Platonic and Socratic idealism/vitalism on the one hand and Aristotelian empiricism/materialism on the other, that is, between a .belief in ideal forms, conceived of as inseparable from religious experience, versus experimentally based categories, conceived of within a scientific matrix, wholly separable from religion. In short, if one believes that Aristotle's scientific writings explore matters that pertain to the existence of a Supreme Being and an immortal soul, as some religious scholars do, then one necessarily sees Aristotle and his theories differently (and falsely, I believe), as a link in a chain of idealism/ vitalism that extends from Socrates and Plato, through Aristotle, to the present time. On the other hand, if one sees Aristotle as publicly preoccupied in his scientific writings with science alone, and willing to temporarily



suspend his religious beliefs (for example, while pondering the anatomical and physiological facts that bear on understanding the mechanisms by which sensory perceptions become organized as knowledge), then one will see Aristotle {truly) as the champion of a separate rationalist, scientific philosophy that flowers after another 2000 years (in the seventeenth and eighteenth centuries). In my opinion, the debate between idealism/vitalism versus empiricism/modern materialism invariably but inappropriately inserts itself into scientific debates whenever discoveries are experienced as threatening to one's belief system, whether religious or scientific. And this is not without clinical implications for psychoanalysis.

Immanuel Kant: The Influence of Mind on Perception Lays the Foundation for Neuropsychology It is impossible to discuss philosophy of mind or theories of learning without reference to Immanuel Kant. To begin with, Kant alters Aristotle's meaning of category significantly.'1 Interestingly for this discussion, Kant's form of empiricism is uniquely complex, including as it does several incompatible yet important ideas (Collins, 1985), an idea I shall elaborate upon shortly and compare with Freud's epistemology. Most important, however, is Kant's recognition that there can be no empirical observations without the influence of mind; that is, that mind influences perception, which is no longer seen as a passive process. In fact, Kant postulates that external reality itself is nothing but a construct of mind, and essentially has no independent existence, a truly subjective empiricism (Collins, 1985)! The key to Kant's appreciation of the mind's influence on perception is his understanding that our very concepts themselves belong to the framework of knowledge; that is, they represent "ways in which the propositional structures extracted in logical theory function as the controlling principles of natural knowledge" (Ryle, 1971, p. 69). Thus, although our categories "provide an objective basis for knowing the world ... there ... [must be] times when mind is incapable of unfettered, intuitive insights" (Walsh, 1971, p. 220). Another way of saying the same thing is that in place of perception is 4

Kant adds distinctions "between simple and compound propositions, between affirmative and negative propositions, between universal, particular, and singular proposition, and between [so-called] assertoric, apodictic and problematic propositions" {Ryle, 1971, p. 68). Universal propositions, such as "All men are mortal," state something about every member of a class. Singular propositions are about one designated individual of a class, for example, "Socrates is tnortal." Particular propositions are about at least one {or some) undesignated members of a class, for example, "Some men are mortal." Apodictic means incontestable or logically certain. Assertoric means "stating something as a fact rather than a mere possibility" (Merriam-Websttr's Unabridged Dictionary, s.v., 1958).


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apperception, a process that involves covert emotional influences of various kinds. Consequently, Kant generally divides the world into two parts: the "noumenal" associated with what he designates as "practical reason, "final truths, and the "thing itself' ("Das Ding an Sich"} which he imagines to be fundamentally unknowable; and the "phenomenal," associated with lawfulness, causality, and determinism, and which is knowable on the basis of something he calls "pure reason" (Walsh, 1971, pp. 219-220). Put differently, these two domains relate, respectively, to either those things which are important to us because they have moral value and authority (but are not subjectable to proof), or those things that have truth value (and can or must be subjected to proof), such as scientific theorizing. As an interesting aside, one can say that Kant is a little like Freud in his willingness to live with the inconsistencies of his thoughts and not have to tidy them up with simplifying theories; hence he develops a cumbersome philosophical system that is nonetheless reflective of some important internal reality of mind. Unlike Freud, however, Kant does not elaborate any theory to begin to account for the existence of simultaneous, conflicting ideas in the mind; in fact, he is not interested in doing so because his purpose is different. Kant's aim seems to be primarily to clarify the importance and structure of scientific method while simultaneously establishing the necessity and value (in practical terms} of human morality. In other words, Kant's philosophic creativity is facilitated by his temporarily and selectively suspending his belief systems. Kant is excited by the power of Isaac Newton's discoveries and wishes to emulate his scientific approach, yet without giving up his metaphysics, that is, his personal belief in God, free will, and an everlasting soul. (It is of course an interesting question, to what extent one ends up modifying one's personal philosophical, scientific, or religious beliefs in order to be able to be truly creative over extended periods of time.) Philosophers of Kant's day offend Kant greatly by trying to prove their metaphysics (i.e., religious doctrine} rather than merely being content with belief. Kant's response is to debunk the details of their logic, arguing that "[while] there ... must be answers to man's causal questions about empirically ascertainable events ... there can be no answers to parallel questions about supposed states of affairs transcending human experiment and observations" (Ryle, 1971, p. 69}. Here again, as in the foregoing discussion of Aristotle, we see a philosopher/scientist attempting a disciplined analysis of a subject matter in a manner that attempts to neutralize insofar as is practical the effects of his personal religious belief system, but which he also agrees beforehand is in principle impossible! One can see in this self-conscious



creativity of Kant a foreshadowing of Freud's discovery years later of the surprising existence of simultaneously incompatible ideas in the mind. There is thus no doubt that by creatively introducing into philosophy the idea that the objectivity of (experimental) observations cannot be taken for granted Kant moves us imperceptibly closer to what will eventually crystallize as neuropsychology hundreds of years later. The key step in this later development will be the shift from Kant's idea of mental influence, to the modern idea of mind/brain's active role in seeking out perceptions that are needed, and therefore discovered in the real world. That is, our mind/brain tells our eyes what to look for, and "seeing" selectively fulfills this inner request for information. It is also apparent that without a Kantian notion of mental subjectivity Freud could never have conceived such a concept of transference. Yet at the same time we are grateful to Kant for identifying the general influence of emotion in perception, we can wonder why he is not able or willing to further specify the role of religious and other emotions in his own thoughts. As Cavell (1988) puts it, Kant waffles on a number of questions about the nature of knowledge, leaving us with a notion that truth value depends merely upon "its consistency with a system of beliefs" (p. 864). But the answer can only be that in creating the category "noumenal" Kant is preserving his own religious beliefs from scrutiny by placing them in the logical category of "Ding an Sich," which is by definition that which requires no further examination. Of course he is also protecting himself from the scrutiny of others because in Kant's day opposing or challenging religious teachings brought with it the danger of severe penalties from those authorities who also controlled the universities. In spite of Descartes's earlier efforts to stand up to Rome the right to think freely was not yet conceded as an academic right.

Freud: The Unfettered Investigation of Mind Of course it is unfair for us to ask of Kant what we accomplish today only with the aid of psychoanalysis, and with the right to freedom of thought. For it was not until Freud that humankind began to examine mind systematically, that is, to turn the scientific perspective upon those aspects of mental life which Kant decides or needs to leave unexplored. Moreover, even modern scientists (or philosophers) may find it difficult at times to acknowledge the extent to which humankind's observations and innovations emanate from private or conflictual aspects of our "psyche." Psychoanalysis represents both a body of knowledge and a method of investigation; as such it contributes to the epistemological discussion with


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which I began this essay. Freud's major contribution to a philosophy of mind lies in three related ideas: (1) his introducing affects into the debate (in his theory of conflict and drive) (Modell, 1993); (2) his unique method of solving the problem of objectifying the subjective, which had become an intractable problem within philosophy before Freud (Modell, 1993), and which will be described presently; and (3) his postulation and examination of an Unconscious (Holt, 1967). In Freud's (1915) epistemology there can be no doubt of his utilization of Kant:

In psychoanalysis there is no choice for us but to assert that mental processes are in themselves unconscious and to liken the perception of them by means of consciousness to the perception of the external world by means of the sense-organs .... The psychoanalytic assumption of unconscious mental activity appears to us, on the one hand, as a further expansion of the primitive animism (narcissism?] which caused us to see copies of our conscious all around us, and, on the other hand, as an extension of the connections undertaken by Kant of our views on external perception. Just as Kant warned us not to overlook the fact that our perceptions are selectively conditioned and must not be regarded as identical with what is perceived though unknowable (i.e. Das Ding an Sich], so psychoanalysis warns us not to equate perception by means of consciousness with the unconscious mental processes that are their object. Like the physical, the psychical is not necessarily in reality what it appears to us to be. We shall be glad to learn, however, that the correction of internal perception, will turn out not to offer such great difficulties as the correction of external perception, that internal objects are less unknowable than the external world [p. 171). Philosophy wrestled unsatisfactorily with mind until Freud. Thereafter, philosophers have benefited greatly from this creation of psychoanalysis and its novel insights into the nature of mind/brain, even although they may freely object to some of Freud's specific conclusions. In a series of discussions Modell (1978, 1993) makes explicit how Freud's epistemology works toward a solution of this so-called philosophical paradox of objectifying the subjective. Freud's primary philosophical method is to carefully sustain an ambiguity in his description of mind, by alternating between statements that describe mental activities in scientific terminology (that is, from an external observer perspective), and statements that anthropomorphize mental agencies in a highly experimental language (Modell, 1993). In this way he weaves together the Weltanschauungen of two major perspectives: the human, reflective sciences ("Geisteswissenschaft") and the impersonal, natural sciences ("Naturswissenschaft"), a distinction that goes back at least to Vico in the eighteenth



Century (Modell, 1978, p. 648). This distinction will be considered further below under the rubric of varieties of knowing. The topic of Freud's epistemology is further covered by Hartmann (1960), who summarizes the situation neatly in his pioneering comments on psychoanalysis and moral values. As Hartmann notes, although psychoanalysis has no Weltanschauung itself, this does not, of course mean that the analyst will underrate or depreciate the ... significance of "Weltanschauungen" in the individual or in society. [Moreover,] while the analyst learns to keep his personal values from intruding into the analytic situation, this does not generally lead to the detachment of his interest from [such} ... concerns [emphasis mine). Quite naturally, analysts and others acquainted with analysis will use its data and hypotheses also in their practical approach to questions of a moral, social, political, or artistic nature. What psychoanalysis can give them in this respect is increased psychological understanding ... [p. 61). According to Hartmann "a systematic psychology of 'moral behavior,' including the

genetic {i.e. developmental] aspect, had hardly been in existence before Freud" [emphasis mine] (p. 24). Continuing, "in clearly rejecting any and all religious creeds and systems, [Freud, as scientist] did not reject the moral aspects of the Wes tern tradition. He wished, however, that one could establish these on nonreligious grounds" (p. 18). As with Aristotle and Kant, Freud is a deeply moral man; where he differs is in his curiosity and perseverance in studying the personal origins of all things, morality, religion, and science included. In short, as analysts we are well aware of Freud's accomplishments in penetrating the privacy of mental life, to the point of appreciating the origin of (individual) morality itself, something which even Plato asserts cannot be understood properly without our knowing the nature of man (Hartmann, 1960, p. 25). We thus have come full tilt, from Aristotle's beginnings in creating a scientific orientation as something independent of religion (that is, which allows the study of "mind'' scientifically in relation to the temporary suspension of various belief systems), to Kant's clarifications of observational bias in perception (with his willingness to go quite far in suspending belief, although only on a selective basis), to Freud's exploration of unconscious mental life (based on his radical willingness to suspend belief seemingly without limit). Along the way we can more easily see. how only gradually in human history is brain discovered, long after the discovery of mind; how long it takes humankind to be aware of the subjectivity of the mind's observations; and how resistent all humans are to facing their unconscious depths, whether they be scientists or philosophers. It has also taken a very long time for religion and science to coexist.


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Further Discussion: On the Need for Freedom to Suspend Belief We are now ready to return more particularly to the questions raised at the outset regarding the implications of the proposed psychoanalytic theory of learning (of Part 1), and the additions to our theory of transference (of Part 2). We could start with the second of the two theories (relating to transference) but cannot fail to rapidly advance to the first theory relating to learning, since transference as seen in Part 2 is at least partially reducible to the mind's/brain's system for acquiring refined, affectively meaningful information about the self and object world (i.e., expanding episodic memory). Transference from its inception has been a complex idea. Freud's major depiction of transference rests on an image of the mind as a form of map, with known territory (the conscious and preconscious) and terra incognita (the unconscious). This powerful topographic metaphor of knowledge distribution within an imaginary space illustrates Freud's capacity to excite our imagination while simultaneously arousing our scientific curiosity. Most critical, however, is Freud's conveyed sense that the fabric of mental life is deeply conflicted as a universal condition, and that only when the mental "pieces" are properly recombined (through analysis) does the entire "puzzle" become intellig~ble (the so-called dynamic point of view). Although Freud does not state his model of mind in explicit epistemological terms, clearly he believes that the confusion in understanding mind/ brain is more apparent than real (as when he states in the quotation above from "The Unconscious" that the psychical is less unknowable than external reality) and that, fundamentally, mental development is guided by discoverable variables, such as "sexuality" and emotional attachment whose influence begins in infancy. Primary and secondary process, transference (of reaction patterns, including affects) across a repression barrier, and combinations of condensation, displacement, symbolization and other mental mechanisms are seen by Freud as component "threads" in a complex, mental "fabric" that expresses how man's sexuality plays out in its various aims, objects, and so on. I describe above how Freud approaches the intractable philosophical problem of objectifying the subjective by combining humanistic and scientific perspectives in a systematically consistent ambiguity. It seems also true, however, that some significant confusion for psychoanalytic theory necessarily results from this same strategy. For example, the sequential theoretical modifications of psychoanalytic models evolved by Freud can cloud the picture and confuse our focus, as well as delight us. Thus after his momentous papers "On Narcissism" (1914) and on "The Unconscious" (1915), in which he explores respectively the narcissistic components of libidinal ties



and the dynamic and systematic unconscious, Freud then constructs his socalled tripartite model in "The Ego and the Id" (1923). The new model, however, can already be seen as a movement away from affects (such as sexual desire, murderous rage, incest taboos, castration, and humiliation) toward an impersonal theory of information processing. Of course, the matter of clarity is not helped by the mistranslation of Freud by Strachey, which is generally acknowledged to obscure Freud's richness of emotional meanings in the cloak of a dry English scientificism (Modell, 1991). That is, the topographic model comes closest to Freud's tendency to creatively capture novel truths in the skillful interplay of ordinary terms; as such it is powerfully evocative and experience-near. In contract, the later tripartite model seems dull, technical, and experience-distant by comparison. It is unfortunate that the gain of precision in the later creative clarifications of theory occurs at the apparent cost of colorfulness and aliveness of metaphor. In addition, the need to alternate subjective and objective perspectives in order to solve a philosophical dilemma not of psychoanalysis's making runs a further risk of adding a potential "rift zone" between our psychoanalytic models and our awareness of the feelings these same models are supposed to explain. Such dilemmas remain a considerable challenge for us in the discharge of our duty to update and understand the scientific basis for what we observe in the analytic setting. Try as we may to be attentive to new observations in our field, or new observations in our clinical work with particular patients, it is easy to lose touch temporarily with either our humanity or our objectivity. In the face of such difficulty it would seem natural for the psychoanalyst to fall back on rigid theoretical positions that essentially serve a defensive function. An important question is whether and how this can be avoided. Before approaching this question directly, it may help us to briefly return to the theory of learning advanced in Part 1. The reader will recall that at the core of Rapaport's (and Gedo's) theory of learning is the Freudian idea that first and foremost in learning is the subject's powerful emotional attachment to the object of desire. Everything hinges on this fact; that is, on the love, or respect, or intensity of the tie to the object, who is at some point no longer available to the subject in reality, but is available in working memory. In other words, the subject must be able to appreciate at some level the importance of his or her feelings about the relationship with the object before he or she can acquire aspects of the relationship in the form of enduring mental functions. In Freud's words, object loss leads to mental structure. In Chicago in particular the theorizing of Heinz Kohut and his collaborators has further refined the understanding of many subtle aspects of such


Psychoanalysis and Knowledge: Part 3

object ties and their relationship to the establishment of such things as enduring values, nuclear ambitions, the unfolding of inborn talents, and even to the so-called "cohesiveness" of the very self at the core of our being. It should be obvious from this work of Kohut and others that what Hartmann discusses under the rubric of morals, Rapaport under the heading of mental functions, and modern theoreticians such as Modell {1993) under the heading of "private self' are in essence all discussing the same thing: the flowering of the basic or core personality pattern of the individual, or how an individual comes into being with certain fixed features that identify that person as unique over time. All such theories attempt to take into account the interaction of biological givens and environmental inputs, to account as well for such things as each individual's core knowledge and his or her method of acquiring it. But such insights as psychoanalysis has gained over its years of closely observing humans tells us unequivocally that learning is not any single thing. sometimes it will be seen as a specific content of the mind, equivalent to adding quantifiable bytes of information to a computer. At other times, however, what is learned becomes a core part of one's self, intrinsic to our personhood (that is, necessary for our very functioning). With this perspective in mind it should be easier to understand why it is that some knowledge acquisition will be dispensable, or at least, function in a manner such that its influence can at times be minimized willfully by the individual, whereas other knowledge will play a continuous role in mental activity, involving as it does the very core of our being. In other words, some beliefs can never be dispensed with, even temporarily, because they constitute core psychic structure without which thinking itself cannot occur in decisive areas. From this conclusion it seems to follow that our belief systems will only be dispensable or suspendable if they are not part of the core of who we are and if we are not dependent upon them for thinking itself. For if our scientific or religious beliefs are so central to our makeup that they can never be even temporarily suspended, then this fact of dependency can or will impact on our scientific and therapeutic work whenever our work requires the suspension of belief. As Modell has noted, this may reach a peak where such beliefs relate to one's hidden grandiosity; but it appears likely that any belief system may prevent the acquisition of any new belief if it cannot be held in abeyance. Religion and science are sometimes antithetical, at other times coincident and mutually supportive. Humankind does not really have the freedom to get along without either. For this reason I personally doubt Hartmann's assertion that Freud actually completely eliminates the religious factor from his life. Rather it seems more likely, as suggested above, that his {and by extension, our own) ability to concentrate during our periods of analytic



activity stems primarily from his ability to temporarily suspend his beliefs. Sirice such belief systems are inevitably part of most of us, however, we should have no expectation that we can think entirely independently of them for long periods of psychoanalytic work. Put differently, perhaps the only kind of truth we can know is a retrospective truth, one that is understood deeply only after considerable investment in time and patience. This is certainly the case of those personal truths discovered in psychoanalysis. I believe the study of the works and the lives of Aristotle, Kant, and Freud suggest this would also be the case for significant learning within any setting, and not just within psychoanalysis. At this point it seems appropriate to present some clinical case material to illustrate some of the ideas noted above. Clinical Cases CASE 1

A middle-aged deaf man presented for psychiatric care after he became afraid that his hearing son would soon leave home. His anxiety about loss was massive, but what was most difficult was that during the first interview with me he signed too quickly for me to understand him and he insulted me for my stupidity in not understanding him. He did sign very clearly and slowly, however, that he hated Jews, men, and doctors! I answered that for this reason it would be better for him to be interviewed first with another person, a woman, someone much more fluent in sign language than I was at the time. But I made it clear that afterward I would return, and that I hoped we could work together. When I returned, to my surprise and dismay this patient was willing to meet with me for therapy, and we made arrangements. All of the beginning sessions involved his asking me to help him in one way or another, most of which I attempted to accomplish. Sometimes I had to help him make urgent telephone calls (at the time portable TfY machines did not exist, nor did the telephone company relay service by which the deaf can get free translation assistance in receiving and sending messages). At other times I was placed in impossible quandries involving making arrangements for him, where he would change his schedule and expect me to accommodate him by changing my own. Usually, after some discussion, we found a compromise time, but often not until tempers had been tested severely. Most troubling, however, was his intense rage. Later, when the treatment came to a highly successful planned termination after about three years of collaboration, I asked him why he had been so angry when we started out. He laughed and signed: "I felt then that life as a deaf person was so hard for me,


Psychoanalysis and Knowledge: Part 3

why should I make things easy for you!" By the this time I had developed considerable affection for him. But along the way he pushed my capacity for empathy as hard or harder than anyone I have ever worked with. Why did this treatment work? My expectations at the beginning were of disaster. Once, for example, he threatened to kill someone with whom he was angry. It was all I could do to help him calm down and convince him that killing someone would be wrong. I threatened to call the police if necessary. I said I would call the intended victim if I did not get credible reassurances that my patient would drop any plans for attacking this person. It was quite frightening. But the fascinating thing is that somehow, in spite of everything, we were gradually learning to trust each other. Yet this was in contrast to how we felt when we started out on our journey. Then we decided to go against our initial impressions that the situation was totally hopeless. He really began with the thought that I was the worst therapist he could possibly have been given. I felt the same: I could not imagine a worse patient. Later we discovered, however, that when we suspended our beliefs about each other, things began to happen that facilitated closer collaboration. Ultimately, we turned out to be very precisely well matched to work together. I loved his cranky intensity, especially his ability to express his thoughts clearly, even though they were very often insulting. His intelligence was quite impressive. He in turn greatly appreciated my ability to concentrate on entering his world, the world of the deaf, with him as my guide. And I believe in this I was a bright student of his. Without a doubt his world felt terrifying to us both, that is, the hearing world in which deaf people can be essentially persona non grata. I learned from him about hearing people who could be cruel to the deaf for no other reason than that the deaf were different. He told me how someone had attacked him viciously in an elevator, nearly killing him, when the person asked him to step aside so he could get out and (of course} my patient had done nothing (since he had not heard him}! I made so many mistakes in treating this patient that it was amazing to me that he continued with me at all. Often I did not understand his signs (I was learning sign language at the time}, so he not only had to explain his difficulties, but teach me his language simultaneously. He had to laboriously finger-spell the meaning of his signs whenever I forgot them, which was often! Yet in spite of everything, there was progress. Especially poignant was a joint session with his son. The son was hearing and had been the patient's ears from childhood. Now 17, he was hoping to head off to college; but how could he abandon his father? By the end of the session we were all crying. Part of what made things progress, I believe, was our ability to assume that we each were working as best we could, and that we did not mean to hurt each other by



what we were doing or not doing. The son did not want to hurt his father by his ]eave taking; he only wanted a chance to grow up on his own, without the

burdens of parenting his father. And the father was not trying to hurt his son by hoping he would not leave; he really loved his son and did not know how he could manage without him. Yet he felt if he could get along with such a stupid therapist as I was, he could possibly get along satisfactorily without his son as translator. If we had been "reasonable" at the beginning of treatment we would never have worked together. Luckily we suspended belief and acted on the assumption that we might be wrong and, in fact, we were. I will always remember this wonderful, brave patient and at times I wonder how he is doing. This case as much as any other reminds me of how often we can be mistaken in judging people by surface features, and how crucial it is to suspend belief until we have facts to fill in accurately the gaps in our knowledge. CASE2

An exorcism assists psychodynamic insights. A middle-aged African American woman presented with free-floating anxiety in relation to being placed under a curse by someone who belonged to the same Cajun culture. Listening to the patient and her history, it was obvious that one could understand her plight from several different perspectives: either from the viewpoint of an ongoing psychotic process (in a schizophrenic or possibly borderline person) in which persecutory delusions were dominating her thinking, or, from the perspective of her cultural belief that, having been cursed, she required exorcism. Questions to her about her culture, and the evidence she used for judging whether she had been cursed or not, proved inconclusive. A mental status examination was not formally conducted, but close listening and observing convinced me that there was no obvious thought disorder. After working with this patient for months, however, it became increasingly obvious that if she was psychotic in a paranoid sense, this seemed localized to the experience of her believing herself cursed, and to nothing else in her life. One day she asked me how I felt about her having an exorcism! I responded, somewhat surprisingly even to myself, that I could well understand this wish, given her upbringing and experience, and if she felt this would help, then why not go ahead with it. After all, she clearly knew much more about such things than I did. I also added, however, that I hoped that whatever she decided to do we would continue to talk about her experience and understand it. Within a week she had arranged for an exorcism, which proved highly effective, after which we were able to continue analyzing what appeared to


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be the residual of a deleterious relationship with what sounded like a deeply disturbed mother. At the end of her treatment she thanked me sincerely, especially for my being understanding about her culture. I had respected her beliefs, and this had been decisive. Her recovery has lasted all these years, so far as I know. By termination she was anxiety free, and had some significant insight into her problems, in particular, the role of her mother in repeatedly humiliating or not accepting her. In the process of exploring her childhood memories she also discovered that much of her source of pride and strength emanated from her Cajun culture, which now appeared less fearful when experienced as separate from her experience of her mother. Diagnostically, I was unable to rule out a psychotic process. It was unclear, however, if she herself was psychotic, or if we had witnessed the memory of a psychosis that belonged to her mother and which the patient experienced in her early childhood (and reexperienced in her treatment). Although my patient experienced me as accepting, actually I was somewhat defensive about listening to someone tell me about such things as spells and exorcism. This became obvious to me when I realized that I first considered this belief system to be something that separated my patient and myself from each other. That is, until I remembered enjoying "Fiddler on the Roof," which is of course saturated with similar Jewish superstitious beliefs that undoubtedly influence me as her beliefs influence her. Fortunately for our collaboration I also felt willing to suspend any defensive use of my scientific belief systems, so with my patient's permission I entered her world, temporarily, with her as my guide. In a similar way, undoubtedly, she suspended her skepticism about working with a Jewish doctor, whatever this meant to her. Because we were each able to suspend belief and judgment about the other we were able to temporarily share experiential space in which collaboration and mutual trust held sway. Our differing backgrounds became incidental to the meeting of our minds, our joint concern for sharing feelings and ideas about what might explain her fears, and finding approaches to their resolution that did not violate her precious values and beliefs. Such examples could be multiplied from everyone's practice. I believe enough has been presented, however, in the two cases above to clarify at least my concrete meaning of the pressure the analyst is under to temporarily suspend beliefs for the purpose of allowing a sufficient level of neutrality and openness to new ideas. This of course severs as a model for the patient's own temporarily suspension of belief, which allows for creative solutions to old problems. It is our job as analysts to do everything we can to support such constructive temporary suspensions of belief. And of course in doing so we are following in the footsteps of Aristotle, Kant, and Freud.



Summary This essay has presented some ideas about epistemology. Freud's work is placed in a developmental line that starts with the experimentalism of Aristotle and builds upon the empiricism of Kant. Freudian psychoanalytic theory, especially the postulation and detailed examination of a dynamic unconscious, represents a decisive turning point in the philosophy of mind (and the history of science), which can be seen as having stagnated in this respect before the invention of psychoanalysis. A major conclusion from the review of the history of philosophy of mind is that creative thinking requires the ability to temporarily suspend one's systems of belief, although it is recognized that this may be problematic depending upon how intrinsic one's belief systems may be for the functioning of the self. The suspension of belief is what allows us to go beyond our current beliefs, in effect, to think the unthinkable. Aristotle did so when he allowed himself to ponder scientific questions apart from the religious beliefs of his time. Kant made a further inroad into such suspension of belief when he thought deeply about proofs about the existence of God, a soul, and free will, concluding that these beliefs cannot be proven in the same way one can prove scientific facts. He made still more progress (and set the stage for neuropsychology) when he observed that there can be no observations that are free of theory, that perception is really apperception. And Freud revolutionized science and contributed to philosophy by temporarily suspending his personal religiosity or spirituality in order to plumb the depths of the human psyche. Through very clever strategies Freud was able to begin to solve the philosophical paradox of being objective about subjectivity (or one might say, subjective about objectivity). But the danger today is that we may use such strategies as his to avoid being open to further change. The challenge is how to hold on to the insights of the past while continuing to discover and create new observations. In Parts 1 and 2 of this essay on knowledge some details are presented of an improved psychoanalytic theory of learning (and of transference) that is not, however, based upon the idea of internal representation. In Part 3, the present essay, I try to bring together some of the philosophical issues raised by parts 1 and 2. In my opinion, the key to further advances lies in two directions: the first is the building and testing of our theorizing through interdisciplinary perspectives such as those presented in this essay and in my earlier papers; the second is to use our psychoanalytic methodology in the service of improving our ability to temporarily suspend our various belief systems as a means of opening up ourselves and our patients to newer and better theories. Our scientific creativity requires that our beliefs remain dispensable.


Psychoanalysis and Knowledge: Part 3

References Barnes, J. (1982), Aristotle. Oxford: Oxford University Press, 1989. Basch, M. (1976), Psychoanalysis and communication science. The Annual of Psychoanalysis, 4:385-422. New York: International Universities Press. Caveil, M. ( 1988), Interpretation, psychoanalysis, and the philosophy of mind, J. Amer. Psychoanal. Assn., 36(4):859-880. Chattah, L. (1993), Metapsychology: Its cultural and scientific roots. Panel report. J. Amer. Psychoanal. Assn., 31(3):689-698. Collins, A. W. (1985), Thought and Nature. Notre Dame, IN: University of Notre Dame Press. Eickelman, D. F. (1985), Knowledge and Power in Morocco. Princeton, NJ: Princeton University Press. Freud, S. (1914), On narcissism: An introduction. Standard Edition, 14:73-102. London: Hogarth Press, 1957. - - (1915), The unconscious. Sta:nda,rd&l,ition, 14:159-216. London: Hogarth Press, 1973. - - (1923), The ego and the id. Standard&lition, 19:12-66. London: Hogarth Press, 1961. Gedo, J. (1986), Conceptual Issues in Psychoanalysis: Essays in History and Metlwd. Hillsdale, NJ: The Analytic Press. - - (1991), Between prolixity and reductionism: Psychoanalytic theory and Occam's Razor.]. Amer. Psychoanal. Asm., 39(1):71-86. - - - (1993), The hierarchical model of mental functioning: sources and implications. In: Hierarchical Concepts in Psychoanalysis: Theory, Research, and Clinical.Practice, ed. A. Wilson & J. Gedo. New York: Guilford. Gill, M. (1976), Metapsychology is not psychology. Psychologicallssues, Monogr. 36. New York: International Universities Press, pp. 71-105. Gilmore, K. (1994), Book review: Mapping the Mind: Vie Intersection of Psychoanalysis and Neuroscience, by Fred M. Levin, Hillsdale, NJ: The Analytic Press, 1991. In: Psychoanal. Quart., 63 (4):781-783. Grene, M. (1979), A Portrait ofAristotle. Chicago: University of Chicago Press. Hartmann, H. (1960), PsyclwanalysiJ and Moral Values. New York: International Universities Press. - - ( 1964), Essays on Ego Psychology. New York: International Universities Press. Holt, E. (1967), Beyond vitalism and mechanism: Freud's concept of psychic energy. In: Science and Psychoanalysis, Vol. 11, ed. J. Masserman. New York: Grune & Stratton, pp. 1-41. Johnson-Laird, P. (1977), Human and Machine Thinking. Hillsdale, NJ: Lawrence Erlbaum Associates. Jowett, B., trans. (1993), Aristotle's Politics. Franklin Center, PA: The Franklin Library. Kent, E. ( 1981), The Minds ofMen and Machines. Peterborough, NH: BYTE Books. Klein, G. (1976), Psychoanalytic Theory. New York: International Universities Press. - - (1968), Psychoanalytic Theory: An Exploration of Essentials. New York: International Universities Press. Model~ A. (1978), The nature of psychoanalytic knowledge. J. Amer. Psychoanal. Assn., 26:641-658. - - - ( 1993), The Private Self Cambridge, MA: Harvard University Press. Rapaport, D. (1951), Toward a theory of thinking. In: Organization and Pathology of Thought, ed. & trans. D. Rapaport. New York: Columbia University Press, pp. 689-729. Reps, P. (1961), Zen Flesh, Zen Bones. Rutland, VT: Charles E. Tuttle. Ross, W. D., ed. (1955-1962), Vie Works ofAristotle, Vols. 1-12. Oxford, England: Clarendon Press. Ryle, G. {1949), The Concept ofMind. London: Hutchison's University Library.



(1971), Category, s.v. Encyclopaedia Britannica. Chicago: William Benton, Publisher. Schlessinger, N., Gedo, J., Miller, J., Pollock, G., Sabshin, M. & Sadow, L. {1967), The scientific styles of Breuer and Freud and the origins of psychoanalysis. Prycholog;.cal Issues, Monogr. 34/35. New York: International Universities Press, 1976, pp. 187-207. Waelder, R. (1962), Psychoanalysis, scientific method, and philosophy. In: Psychoanalysis; Observation, Theory, Application, ed. R. Waelder. New York: International Universities Press, pp. 248-274. Walsh. W. H. (1971), Kant, s.v. Encyclopaedia Britannica. Chicago: William Benton, Publisher, pp. 217-223. Webster's New /nternatioTUJl DictioTUJry, 2nd ed., Unabridged, ed. W. A. Neilson. Springfield, MA: G. & C. Merriam. White, A. R. (1982), The Nature ofKnowledge. Totowa, NJ: Rowman and Littlefield.



The History ofPsychoanalysis in Chicago, 1917-1975 ROY R. GRINKER, SR. Preface Roy R. Grinker, Jr. Psychoanalytic institutes (and the education they provide) have been in ferment since their inception. Criticized, admired, and attacked, institutes have attempted to adapt to internal and external changes and needs. The major survey of education and institutes (Lewin and Ross, 1960) demonstrates this clearly. Since the advent of so-called biological psychiatry, the demedicalization of training; changes in curricula, theory, and research; applied psychoanalysis; lesser attention to Freud, greater attention to other theorists and theories; theories of symptom-formation, character, analytic technique; criteria for graduation; changes in methods of evaluations of students; issues of accreditation, membership, and certification (now split off from membership), all demonstrate that the ferment continues. Roy R. Grinker, Sr., was a scientist, direct, sometimes abrasive, intellectually honest, and had a firm sense of what was right and what was wrong. He had very strong feelings about the defects, as he saw them, in psychoanalytic training. At one time, he was asked to be pro-tern director of the Chicago Institute (between the directorships of Franz Alexander and Gerhart Piers) but refused on the grounds that the directorship of training and research at Michael Reese Hospital precluded dividing his time. But he had strong opinions about the Chicago Institute for Psychoanalysis and its training activities. His input into the public system-and he was never one to be silent--:-was through residency training (most Michael Reese graduates went on to become psychoanalytic candidates), using a cadre of analysts as supervisors of residents, faculty participation, Society involvement, and playing his favorite role as intellectual gadfly, biting the flanks of Organized Psychoanalysis. During his later years, Grinker was asked to submit a history of psychoanalysis in Chicago to this Annual. Not surprisingly, it was rejected. (Had I 155


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been on the Editorial Board then, as I am now, I would have rejected it outof-hand too.) It was chronological, honest, abrasive, and in some respects disrespectful and critical. As one reader put it, Grinker was "scathing, salty, and scurrilous." Grinker could be constructively critical, but destructively critical as well. I well recall his outrage that this manuscript had been rejected, particularly after it had been solicited. It is my belief that at that time his honesty and educational zeal overcame his sense of tact, and his narcissistic injury at rejection was fostered by his clear-in the body of the manuscript-contempt for the political climate of the Chicago Institute for Psychoanalysis. Since that time, over 20 years ago, many things have changed. The author is dead, all of the people he most vehemently criticized are dead, for the most part those he admired are still alive, and the climate of the Institute has changed. In Grinker's mind, he would say it still has a very long way to go to change enough to satisfy his academic standards. And many others share this view. Roy Grinker was a prolific and productive man. Analyzed by Freud, professor at three medical schools (Chicago, Illinois, and Northwestern), founder of PPI (the psychiatric pavilion at Michael Reese Hospital), training and supervising analyst and faculty member at the Institute for Psychoanalysis in Chicago, president of numerous professional organizations, during his lifetime he wrote 28 books and over 400 articles and speeches. He was a seminal figure in neurology, psychiatry, and psychoanalysis. He was involved in the training of hundreds of professionals, many of whom remember him fondly, some with awe and admiration, others with hostility and fear. He indeed did not suffer fools gladly. As a historical figure, he was one of a group who followed Freud, Jung, and Adler, was contemporaneous with the ego psychologists, and preceded the self psychologists and object relations theorists. He wrote prolifically, lectured extensively, and saw himself as the conscience of the scientific community and an agent for an attitude of inquiry and a multidisciplinary focus on human behavior. To my knowledge, the paper that follows is the only one he ever tried to publish that did not see the light of day. As his literary executor, I felt it my responsibility to try to follow his wishes. In resubmitting this article I bowdlerized it, so as to not offend any person, living or dead, including the reader. Much to my surprise, three of the four anonymous readers felt-in fact, insisted-that it should be unbowdlerized, that the true "vintage" Roy Grinker, and his feelings about the Chicago Institute, be published, and that the reader would have the maturity and sense of history to read it as a valuable and true document of the 1975 era of psychoanalytic education in much of the United States.



Thus, the only changes I have made involve tenses, punctuation, full names, and titles; this history is as it was written.

I Several times I have been asked to write my views about the changing American psychiatric scene through episodes of my life, all of which opporttmities I refused. When the editors of this Annual asked me to write an essay and agreed that it could be an outline of the history of psychoanalysis in Chicago, I accepted because I could report fairly accurately on observations of three generations. If we accept the fact that Franz Alexander, as the founder and first director of the Chicago Psychoanalytic Institute, represented the focus of psychoanalytic history in Chicago, then the field, like "all Gaul," can be divided into three parts. Part of the pre-Alexandrian period was experienced and documented by Julius Grinker, my father, the contemporary period by younger analysts, my son's generation, and I the long era in between. These three periods will be described in broad sweeps only; a detailed history would require a lengthy monograph. As anticipated, the contemporary era gave me the most trouble, because I could only view it ·from a distance and from the vantage point of a past generation. I therefore wrote to 17 psychoanalysts who were trained and are functioning in the post-Alexandrian era. I wrote that I needed their help and that their information would be held confidential. I needed a consensus regarding what is bad, what is good, and what can be improved in the activities of the local Institute and Society. It is hard to believe that I received only four responses in the form of verbal interviews-a meager 23 percent! How should I explain this: apathy, unconcern and detachment, feeling that others would contribute better, or fear of reprisal based on the mistrust of promised confidentiality? At any rate, thanks to those who did communicate, the post-Alexandrian era is well described even though ambivalences do confuse matters somewhat. Historiographers use a mixture of methods with which to determine the facts of past events, their causes, the significant persons involved, and their meanings. The hope is that if contemporary man knows as much as possible about his past he may avoid making similar mistakes in the future. Thus stated, the psychoanalyst is a special kind of historian attempting to uncover and bring to consciousness in the here and now, past pathogenic experiences in an effort to correct deviant behavior for the future of those suffering from the lasting effects of suppressed or repressed memories. History in general and psychiatric anamneses in particular seem to be partly scientific but predominantly undocumented, biased and romantic interpretations of the past. Thomas Jefferson long ago stated that "the life


History ofPsychoanalysis in Chicago

and soul of history must forever be unknown." Certainly reliance solely on preserved documents, books, book reviews or minutes of meetings misses the feelings of fear, anger, depression and arguments of the humans involved at the time. Reverence for the leaders or innovators of the past gives a distorted picture of significance, and romantic historical novels are highly inaccurate. For this reason a living oral account of what is happening is an important source of what later becomes history. As Graubard (1974) states: "In higher education, autobiography is a resource whose value ought never to be underestimated. While there is always the hazard of mistaking one's own experience, within one's own institution or local community, to be representative of a larger, national pattern, there is much to be said for exploiting the knowledge that is made available through such observation"

(p. ix). Mora and Brand (1970), staunch advocates of oral history, know that older clinicians who have seen their specialty grow and had a hand in its changes have the urge to record their impressions, but recently the young behavioral scientists have also gradually embraced the need to know the history of their fields. Mora and Brand emphasize three sins: (1) the use of secondary sources, (2) overly dramatic accounts out of context, and (3) the pottering repetition and inundation with minor details. According to Carl Becker (1935), "History is the memory of things said and done." Every man knows some history, often as valuable as that written by historians; for according to Becker, even history written by historians is a blend of truth and fantasy, fact and interpretation. He wrote: "Historical facts do not speak for themselves. They need the perceiving mind to reveal their special meaning." That mind cannot be entirely objective and scientific in viewing historical events is quite evident. "Each change and movement of mankind alters his view of history." In 1963 I wrote a paper (Grinker, 1963) on a psychoanalytical island in Chicago in 1911-1912, the beginning year of the American Psychoanalytic Association. It was rejected by the program committee of the Chicago Psychoanalytic Society because "the issues would not be clear to its membership." I never could find out, despite repeated requests, what these issues were. Later, in my 1970 Benjamin Rush Lecture (Grinker, 1970) at the American Psychiatric Association, within a broader perspective I wrote: "The history of psychiatry and psychology in their search for meaning of human mentation in the health-illness continuum corresponds with the history of social dynamics and change and with the story of individuals as they struggle in their search for meaning. The psychobiography of the heroes, of whom Benjamin Rush was one, gives a clearer understanding of the difficulties all of us have in developing a unitary system of thought [p.




II The history of psychoanalysis in Chicago seems to begin with Franz Alexander's arrival on the scene, but there are indications that two decades before (1911 and 1921) interest in the field was apparent (Grinker, 1963). The typical psychiatrist of 1911, of whom there were few, practiced the neurology for which they were trained, but many of their patients were neurotic or psychotic. Some were sent to sanitariums out of town or to so-called "restcures" in Chicago for long periods of time for bromide or opium sedation, special high-fat diets and "suggestive" psychotherapy. The psychotic poor were sent to the large warehouses called State Mental Hospitals. Many neurotics were treated in private offices with sedative drugs, hypnotics for sleep, encouragement, persuasion, and suggestion. These patients experienced temporary improvement but maintained their dependency by frequent visits to their doctors. Behind these therapies was the hidden theory that heredity and constitutional defects were the basic causes, although Julius Grinker stated that environment could be manipulated to alter the effects of heredity. Julius Grinker (1912) wrote that psychotherapy was as old as humanity. Any form of treatment is good if the physician is convinced of it. Long before the oft-quoted R. G. Brown, he stated, "The stronger the physician himself is convinced of the efficacy of his treatment, the more the doctor's personality has a great deal to do with instilling the patient's confidence." In addition, he stated that a full beard, a silk hat, and a long coat are important (for those days!). "Some people are born psychotherapists; some acquire the skill." Drug therapy of the day was contrasted with psychotherapy, which requires active participation by the patient. There were two main forms of psychotherapy: (1) hypnosis and suggestion; and (2) instruction and persuasion. Julius Grinker favored the latter, which increased the powers of resistance and facilitated education of the patient. He directed his patients to participate in charity, absorbing activities, and regular exercise. Then in 1911 Ernest Jones presented a paper before the Chicago Neurological Society which split the specialty into two camps; those violently opposed and those eager to learn and understand the "new psychology." The senior neurologist, Hugh T. Patrick, gave serious and understanding consideration to psychoanalysis with the following points: 1.


The more information we have about patients, the better. The psychoanalyst goes painstakingly into their early lives in an effort to uncover their basic problems. Adult symptoms are related to very early life experiences.


3. 4. 5.



History ofPsychoanalysis in Chicago Early impressions in childhood have profound effects on childrenthey do remember. The self-preservative and sexual drives have the greatest influence on human life. The major human conflicts are between desires, passions, and the beliefs and teaching of society. I see more and more patients whom the existing methods of treatment cannot help, and about half of all neurotics need psychoanalysis-the others can do as well with older methods. The latter group would increase if therapists would take the time and interest in their basic problems. I have a high respect for people in the field of psychoanalysis. It is poor taste and unscientific for one not experienced with the method to indulge in sweeping criticisms.

Julius Grinker stated: It must be admitted that it is not very easy to understand Freud's viewpoint, and for that reason we are under obligation to the essayist (Ernest Jones) who has in numerous contributions and discussions endeavored to acquaint the American profession with Freud's work. The physician who does not practice psychoanalysis in the broader sense is not competent to treat nervous cases. The man who either had no experience with the method or else is too indolent to learn it, is a very poor critic indeed and had better learn something about it. This new psychotherapy has as its basis a plausible psychology, splendid reasoning and a profound acquaintance with the innermost depths of human nature. Regardless of whether Freud's psycho-analytic method will ever become popular in therapeutics, it has certainly opened our eyes to facts hitherto completely ignored or not at all recognized. Many others took a harshly critical view of Jones's paper and psychoanalytic theory or methods. But the controversy did not last long because those who tried the method were soon overwhelmed by transference reactions of love and hate from their patients. Only one psychiatrist persisted, talking and writing little. Indeed, Dr. Ralph Hamill was the only Chicago psychiatrist who became a charter member of the American Psychoanalytic Association with James J. Putnam, M.D., president, of Boston; Ernest Jones, M.D., secretary, of Toronto, Canada; Trigant Burrow, M.D., John T. MacCurdy, M.D., Adolf Meyer, M.D.; G. Lane Taneyhill, M.D., of Baltimore, Maryland; and G. Alexander Young, M.D., of Omaha, Nebraska.



Ilse Bry (Bryand Rifkin, 1964) states in a personal communication: "The well-known period of articulate opposition to psychoanalysis had been preceded by a period of equally articulate appreciation which was later obscured and forgotten. It is intriguing to note how often the same individuals who had first made a sincere effort to assimilate Freud's ideas later changed their mind and their attitude." Bry and Rifkin (1964) would like to draw a line of thinking of scientific consistency rather than historical continuity through the half-century from 1911 to 1961. There is a nucleus of truth in this idea (Kahler, 1964). We are seeing within the psychoanalytic profession a growing criticism of theory and methods, a criticism not based on prudery, ignorance, or emotionality but on a sophisticated attitude by persons whose training is more scientific and whose vistas are wider from contact with other fields, rather than those completely immersed in the psychoanalytic discipline. Hardly anyone in Chicago had been aware of the 1911-1912 island of psychoanalysis which was short-lived, but the statements of the participating neuropsychiatrists were accurate about psychoanalysis of the time. I had always thought that the two decades between 1912 and 1932 was a silent period except for the occasional statements of Dr. Raph Hamill and the solitary, briefly trained Dr. Lionel Blitzsten shortly before 1930. Thanks to Dr. Jerome Kavka I recently learned of an enterprise in 1921 about which few details are known. Kavka discovered several brochures published by the American Institute of Psychoanalysis written by Dr. Edward N. Schoolman, psychological director, and Daniel H. Barus, general director, apparently a nonprofessional. They introduced the first of nine brochures, each containing two lessons, with the following statement: For a number of years the authors of this Course, actively engaged in the practice of Psycho-Analysis in the field of nervous and mental diseases, have received numerous letters requesting information on various phases of the work. These inquiries were usually requests for advice on personal problems or for suitable books to read in this connection. We were often asked to recommend a reading course which would give one a comprehensive working knowledge of Psycho-Analysis. Many of the writers had already read books on the subject but with unsatisfactory results. This was mainly due to the fact that these books were written primarily for scientific workers in the psychological field. Because of this the subject-matter was purely theoretical and difficult of comprehension by the average reader. Further, in order to gain a comprehensive view of the subject, one would be compelled to make an intensive study of many works. In these cases we were confronted with the serious difficulty


History of Psychoanalysis in Chicago

of selecting from the available literature, such material as could be profitably studied by the layman. All nine brochures were published in 1921. The "lnstitute's" publications reveal no address and no price. It seems that they were oriented to the general public, not for physicians or scientists. Each lecture or lesson ended with a reliable and adequate bibliography, there were questions at the end of each lecture to be sent to the Institute, but there was no address for the answers even though questions to a "faculty" were invited. It was obviously a correspondence course but there was no hint where students registered and beyond the nine lectures totalling 354 pages we have no more brochures, possibly indicating that the "Institute" had a short life. The "systematic course" was to correct confusion regarding psychoanalysis and its erroneous confusion with "spiritism, Christian Science, suggestion and other mystical methods of mental healing." The authors indicate that psychoanalysis consists of theoretical knowledge and practical utilization, which are difficult studies but of general educational value, and both must be learned by the student himself. "Psychoanalysis presents a definite ethical program for the conduct of life" and does not undermine "social morality." The field has educational value, favorable influence on the self, increases knowledge of others, and expands one's personal powers. What is amazing about the contents of the 354 pages of writing is the accuracy of the description of psychoanalysis of 1921, the excellent bibliography, and the cogent questions. Further information about this "Institute," its address, director, students, and lifespan are not known to either Dr. Kavka, to whom I am greatly indebted, or to me. It does, however, represent another island of psychoanalysis in Chicago. However, I was able to contact Dr. Schoolman's son, Dr. Harold Schoolman, assistant deputy director of the National Library of Medicine, who wrote as follows: My father was, indeed, among the early pioneers in this country in psychiatry. It was a field to which he came somewhat by accident. He was trained initially as an internist, but early in his career he had severe bilateral retinal hemorrhages-probably detachments-that left him almost blind. It was at this time that he went back into training. As I recall, he spent time at the Elgin Psychiatric Hospital and then somehow became involved with Herman Adler. My own personal memory is that of my father practicing psychiatry, but also doing a great deal of lecturing which contributed, I believe, a major portion of his income. He was also established as a "consultant" to Temple Sinai. At that time, Dr. Louis Mann was the Rabbi, but I believe the man most involved in bringing my father into the temple was Mr. S. D.



Schwartz. My father continued in his practice, and lectured as well all over the country. I have [had] the privilege of hearing and reading many of these lectures as well as listening as a child to a group of people, such as Clarence Darrow, Preston Bradley and Dr. Schmoulhousen, a psychiatrist in New York, who appeared repeatedly on this circuit. My father died suddenly in 1935 at the age of 41.

III Franz Alexander, the first and most promising student at the Berlin PsychoAnalytic Institute, early held out great hopes for a productive career. As his reputation grew, Americans went to him for training in psychoanalysis. Their effect on the Chicago scene will be discussed individually, but one incident especially had a profound influence on the future of psychoanalysis in Chicago. The then chairman of the Department of Sociology at the University of Chicago arranged a visiting professorship for Alexander during 1930. Alexander insisted that his appointment be in the Department of Medicine, because of his M.D. degree, as the first-ever Professor of Psychoanalysis. He was asked to see patients in consultation, began the analyses of interested young psychiatrists, and fatefully began a seminar in the Department of Medicine attended by clinicians and basic scientists; in fact, the seminar was open to all faculty members of the university. Alexander, born in Hungary, spoke English with an accent at the time, mixed the genders of pronouns, and his extemporaneous speech was somewhat stuttering. By intention he spoke first about psychosomatic disturbances and unfortunately used the example of a woman whose constipation was cured by Alexander's advice to the husband to present her a bouquet of red roses! At that point the hostility of the basic scientists erupted and a diarrhea of criticism and invective overwhelmed Alexander as never before or since. The seminar came to a standstill necessitating the dean, Dr. Franklin McLean, to circulate a memorandum ordering that discussion be reserved until the completion of the seminar, months ahead. The audience melted away, myself among them, and the seminar fell apart. At the end of the year Alexander quietly left Chicago for Boston's Judge Baker Foundation where he worked with lawyer Hugo Staub on the psychology of criminals. Alexander was soon to return to Chicago with financial support from Alfred K. Stern, a director of the Julius Rosenwald Fund by virtue of his marriage to a Rosenwald daughter. His money established the independent Chicago Institute and supported it for a time beginning in 1932. The Institute was a successful operation with a rich Board of Trustees, a professionally distinguished Advisory Board, consultants, and staff. The 1932 report


History of Psychoanalysis in Chicago

and the Ten-Year Report {1932-1942), available from the lnstirute, contain the names of the persons involved in these early operations. A chronological account must now give way to a discussion of personalities whose activities wove back and forth in transactions with others, some of whom will be discussed individually to give a feeling of the personalities involved, their verbal and written statements. After Alexander returned to Chicago to found the Chicago Institute, two incidents shattered the peace of the psychiatric community. The first occurred at the University of Chicago when a medical student was hired as a "yard boy" by a professor on the faculty. In answering a question concerning his need for a job of physical work, he answered that the money was necessary to pay for his analytic fees. This was reported to the medical school and a violent eruption ensued based on the tradition that physicians and medical students should be given free treatment by other doctors. No one took into consideration the many weekly sessions often lasting for years. The principle of charging was not only based on the time needed, much longer than any other medical therapy, but on the axiom that payment for analytic fees is a necessary sacrifice to make an analysis work, a concept now open to question. But the professor of surgery, Dr. Dallas B. Phemister, practically blew up the place. Years later he was still antagonistic to the psychiatry I had set up on my return from a fellowship abroad. He was horrified that I put a sign on the door to the psychiatric unit reading "Division of Psychiatry," and he made psychiatry impossible by the obstruction of simple, generally accepted procedures such as protecting confidentiality of records. He managed to oust Dr. Franklin McLean from the Deanship of the Medical School (Dr. Helen McLean, his wife, had become an analyst on the staff of the Psychoanalytic Institute). In reality Phemister never forgave McLean for inducing him to take a full-time position at a low salary. Fortunately through the efforts of Louis Leiter, Leon Block and myself, Professor Ajax Carlson gave McLean a professorship in physiology where he established a new and brilliant creative career as an investigator into bone structure and metabolism. Finally, a second episode horrified the new faculty of Institute analysts more than those at the medical school when Harold D. Lasswell {1935, 1936, 1938, 1939) started analyzing volunteers while simultaneously measuring concomitant physiological changes! It is almost incredible in view of the widespread acceptance, indeed uncritical acceptance, of psychoanalytic concepts today to believe the violent resistance the University of Chicago incident demonstrated in 1930. Shortly after the first Lasswell publication, the New York Psychoanalytic Institute forbade its members to record the contents of psychoanalytic interviews. Despite my own repeated attempts over the years, no member of



the Chicago Psychoanalytic Institute would permit me to record physiological or biochemical processes in patients under psychoanalysis during or after emotional turbulence. Coincidentally, it was Alexander, in the last years of his life in Los Angeles, who subjected patients and himself to observations from behind a one-way mirror, taped their verbalizations, and recorded physiological variables. Let us now examine what Lasswell did and what he found in his researches, published between 1935 and 1939, and which no one remembers or quotes. To begin: Lasswell apparently psychoanalyzed patients and volunteers. Certainly he had undergone no formal training in the field and his writing gives no clue to the technique he employed. Indeed, he writes about "psychoanalytic interviews," not about psychoanalysis. In my view this is unimportant because he observed and recorded phenomena that transpired in a dyadic relationship, and for his research it makes little difference what formal label is placed on the procedure. Lasswell states that psychoanalysis is a process of repeated systematic observations that needs a consistent type of reporting. Comparisons between sessions and between different patients are difficult because of variations in reporting practice. Neither behavior nor individual movements are usually described. It should be kept in mind that Lasswell's investigations were done before the advent of "ego psychology" and the analysis of resistance. It was the era when the task was to make unconscious affects and conflicts conscious-to bring id processes within the scope of the ego. Accordingly, he was careful to keep what he termed "unconscious tension" within bearable limits lest it erupt into "conscious affect." Lasswell's later subjects were volunteers who were not, or were only slightly, neurotic. They lay on a couch at a regular time in the same place and for the same duration. A microphone transmitted and recorded the spoken words on wax cylinders. A blood-pressure cuff was attached to a leg and readings were obtained by the experimenter before, during, and after an interview. A pneumograph recorded respiratory rates. The bodily movements were recorded by the observer. Observed affects were correlated with physiological measurements. Reliability was tested by repetitive observations (!} and by rereading the records after a lapse of time. Lasswell attempted to define stages in the development of insight: (1) initial reference to the problem, conflict, or affect with subsequent verbal and physical excitement; (2) rejection of the formulation; (3) repeated emergence of the unconscious "material"; (4) acceptance of the formulation with certainty; (5) reaffirmation despite countersuggestion and despite the passage of time; (6) reaffirmation with diminished excitement He stated that affects were expressed in the "transference" relationship more fully than when the subject was alluding to persons in past time or space, or to self.


History ofPsychoanalysis in Chicago

Slow speech and motor inhibition indicated more tension than when the rate of speech and movement increased. Physiological measurements included those of pulse rate and skin resistance. Pulse rate increased with outer affect (conscious), and skin conductivity increased with inner tension (unconscious}. Using only these two measurements, four pairs of permutations were possible. Using indices of skin conduction, pulse rate, word frequency, and body movements, Lasswell divided his few subjects into four types. When a trend in these indices was absent there seemed to be little energy free for psychological work, and a long drawn-out analysis with little insight could be predicted. A trend toward inactivity was associated with overdependence. Lower skin resistance and disturbance in motor activity spoke for much inner tension, and if retained in treatment these subjects worked hard. Increased skin resistance, increased motor activity, increased pulse rate, and slow speech were associated with responsiveness to treatment and progressive insight. This sketchy outline represents one of the first attempts to link autonomic and behavioral variables with personality as defined by therapeutic outcome and was a forerunner of much subsequent research in this field (Grinker, 1969).

IV The first faculty of the new Institute founded in I 932 included Alexander, Karen Horney, Thomas French, and Lionel Blitzsten by courtesy. Local additions were Karl Menninger, Helen McLean, and Catherine Bacon. A little later, Eduardo Weiss, Therese Benedek, and Martin Grotjahn were added. During the next 10 years Leon Saul, George Mohr, Milton L. Miller, Rudolph Fuerst, Margaret Gerard, Adelaide Johnson, and Carel V anderHeide joined the faculty. Research associates (a misnomer because they did no psychoanalytical research) were Rudolph Bollmeir, Edwin Eisler, Max Gitelson, Albrecht Meyer, Gerhart Piers, Elizabeth Tower, George Wilson, and myself. Eventually Grotjahn, Wilson, and V anderHeide left for California, Mohr also went to California with Alexander, Horney to New York, Bacon and Saul to Philadelphia, Miller to Chapel Hill, Adelaide Johnson to Rochester, Minnesota, and Menninger back to Topeka. The one departure that created a stir was that of Horney, who not only moved to New York (for personal reasons) but also established an independent Institute and Society significantly emphasizing social and cultural factors in contrast to the biological (instinct theories of Freud) in the etiology and treatment of the neuroses. In Chicago she was antagonistic to Alexander and engaged in a polemic against Freud over female sexuality. When I told



this story to Freud during my analysis, he answered cryptically that Alexander should have known better than to appoint her since he knew what she was like in the early Berlin days (Grinker, 1975b). Surprisingly, I was invited by the Association for the Advancement of Psychoanalysis, although not a member, to give the Fourteenth Annual Karen Homey Lecture entitled "Open-Systems" Psychiatry (Grinker, 1967). Horney certainly emphasized what had been excluded from psychoanalysis in its closed-system period. Neurotic conflicts were considered by her as more than internal drive derivatives. I pointed out that in this era of open systems we no longer need splinter groups emphasizing this or that. But splinter groups develop lives of their own, persisting long after their usefulness is over. The Chicago Psychoanalytic Institute since its founding in 1932 was under Alexander's direction until 1956. In general we may describe its relations with the local society and the national organization and then discuss how it has functioned in the care of patients, education, and research. It is clear that the Chicago Psychoanalytic Society was organized by a handful of people, before the analytic Institute existed, and was not involved in training. Alexander wanted the new Institute to be an academic organization independent from the Society with a faculty responsible for training. Members of the Society, not the faculty, were welcome to attend conferences and seminars. The Society did not control the Institute as in other cities, but in an indirect way served as a postgraduate forum. Later the Society "screened" graduates from the Institute for membership but I do not know that they rejected any graduate. The main goal for the new Institute was to establish a free and liberal organization with new ideas, open to all analysts. Alexander had broad interests and sought out and participated in the local academic, medical, and psychiatric activities. As more students were graduated, some indoctrinated by the antagonistic Lionel Blitzsten (of whom more later) group, more resistance against new approaches developed and conflict within the organization increased. In those early years the various local societies were banded together into a Federation. As time went on the conservative and often reactionary groups in the country turned the national organization into an overall association with each society an affiliate, subject to the same general rules and regulations. As a result, general rules, regulations, and procedures were laid down by the American Psychoanalytic Association which all component Institutes and Societies have to follow. Accreditation of new local organizations, disaccreditations, surveys, number of hours were rigidly controlled. Graduation from a local Institute did not mean easy access to the American Psychoanalytic Association. This was only possible through lengthy documentation


History of Psychoanalysis in Chicago

of patients analyzed and extensive paper work that turned many from applying to the Establishment. Robert Gronner in his unpublished presidential address before the Chicago Psychoanalytic Society in 1971 stated: "The National Association is not a personal associative system but a depersonalized organized corporate system." Alexander fought vigorously against the minimum of 4-day-a-week analyses and other dictatorial directions from the American, but lost. On the other hand the establishment wanted to create a diplomate board for psychoanalytic certification of its own students by the American alone. The Academy of Psychoanalysis objected to this inbred control and won. In the meantime the younger analysts in Chicago objected to the procedures for obtaining membership in the American and many never applied. On the other hand, the newly educated analysts during Alexander's time became more and more compliant and orthodox. In fact, Alexander's departure from Chicago for Los Angeles before his retirement age was at least partially due to his staffs discontent and open revolt against his liberality. Among .these liberal attitudes were his three-day-a-week analyses, his "betrayal'' of the libido theory, manipulation of the transference by "roleplaying," and finally his attempt to move the Chicago Institute out from control by the American Psychoanalytic Association. In Chicago, splits in the Society were avoided not only because of Alexander's personality but also because all were banded by some aspect of group membership in the Institute. Maxwell Gitelson, however, refused to join the faculty of the Institute because he had ambitions to become involved with the establishment's conservative policies opposed to Alexander's liberalism, and eventually Gitelson reached the highest point of his ambitionpresident of the International Psychoanalytic Association; only then did he agree to join the Institute. His antiliberal attitudes are clearly exposed in his paper "On Identity Crisis in American Psychoanalysis" {Gitelson, 1964). As stated in another section, his emotional basis for refusing to join the faculty of the Institute was his personal hostility to Alexander, to some degree justified. Therese Benedek contrasts the free and open communications among the faculty when the Institute was small as compared with today's controlled competitive fears and jealousies within a large group of three generations of analysts. There is currently very little unity of purpose. For the present generation, psychoanalysis is not the center of analysts' lives. They are engaged in many other ventures and jobs and are much more eclectic than the pioneers of psychoanalysis. The Analytic Institute's first quarters were on Ohio Street, two doors away from the Alexandria Hotel. It included a huge secretarial pool with



files to hold the typewritten records of all patients treated by the faculty. Thete were many small offices for the staff, each with its own waiting room and secretary. There was one conference room for case conferences and a large library serving as a dining room (kitchen attached) and as a meeting place for the small analytic society. Later the Institute moved to 664 North Michigan Avenue to more spacious quarters, and the enlarging society held its meetings outside the Institute. By this time the town-and-gown conflict permeated the relationship between the two and vigorous arguments ensued. Only lately has this conflict quieted down. But the interminable discussions in Chicago and at the American lasted endlessly with resolution of simple questions requiring multiple committees and futile arguments. One of my more philosophical informants among the middle-aged group of analysts writes: "Regarding the main question you pose, it seems to me the issues devolve essentially into the experiences with, and reactions to, the bilevel structure into which most social groupings inevitably tend to divide, i.e., the archaic but ubiquitous antagonism between the 'ins' and the 'outs.' From an historical perspective the general lines of move and counter-move, like a chess game, do not really change much. Only the cast of characters and the specific contemporary issues, which mask the interminable power struggle, change." The current quarters of the Chicago Psychoanalytic Institute at 180 North Michigan Avenue are well equipped with adequate conference rooms and a splendid library well organized and attended by Glenn Miller, an expert librarian. However, the decor of the waiting space for individual analysts is somewhat garish. In the Chicago scene, violation of confidentiality was a daily occurrence. Analysts talked about their patients in the building elevators, at lunch and at social gatherings. Repeatedly memos were distributed warning against this habit, but with little effect. Born in Hungary to an intellectual family, Franz Alexander's intelligence and ability were soon recognized. After a classical education he turned to science, becoming a biologist with a promise of distinction, but he only found his way in life when he "discovered" psychoanalysis, which led him to the Berlin Psychoanalytic Institute. After a personal analysis and completion of the then brief training program. Alexander became a practitioner and teacher in his chosen field and several Americans were attracted to him for analysis. Alexander was a complicated person whose several sides I shall endeavor to portray from my viewpoint. As a liberal he was firmly against orthodoxies, conservatism, and the rigidities of establishments. Perhaps this aspect of Alexander can best be gleaned from his books: Our Age of Unreason (1942)


History ofPsychoanalysis in Chicago

and The Western Mind in Transition (1960). From the latter's dust cover the following accurate description of his early life may be gleaned. Franz Alexander cannot be defined by his profession, alone. Not only is he one of our foremost psychoanalysts, who has had a great influence on the history of psychoanalysis, but he is also a reflective scholar, who-more than any other man-has united psychoanalysis with scholarship and medical tradition, keeping it free of narrow dogma. Dr. Alexander's role as an innovator in his field is based, also, on his wide range of interest, which includes all aspects of human experience, especially in relation to the life of the individual. This broad perspective is no accident. The son of Bernard Alexander, a philosopher and educator, Franz Alexander grew up in a world of artists, philosophers, scientific theorists, and scholars dedicated to the humanistic tradition. Later, while studying medicine at the Universities of Budapest and Gottingen, he came to know a different approach, that of the experimental scientists. After receiving his medical degree in 1912, he started research in brain physiology (interrupted by his military service as a physician during World War I but later resumed) which led him to an interest in psychiatry, and from there to the works of Freud. He soon found what was, for him, the ideal synthesis of the humanistic and scientific approaches-psychoanalysis. He went to Berlin to study, became the first training candidate at the Berlin Psychoanalytic Institute. Like Freud, Alexander was less interested in treating patients than in research. As one of his analysands 5 years after my experience with Freud, I found that he capriciously cancelled appointments or was late. Not only did he answer his telephone during my hours but I found that he frequently slept or was busy writing a paper. This all created a devastating effect on my own professional schedule. Alexander was what we could term in our jargon an "oral character." Thick-lipped, stout, he ate large amounts of food quickly with smacking gusto. He needed someone to take care of his personal needs, so that women who were attracted by his sensuality served his every wish. Eventually Helen Ross became his administrative assistant and part-time editor, without whom he would have been lost. Correspondingly, Alexander never maintained a close relationship with his male students; they all eventually left him. Leon Saul and Milton Miller did not even return after their military service. The contrary was true of the females with whom his contacts were much closer. The exception was another Hungarian, Sandor Rado in New Yark, who was extremely dependent on his fellow countryman. Rado, May Romm and Alexander formed a steadfast trio which too infrequently included me as a fourth.



Alexander's "orality" was productive in that he was always optimistic for the future. He struggled for liberality in the American organization, which imposed rules, regulations and restrictions that Alexander could not accept. He fought politely but consistently against A. A. Brill in New York and Gitelson in Chicago. In fact he went so far as to state that a "normal" applicant for training in psychoanalysis might need only a few weeks of personal analysis. He sometimes made outrageous statements, as he once answered a criticism from me: "I know my unconscious." Indeed criticism was hard for him to accept as I know from my experiences when disagreeing with him. He would invite me to lunch at his club so that I couldn't pay my way (one-upmanship) and either seduce me with flattery or accusingly ask my why I was so hostile to him. Alexander lost the war against mediocrity and regulation so that, after serving as director of the Chicago Institute for just short of 25 years and at almost 65 years of age, he left Chicago for a new career in Los Angeles. What probably hurt him most was that his inbred faculty did not support him adequately. Alexander's psychosomatic research was begun in Berlin and developed in Chicago with 63 papers and books co-authored by Alexander and his faculty. His concepts remained hypotheses with many uncontrolled variables, complicated research designs and considerable slippage in reliability. Yet his ideas became so fashionable that psychiatrists and students could always find, in their interviews of patients, data that confirmed Alexander's hypotheses about specific psychosomatic disturbances. The fashion continued for many years, even migrating with him to his last post in Los Angeles. Alexander died on the West Coast in 1964 at the age of 73. Alexander's ( 1950) theoretical model may be succinctly expressed as follows: 1. 2.

3. 4.


All healthy and sick human functions are psychosomatic. Emotions are always associated with concomitant action patterns expressed through a portion of the autonomic nervous system and its innervated organs. For specific emotions there are appropriate concomitant vegetative patterns. Emotions repressed from overt expression lead to chronic tensions thus intensifying in degree and prolonging in time the concomitant vegetative innervation. The resulting excessive organ innervation leads to disturbance of function, which may eventually end in morphological changes in the tissues.


History of Psychoanalysis in Chicago

By Alexander's definition, unlike hysterical conversion symptoms, which were assumed to be symbolic expressions of emotional tension, psychosomatic disturbances, in the narrower sense of the word, are vegetative responses associated with chronic emotional states (Alexander, French, and Pollock, 1968). However, the sharp differentiation between vegetative and somatic systems is not correct. Furthermore, patients laboring under the same emotional conflicts revealed shifts of somatic symptoms. Their physiological regressions to more global dedifferentiation occurred no matter what the stimulus, in a manner specific to their own life patterns. Historically the field had great expectations for a potential breakthrough when the journal Psychosomatic Medicine was established in 1939 based on the ''specificity theory" of Franz Alexander, who contended that each of seven diseases {bronchial asthma, rheumatoid arthritis, ulcerative colitis, essential hypertension, neurodermatitis, thyrotoxicosis, and duodenal peptic ulcer) was aroused by unexpressible specific emotions. Only the vegetative components were present in overfunctional action leading ultimately to morphological change. For years the journal was inundated by reports of psychoanalytic investigations confirming this specificity. The idea that a unique personality type or a specific intrapsychic conflict was essential to the development of a psychosomatic disease can no longer be entertained. But new methods and sophisticated apparatus were necessary to establish general relationships between stress stimuli and biological responses. The literature was then inundated with physiological and biochemical researches which were weakly related to clinical problems. Correlations between the physiological and psychological systems have been more important than linear "cause and effect" concepts. First, there is the general response to stress stimuli with or without conscious emotional arousal, without differentiation, among the primary affects of anxiety, anger, depression, or pleasure. The general response is largely within the pituitaryadrenocortical axis and suggests a preparatory facilitation of stress responders. Second, there are the specific, more or less localized responses which are individually specific ("response specificity") and which occur no matter what the stimulus may be. It may be constitutional, inherited, or acquired early by conditioning experiences. What is psychological is the subject's appraisal of the meaning (dangerous or not) of stimuli to his comfort, integrity, or very existence and how he defends himself against false interpretation of these meanings. But he does know that, whatever the meaning, he reacts in his personal way, whether this be diarrhea, sweating, tachycardia, or tremor. After much time, energy, and work we began to understand that a variety of stress stimuli could produce not only general adaptational mechanisms, but



also specific responses in individuals. The theory of response specificity was thus developed (Grinker, 1973). One area Alexander damaged greatly, and it still suffers from its early neglect. Despite the fact that several of the Chicago group intensively studied child psychiatry and child analysis with Anna Freud (Margaret Gerard, Helen Ross, and George Mohr), they were given little opportunity for further development. Alexander stubbornly believed that the problems of children were all due to their parents. It was not necessary to treat the child; treat only the mother, father, or both. All three of the above analysts left the field, at least for a long time, and only later after Alexander left Chicago were child analysis, child psychiatry, and child care supported. But it will be many decades before Chicago can make up the time lost. In Chicago child psychiatrists are a scarce species and have isolated themselves from the main body of the field. "We know all we need to know, need no research-we can treat children adequately." This is a direct quote from a leader in this specialty. In summary, Alexander deserves the paeans that I have written about him, but the negative statements above must include his ill-advised support of Dr. Clarence Neyman, the psychiatrist who shocked patients several times daily until they were vegetables; his aversion for diagnostic entities; and his countertransference hostilities and special favoritisms. But in sum, despite the failure of several of his innovative ideas, he was a marvelous and exciting leader, a charismatic character. Thomas M. French was among the first faculty members of the Chicago Psychoanalytic Institute beginning in 1932, continuing as an active member until a recent cerebral vascular accident impaired his physical and mental abilities. He had an early mathematical background but switched to medicine, general practice and finally, psychiatry. French was analyzed by Alexander in Berlin in 1926 and trained at the Berlin Institute. He was already in Chicago in 1930 working at the Institute for Juvenile Research, joining Alexander's original faculty in 1932. In my opinion French was the most careful, somewhat obsessive, scientific psychoanalyst in Chicago. With a broad socialistically inclined background his interest extended beyond the strict limitations of psychoanalysis into other disciplines such as social psychology, social conflicts, and Pavlovian conditioned reflexes. He revised the theory of dreams by dealing with current focal conflicts in relation to the nuclear conflicts of childhood (Pollock, 1970). In fact his three-volume publication concentrated mainly on the detailed analysis of one dream presented by another analyst's (Helen McLean's) patient (French, 1952, 1954, 1958). He always emphasized, in contrast to the so-called orthodox position (cf. Gitelson), reality adjustment


History ofPsychoanalysis in Chicago

and emphasized the importance of "hope" for the future: what others called "expecting well." French was a highly respected member of the analytic community, always serious and never relenting in his desire to learn and teach. Fortunately, as one of his students I learned a great deal and was particularly impressed with his commitment to a fundamental axiom of science-prediction. In a supervisory session with him he would correctly predict the content of the ensuing hours. Now I know that such predictions can be self-fulfilling in that I could find what was expected, but I was truly impressed and at that time felt enthusiastic about psychoanalysis as a science! French was very persuasive and did not indulge in intuitive interpretations as did others. In fact, it was difficult to break away from him because of his interminable discourses. Another psychoanalyst among the first faculty of the new Psychoanalytic Institute was Therese Benedek, who also came from Hungary. Despite the many years in the United States, she maintained her foreign accent and the Hungarian sexless pronouns. I present her in juxtaposition to French because she was a completely different type of analyst. Benedek represents the acme of the intuitive analyst as contrasted with the obsessional objectivity of French. She could read people's faces, gestures, and verbal interactions, and interpret moods before the subject was consciously aware of them. Her post hoc explanations were rationalistic, so that she could never teach adequately the steps by which her conclusions were reached. Nevertheless this short, frail, increasingly deaf, gifted analyst who made her colleagues' problems her own began a research career which gradually improved in excellence. From her first collaboration with an endocrinologist in the study of psychosexual functions in woman from development to motherhood she broke new ground in the study of females. She correlated hormonal variations of the sexual drive. As yet no one has repeated her excellent research (Benedek, 1952; Benedek and Rubenstein, 1963). Dr. Lionel Blitzsten was a peculiar personality with an admixture of brilliance, erudition, pedagogical expertise with free-floating anxiety, arrogance, and unrelenting hatreds for special persons. His analytic story (I have no knowledge of his early life) began with a short trip to Europe as was the custom among various American physicians who wished to become instant specialists, before the Specialty Boards and formal residencies were established. Blitzsten found his way to Berlin, where he entered into analysis with the young and promising Alexander. After a few months he had to return home because of his first wife's serious illness, but first asked permission to start analyzing patients in Chicago. At this point Alexander's naivete expressed itself when he gave permission for this highly neurotic but gifted person to assume the role of analyst in



Chicago because as he told me: "I thought the Chicago population consisted mostly of Indians." This approval was a fateful decision that adversely affected the history of psychoanalysis in Chicago for decades. Blitzsten prospered in practice and through his teaching at Northwestern Medical School developed a coterie of students from many schools in the city. At his home he developed a weekly seminar for future psychiatrists, who were constantly amazed by his intuitive powers. Alexander did not like Blitzsten (or Gitelson) as representatives of a second generation of Eastern Europeans. Others felt this and reacted in tum, and several took their second analyses with Blitzsten, including the cold unbending Minna Emch. As a result, a fairly large group hovered around Blitzsten, motivated not only by desire for learning but also by hostility to Alexander. (Blitzsten had wanted to be assistant director of the Institute but Alexander chose French.) We used to call them the "Blitzstenites." Irritating, annoying, openly hostile and articulate, they seemed to pose a constant threat of splitting away from the Chicago Psychoanalytic Institute and Society as happened elsewhere and still does (Boston). Alexander's liberality and concern for freedom opposed their orthodox, reactionary, and authoritative position. Yet Alexander was unalterably opposed to a formal split, although it existed in fact. He was almost paranoid about this in that he suspected for many years that I would set up a competing Psychoanalytic Institute at the Michael Reese Medical Center, which I had no intention of doing. How we endured the sniping and ultrareactionary stance of Gitelson, who took over the leadership of this group from Blitzsten, is difficult to determine. But the axiom that the sins of the father fall on the children certainly applied to all of us. Aside from psychoanalysis, I had an extra share of this antagonism because Gitelson and some of his followers were on the staff of the Department of Psychiatry at Michael Reese. The experience was indescribably difficult. All of this group seemed to have several characteristics. They were "fish-faced," revealing little feeling, as if emulating the mirror concept of the early analysts. They spoke ponderously as if vocalizing ultimate truths and they kept socially apart from others. I personally experienced another difficult problem with Blitzsten, who for a time was a part-time neurologist and an assistant to my father at his neurological clinic at Northwestern Medical School. He boasted frequently of his analytic training in Europe with Freud. During my analysis with Freud I mentioned Blitzsten's name, which the Professor did not recognize. He firmly declared that he had never met Blitzsten. So I knew. Then rumors came to me from Chicago that Blitzsten was talking adversely about me, a person who had had no dealings whatsoever with him. It was apparent that he was preparing for my disclosure of his distortion of the truth, for which he


History ofPsychoanalysis in Chicago

had a great proclivity. But I did not reveal the truth until after Blitzsten's death. The effect of Blitzsten on the training program at the Institute was deleterious in that the overwhelming illusion of magic in interpretations caused many students to emulate him under the guise of orthodoxy. As Gitelson said as he criticized a member of his group, which he dominated completely: "Orthodoxy is what I do." The Chicago Institute survived the turmoil of its early years thanks to Alexander's optimism that matters would improve and unwillingness to indulge in open fighting despite the revolutionary spirit that gathered force and contributed to his early retirement and move to Los Angeles in 1956. In a paper read before the American Psychoanalytic Association published in 1964, Gitelson entered into a "debate" with me as an anonymous "straw man," which I answered in 1965. The reactionary stance of this Chicago psychoanalyst who assumed spokesmanship for psychoanalysis may be glimpsed by the following excerpts: "Adaption to a culture has no place in psychoanalysis, which needs to be free of the gravitational pull of a specific culture." He lamented that teaching and education in psychoanalysis has not been authoritative enough and implicitly "advised intensification of the policy of dogma and self-serving regimentation." "None of us can say that we are not disillusioned. Unfortunately, many have also been bitterly disappointed. The difference is between insight and transference reaction." Those who criticize have transference reactions, and in the next section he says: "Paradoxically, but not incomprehensible to psychoanalysts, the child has turned against the father while accepting its birthright." Reacting to the relevant animal experiments of the analyst Dr. Philip Seitz and the psychologist Seymour Levine at Michael Reese, Gitelson stated: "Animal experimentation is the degradation of the problem of the human mind, and derivative psychotherapies represent insufficient sensitiveness to the meaning of unconscious process." Then Lustman (1963) is quoted to the effect that critics represent antitheoretical nineteenth-century criteria of science. "This is leading some research analysts to abandon the analytic method for the comparative methodological safety of laboratory research.... Experimental sophistication and scientific sophistication are not synonymous. It prevents or should prevent analysts from distorting and diluting their area of study through the use of available experimental techniques developed by neighborhood disciplines." Critics of psychoanalysis receive from Gitelson analytic interpretations among which are included the return of the repressed, anti-intellectual



trends, atavistic, antitheoretical, and so on. Gitelson believed that cooperation with other sciences is an intellectual flight from the unconscious; that psychoanalysts moving out into research using other than psychoanalytic methods are concerned with prestige and with secondary gain of government financial support; that social anxiety leads them to action to counteract this feeling; and that objectifying techniques (such as observations and recording of sessions) introduce new variables-as if living in the world did not (Gitelson, 1962a,b, 1963). "Psychiatry is not a science, psychoanalysis is a basic science of individual psychology." These are strong phrases used by Gitelson, denying the scientific basis of psychiatry and allocating to psychoanalysis the position of being basic. There is a turn-about nature to this declaration, since for decades the criticism has been leveled that psychoanalysis is not a science. When the American Psychoanalytic Association started its own journal, Gitelson became chairman of the Editorial Board, dominating its policies for many years in favor of the standard reiteration of psychoanalytic theories. Seldom was anything new or controversial published during this period and repeatedly we read about "our science" as if analysis possessed the whole truth. It constantly violated Freud's dictum that trivia could not be used as evidence. The reactionary authoritative stance of the American Psychoanalysts as spoken and written by its representative in Chicago, Dr. Maxwell Gitelson, eventually stimulated the formation of a new forum for the exchange of ideas of common interest for all psychoanalysts and related disciplines. The new Academy of Psychoanalysis, founded in 1957, was designed to stir the American Psychoanalytic Association into progressive thinking and action just as the Group for the Advancement of Psychiatry (GAP) did for the American Psychiatric Association. I was one of the founding members for the organization of both groups. Both accomplished their goals at least partially, and despite the fact that their missions have been completed as far as possible, GAP more than the Academy, they have developed persistent lives of their own. Strangely, some Chicago analysts considered that the Academy did not represent a split, but was a separation from psychoanalysis. Fitting the meaning of the new Academy, its first meeting was held in Chicago on May 12, 1957, when I spoke on "A Philosophical Appraisal of Psychoanalysis" (Grinker, 1958). In this brief essay I tried to demonstrate that, despite the denials of Freud and many others, psychoanalysis as an approach to all of man's functioning conforms to the definition of a philosophy. Furthermore, as a surcease from the uncertainties, ambiguities, and disappointments of its therapeutic applications, the use of psychoanalysis as a W eltanschauung and a way of life has helped the practicing psychoanalyst. But psychoanalysis has become separated in practice from the biological and


History ofPsychoanalysis in Chicago

social sciences, and both in theory and practice has neglected the scientific principles of hypothesis testing, controls, prediction making, and strict test for reliability and validity. Furthermore, it is maintained as a closed system, for the most part, in its basic premise of instinctual self-action, implicit concepts of psychic autonomy, and its isolation from other scientific disciplines. For these reasons psychoanalysis cannot ever become an adequate philosophy but, only for those who need it, a belief or faith. Psychoanalysis can become a science by using the scientific methods of thinking and operating without sacrificing its conceptual domain or intrinsic methods. There is a great need for it to become an open system with freer exchange through its boundaries. Progressive evolution does not occur in isolation but only through partial separation (specialization) to concentrate the genetic pool (conceptual formation} and by transaction with other groups to add gene symbols (communication} and to test them through natural selection (scientific method). This I hope will be the future course of psychoanalysis [Grinker, 1958, pp. 126-142]. The last exchange between the two analytic organizations occurred in 19621963, after Gitelson wrote that he decries the liberal academy, which was politically active against the American Psychoanalytic Association because of the narcissistic injury of its members (Gitelson, 1962}. The Academy's response was that in agreement with Ernest Jones, Edward Glover, Siegfried Bernfield, and others we needed to be receptive to the freedom of ideas not as rivals but as a mutual trend toward development. The Academy flourished and many members of the American joined its multidisciplinary membership. But many were afraid, especially in Chicago, of punitive action by the Chicago organization. To quote one analyst: "I'd like to join but I had better wait until I am a training and supervisory analyst; otherwise I'll never get there." This is not true today since the last bitter struggle, when the Psychoanalytic Association attempted to set up its own sub-board for certification, limiting its membership and certification only to members of its own organization. The Academy strenuously fought this proprietary concept and won. Since then some analysts are members of both organizations without fear of reprisal. When Alexander left Chicago for Los Angeles in 1956 there was much concern over finding a new director. I strongly advised the Board of Trustees to look outside the local scene because the Chicago Institute was becoming inbred and a fresh breath of air was needed. A decision was difficult to reach and Mr. Sidney Schwarz, the president, asked me if I would take the job. I told him that I could not possibly leave my position at Michael Reese for any



job, that I couldn't handle the Institute's problems, and that I was unsympathetic to its goals and procedures. I offered to assist temporarily in dealing with administrative problems. So they appointed Gerhart Piers, who strangely enough never trusted his predecessor. This was a strange appointment for several reasons. Piers had no administrative experience or ability. He was not a leader or an academician in his field, and he was not a research person. I knew Piers professionally because he officed for a time with George Wilson and me and both of us frequently consulted Wilson for his excellent intuitive interpretations that were beyond our immediate grasp. With the sociologist Milton Singer from the University of Chicago, Piers wrote a monograph on "Shame and Guilt,, published under my editorship (Piers and Singer, 1953). They caused me much trouble because they refused to change anything in their manuscript. Later Piers began to dabble in learning theory applied to psychoanalysis. Piers also tried to bring other disciplines into the teaching program, such as the humanities and sociology, but when he consulted me I pointed out that a few lectures would not accomplish much. A social scientist on the faculty was a necessity. Overall the Piers regime was a timid period of consolidation among the antagonistic forces in the Institute and Society. It was a relatively peaceful era, probably necessary at that time, but no one expected nor did there occur any significant progressive changes. His philosophy was service to the community. Finally his illness forced him to retire in favor of a successor waiting in the wings. During the 12 years of Piers's directorship there was an intellectual vacuum. His positive achievements were the establishment of a child care training curriculum for non-analysts first directed by Esther Schour and later by Joseph Palumbo and Ner Littner. He helped Maria Piers, his wife, set up the Erickson Institute for the training of schoolteachers, and he expanded the educational program for teachers. The psychoanalytic training program Piers gave to Joan Fleming, with complete authority. She developed the program in her own image and theory, with beginning, intermediate, and ending courses. There was no curriculum review but standardization with rigid rules, regulations, and strict discipline. Selected students were in lock-step with no room for individuality of the student, or for his analysis or for his graduation. Teaching personnel were chosen from her favorites by means of a complicated system. Finally the students revolted and new teachers were appointed and new classes instituted by Louis B. Shapiro, the new dean of education. This helped a little. George Pollock became the third director of the Psychoanalytic Institute in 1969. He entered the task with considerable scientific background, had been


History ofPsychoanalysis in Chicago

close to W. F. McCullough, Alexander, and Percival Bailey, all of whom influenced his world outlook. He is a man with extensive energy, ambition, optimism and enthusiasm. There is considerable disagreement concerning his achievements, but I can only praise him for opening up the Institute, liberalizing the faculty, moving ahead with many new ventures, permitting and encouraging the younger analysts to think creatively, independently, and even criticize the establishment. Two areas of research were opened up. One was the program on narcissism developed by Kohut {1971), whose statements have swept the country and stimulated much constructive discussion and ambivalence. Kohut represents a renewed intellectualism in clinical psychoanalysis dormant for 20 years. On the other hand Michael F. Basch, John E. Gedo, Arnold Goldberg, Ernest Wolf, Nathan Schlessinger, Leo Sadow, and other younger analysts who were not fully accepted into the inner circle of the Institute have been revising and consolidating psychoanalytic theory. The teaching program has changed very little, still bearing the marks or wounds of the organized but rigid effects of Joan Fleming. But at least on the surface matters seem to be running smoothly. Pollock was helpful in establishing the Center for Psychosocial Studies [Editor's note: now defunct] founded and partially supported by Bernard Weissbord and staffed by Basch and Wolf, but its funding is now declining. The relationship is informal, and it has not been integrated with the Psychoanalytic Institute nor has it influenced Chicago psychoanalysis much. Even so it is unfortunate that because of decreasing financial support this enterprise has a dubious future. The 1974-1975 annual report indicates clearly that the Center is designed for distinguished scholarly productivity. Extramural activities of teacher training by Kay Field, continuation of teaching child care originated by Piers, teacher institutes, training for research of non-doctors of medicine, and the confusing Chicago plan for education for higher degrees without clinical training all indicate that the Institute is stirring from the lethargy of the Piers era.

V Psychoanalysis, alongside its other functions, is a method of treatment particularly adapted to neuroses. Edith Weigert and I have both stated verbally that this therapy is best adapted to the treatment of relatively healthy subjects, heresy indeed for the establishment! Nevertheless adaptation of psychoanalytic theory to the treatment of psychoses, character disorders and personality disorders had led to psychodynamic psychotherapy. In



other words, knowledge of depth psychology as formulated by Freud is helpful in all forms of psychotherapy. Recently these have been somewhat arbitrarily divided into crisis therapy, behavioral therapy and brief therapy based on psychoanalytic principles. Despite this division, all are in fact procedures that are based on learning how to deal with contemporary actions, that is, with ego functions involved in coping. The faculty of the Chicago Institute all made their living through private practice since faculty functions were only part-time. Patients treated as part of their faculty position were chosen to contribute to the early ongoing psychosomatic research programs. A number of activities were developed over the years to contribute to helping persons who could not pay the usual analytic fees, such as a "lowcost clinic" begun in 1932; applications numbered 2,098 in 1974. When Joy Simon took over the direction of this clinic she obtained state support in 1962, helping to buttress the shaky support of the Institute, which has only a small endowment. Unfortunately both analytic and nonanalytic psychotherapists have utilized parts of psychoanalytic theory to make interpretations with reified statements of functions as if they were observable concrete structures. Even Alexander wrote about the "transfer from the superego to the ego." Analysts in general in the early days depreciated psychotherapy, contending that significant or real and permanent changes could occur only through analysis; other forms of treatment resulted only in symptomatic improvement, as if that were not enough. What bothered Alexander was the frequent interminable analyses conducted by his colleagues (Alexander and French, 1946). When analytic theory moved from the Oedipus complex as the most important focus for change to a study of pregenital experiences and conflicts, analysts attempted to reconstruct these early experiences in the transference. Year after year was vainly wasted by Blitzsten, Minna Emch, Gitelson, and others in an attempt to reorganize the total character structures of their patients. These attempts were unrealized therapeutic ambitions, as one could observe by the wide variety of neuroses and personality and character disorders of analytic graduates (McLean, 1965) .That there is no simple correlation between therapeutic results and the length and intensity of treatment has been recognized, tacitly or explicitly, by most experienced psychoanalysts and is an old source of dissatisfaction among them (Mora and Brand, 1970). The deeper structures of the mind, evolutionarily developed and characteristically programmed, are overlaid by experiences that together produce a phenotype that cannot be fragmented and united anew in a less neurotic


History ofPsychoanalysis in Chicago

way. The same applies to structural linguistics which are programmed but modified by learning, as Stent (1975) states: The great strength of Freudian analytical psychology is that it does offer a theoretical approach to understanding human behavior. Its great weakness, however, is that it is not possible to verify its propositions. And this can be said also of most other structuralist schools active in the human sciences. They do try to explain human behavior within a general theoretical framework, in contrast to their positivist counterparts who cannot, or rather refuse to try to do so. But there is no way of verifying the structuralist theories in the manner in which the theories of physics can be verified through critical experiments or observations. The structuralist theories are, and may forever remain, merely plausible, being, maybe, the best we can do to account for the complex phenomenon of man. Then Alexander conceived the idea that briefness in therapy should be emphasized and began a series of investigations with other members of his staff. Unfortunately he called this "Brief Psychoanalysis," which brought down on him the wrath of most analysts in the country except for a few of his colleagues. Brief psychotherapy would have been accepted but not brief analysis! But the term persisted and like the typical American bandwagon many younger analysts hopped on but gradually dropped off, and "brief" now is only applied to psychotherapy. In the late 1940s and during the 1950s psychoanalysis became fashionable for discontented wealthy people, mostly women, who experienced anxieties or depressions with which their culture could not cope. They sought analysts in droves. Unfortunately some analysts avoided analyzing anger within the transference, maintaining their patients in an enthralled state of dependency for y~ars. When their analysts died or left Chicago the released rage within their social groups was something to behold. Gradually many lay people in Chicago have become disenchanted with psychoanalysis as a form of treatment. Its therapeutic results were not great and the cost in time, energy, and money was excessive. As a result, many analysts did more psychotherapy than analysis, except for the training analysts who seemed impervious to the realities around them. Even today, highly competent and experienced analysts put their names on lists indicating that they have free analytic hours!

VI The term training, utilized by psychoanalytic institutes instead of education, early set the climate for the goal of a technology rather than a graduate education in an academic environment. Alexander realized this but he could



do nothing to change the name except for his own personal desire to be an academician. Thus, he joined my clinical conferences at the University of Chicago and later became a faculty member of the University of Illinois Medical College from 1938 to 1956. He futilely urged the development of psychoanalytic departments within universities. I obtained my certificate (number 27) from the Chicago Institute in 1939, so I was part of the lnstitute's early training programs and can describe it firsthand. My earlier training experiences were as a neurologist at the National Hospital for Paralyzed and Epileptics on Queen's Square in London. Gordon Holmes, after a completely negative neurological examination, would kick his patients in the buttocks and say: "There is nothing the matter with you. Go home and forget about it." As my father's assistant I saw the temporary results of persuasion, suggestion, support, and direction but never any degree of permanent relief. When I became chief of Neurology at the University of Chicago, psychiatric patients were referred downtown, until finally the dean offered me a Rockefeller fellowship to study psychiatry abroad. Both C. J. Herrick and K. S. Lashley warned me not to get involved in psychoanalysis, but I did. Alexander suggested that I negotiate with Freud, who finally accepted me despite his feeling that it would ruin my academic career, which it did not. I returned to Chicago and set up a small psychiatric unit at Billings Hospital to the dismay of the professor of surgery. Alexander and Leon Saul helped me start weekly inpatient conferences, Jules Masserman was my first psychiatric resident, and Helen Richter the first psychiatric intern. I immediately entered the training program at the Chicago Institute despite only a year of personal analysis with Freud. The general attitude of the faculty was that the students were adults capable of learning through experience and their own selected readings. There was no prescription for the number of so-called control patients (supervision), no set number of hours and no time-spread for supervision. One of my supervisors told me to return whenever I needed to. Another intuitive analyst, George Wilson, informally helped me understand dream interpretation. But French was the supervisor I saw the most. The work was long, hard, and interesting, and for the most part, we learned on our own to analyze, to understand, to absorb the readings, and to become members of the analytic establishment. I must say that our choice of patients for analysis was not intelligent and we failed often in our attempts to hold them in treatment. Transference interpretations were most difficult for the novice who received little help at the time. Among the students were many so-called geographic trainees who came from Topeka, Cincinnati, St. Louis, and elsewhere, for weekend analyses,


History of Psychoanalysis in Chicago

conferences, and superv1S1on. In fact, one of the big obstacles to a good education was the weekend form of teaching necessary because candidates did have to make a living in practice or jobs. The outline of the curriculum was simple. Saturday morning was devoted to a clinical conference attended by the young faculty and students. At noon lunch was served from the lnstitute's kitchen, after which a book or a series of articles was reviewed and discussed, led off by a student. In the afternoon the society (same people with one or two additions) held a meeting where a faculty member would give a paper followed by discussion by faculty and students. After a certain time the student would feel that he was ready for a final examination, and so indicated. This was brief and entirely oral because what the student knew and could do was well known by the faculty. I remember that I was ushered into a conference room and asked one question: "What is the superego?" In 5 minutes I was through, discussed, and received my certificate. This entitled me to become a member not only of the Chicago Society but also of the American. Thus there were no complicated reports of cases analyzed and a host of other contemporary ploys that keep the student fearful, dependent, and conforming to the will of the establishment. Nevertheless, as my friend M. R. Kaufman of New York correctly told me, it took at least 5 years of experience to really become an analyst. Dedicated, optimistic, and hard-working, we studied, talked with our peers, and acquired the necessary experience. But all was not that simple for long, because analytic groups became more mired in ritual, more controlling and more infantile in their conflicts. There was conflict between local institutes and societies and within institutes between liberals and conservatives (really orthodox). Students were treated like children. Classes were formalized and curriculum planned for at least 5 years. Alexander's liberalism was lost and, at least temporarily, the free Chicago Institute became fettered by the American's restrictions. If students asked questions that were searching, skeptical, and indicated doubts they were threatened with probation and return to more analysis, thereby stifling free discussion. Analysis of students was handicapped by the role of their analysts in supporting or denying admission to the training program. Teaching of Freud's papers and books, from even the earliest days, was put forth under the guise of historical data without enabling the student to know what was currently accepted (Grinker, 1969b). Progress seemed at a standstill. In 1953 Robert Knight wrote that the major disputes resulting in splits within psychoanalytic societies were concerned with psychoanalytic training. These disputes did not concern techniques of treatment but concepts basic to training and to restraints on research. Strangely enough and damaging to the image of psychoanalysts, disagreements about training resulted



not only in splits of professional institutes and societies, but in their members becoming personally angry and often not speaking to each other, as for example in Los Angeles. They also fought angrily in Vienna, sometimes violently, but Freud responded to my shock by saying "After all, analysts are human." Alexander's academic ambitions led him to pursue closer ties between the Analytic Institute and the psychiatric training centers. He envisaged analysis as the focal point for all training. But Henry Brosin of the University of Chicago and I saw otherwise. We finally set up the Associated Psychiatric Faculties. Selection of residents and analytic candidates was carried out by a group interview with representatives of all the training resources. Acceptance meant matriculation in analysis and for psychiatric residency. A few "strong" candidates were given a rotating residency at the University of Illinois, the University of Chicago, and Michael Reese. After a few years this system collapsed because of under-the-table negotiations before the Selection Committee came to its decision. A later proposal by George H. Pollock that the Analytic Institute furnish teachers to the residency programs (a means of increasing enrollment at the analytic institute) was rejected out of hand because most of the residents learned enough psychodynamics from their own teachers (mostly analysts) so that the first-year courses at the Analytic Institute were repetitive and boring. In 1971, when George Pollock became director, a new policy was instituted. The director of the Institute is now chosen by a council of 19, elected by the faculty, for a period of 5 years and can only be reelected once for a second 5 years.* Likewise members of the council are selected by the faculty for 3 years plus one second 3-year term. Given the increasing complexity in the Institute's organization because of its increasing student body (although for the last several years the numbers have remained about the same), geographical training, community services, and research fellows (nonphysicians not permitted officially to treat patients), the committee structure has become complicated. As for the faculty, there is a calm stability. Student selection, curriculum and progression are now programmed without the excessive constraints of the previous overly disciplinary attitudes. Although the Institute has only a small endowment, owing to the fundraising abilities of Pollock there has been no deficit for the last 5 years. Yet the Institute has been able to publish an "Annual" and a literature index, and to mount a continuing-education program accredited by the Illinois State •Editor's note: Now, in 1995, selected in an entirely different way.


History ofPsychoanalysis in Chicago

Medical Society. Pollock advocates an open system and the end of psychoanalytic isolation; hence more younger analysts are included in committee activities, more training analysts have been appointed, and more workshops organized. Pollock believes that psychoanalysis, community psychiatry, and psychopharmacology can become complementary. The Chicago Institute, despite grwnblings from some participants, has reverted to the salutary openness of the original Institute founded by Alexander but dormant for too long. Perhaps Pollock is spreading his activities and those of his staff too thinly over a wide range of activities. In 1960 Lewin and Ross presented their national survey of psychoanalytic education including data from Chicago. But surveys of psychoanalytic educations have the tendency to reveal what people say they do or what they think they do, but do not reveal what actually is done or the meaningful impact of what is accomplished regardless of what the intent may be. In our language, such surveys tap conscious attitudes as contrasted with preconscious or unconscious meaningful trends. In a sense, surveys always reveal the more liberal and the more avowed experimental purposes, while concealing that which is rigid and parochial. In 1962 I wrote (Grinker, 1975b): One could take all the surveys, all the righteous and well-meaning statements, and all the expressions of liberality at face value. But the real and crucial considerations of what is accomplished in education can be achieved only by examining its products. It requires not much in the way of planned examination to indicate to us in this, the decade of the sixties, that psychoanalytic education has not been especially helpful for the advancement of psychoanalytic theory, research, or practice. How then shall we change this end result? Certainly not by accepting the notion that combinations of teaching and training are syncretisms {meaning incompatibles); certainly not with the notion that teaching must follow a line that derives itself from original Freudian statements; certainly not by decrying research into the active ongoing processes of therapy; and, finally, certainly not by using the so-called "training" analysis required of all students as a means of instilling conforming and adaptive attitudes toward faculty philosophy [pp. 218-219]. During Alexander's directorship, Thomas French was associate director and George Mohr, dean of students. For Piers, Fleming was dean of education from 1956 to 1969 and Shapiro in 1969 (continuing during Pollock's directorship, which he assumedin 1971) until 1974 when Henry Seidenberg and Edith Sabshin took over. Aside from psychoanalytic candidates, a child care program of debatable value started in 1950, ending in 1961, a child therapy program was begun in 1962 and a teacher education program in 1965.



Among special long-term projects are Clemente High School-consultation on a weekly basis (1971-); vocational rehabilitation workers-formal training, 2 years (ongoing); Mental health workers-continuing education series for all sorts of specialists, including psychiatrists (ongoing); workshops under joint sponsorship of Institute and Center for Psychosocial Studiesfor analysts and other professionals (ongoing); businessmen's seminars, cosponsored by Institute and University of Chicago Graduate School of Business, on an annual basis (1974, 1975 thus far). Also many special training projects at different periods and for varying lengths of time, for such groups as public health nurses; ERA teachers; team leaders (Board of Education); principals (Board of Education); the Chicago Latin School; the University of Chicago Laboratory Schools; social workers dealing with adolescents; school supervisors dealing with maladjusted children; Head Start social workers; Head Start teachers; and many public schools and school districts. When I was a student at the Institute, tuition was not a factor nor did I pay fees to supervisors. Here is the current (1975) fee structure at the Chicago Institute: Application fee ................................. $ 25.00 Selection interview fee .......................... . 100.00 Matriculation interview fee ...................... . 50.00 50.00 Initial registration fee ........................... . _Tuition ....................................... . 7,500.00 Tuition is payable in three installments: $500.00 due on October 1, $500.00 due on January 1, and $500.00 due on April 1, to a total of $1,500.00 per year. Students who continue their training beyond 5 years, for whatever reason, are expected to pay a registration fee thereafter of $ 100.00 per quarter. The tuition covers the 5-year course of study and 200 hours of supervision. For supervisory hours in excess of this amount a charge of $20.00 per hour is made. Tuition does not cover the cost of the applicant's preparatory analysis. The average time for matriculation to graduation is 7.5 years. No wonder that when our residents finish their psychiatric training they cannot take part-time or full-time institutional positions as teachers or investigators. They have to enter private practice to make a living for themselves. After the initial postwar influx of psychoanalytic students, an analytic training was no longer necessary to become a first-class citizen of the psychiatric specialty, so that the Institute had to initiate a seduction of


History of Psychoanalysis in Chicago

residents in the local psychiatric training centers. But the residents of the 60s and 70s are a new breed. They want to become general psychiatrists rather than narrow specialists. At the time when young men and women clamored to enter psychoanalytic training, the medical schools wanted chairmen of departments who were analysts. But when these new chairmen understood the enormity of their responsibilities and the extent of their field, they in truth became general psychiatrists. The fashion has now shifted to the search for chairmen who are trained, experienced, and skilled in psychopharmacology. This trend away from dynamic psychiatry has also influenced the career choices of younger psychiatrists and the selection of residents.

VII Psychoanalytic research in Chicago has been a mixed bag. The results of a wide range of investigations cannot be evaluated until considerable time has passed. Posterity is the final judge (Grinker and Spiegel, 1963). But we have seen clearly how research findings from Chicago have affected clinical psychoanalysis-treatment and teaching-not only locally but also nationally. Thus Alexander's psychosomatic specificity, French's dream interpretation, Benedek's female psychodynamics were fashionable in their time. Younger psychoanalysts searched their clinical material for confirmatory material. In the wide variety of data one can find what one looks for. Another way in which the professionals have changed in the Chicago area, and probably elsewhere, is the bandwagon trend of going with the newest fashion in diagnosis. As we studied the Borderline Syndrome (Grinker, Werble, and Drye, 1968) at Michael Reese that diagnosis greatly increased, as it has now for schizophrenia, since the establishment of our program of research on this disease. At the Analytic Institute the diagnosis of narcissistic neurosis a la Kohut is heard everywhere despite the tentativeness and vagueness of his formulations. Two categories of research may be mentioned. One includes the extensive, long-duration studies of psychosomatic specificity, dream studies, female sexuality, narcissistic neuroses, parent-loss narcissism, psychosocial studies. These had structure, planning, multiple participation, and at least a semblance of design. The second category is more individualistic and usually reports on one or two cases from which Freudian theory is confirmed or new theory advanced. I would not challenge the efforts of young analysts to think for themselves and express new theoretical ideas, but it is hoped some will eventu~ly engage in decent empirical studies. The so-called work-shops, meeting interminably, have produced little in the way of publications. Their current



titles are as follows: aging, treatment of narcissistic personality disorders, dream research, female sexuality, interface between psychoanalytic theory and technique, narcissism, philosophy of science and psychoanalysis, psychoanalysis and anthropology, psychoanalysis of the adolescent, psychosomatic problems, structural change in the terminal phase, structuralism, and so forth.• I will not discuss the participation of individual analysts in multidisciplinary research because they usually wear the respectable hat of research psychiatrists. One interesting anecdote. During the first year of World War II, Alexander suggested to General Dovovan that analysts could accurately gauge the morale of the civilian population from their day-by-day contacts. So an elaborate questionnaire was devised but the results were zero. Our patients were more concerned with their daily lives and internal feelings. This experience, plus the consistently wrong predictions by the analysts about the fighting spirit of the Russians, turned the scales to push me into the air force. It was my war, and even though I was over draft age, I enlisted. With John Spiegel we served well and learned a great deal that has since been published and which stimulated our research on stress after the war {Grinker and Spiegel, 1963) in the laboratories at Michael Reese Hospital. Several of the younger analysts {most were trained in psychiatry at Michael Reese) have written theoretical papers and books recently, with great difficulty in finding editors and publishers for their works because they have been concerned with emendations to psychoanalytic theory. Basch (1975) describes syndromes as general systems dysfunctions and describes symbols as metaphors. He would like to substitute communication and information theory for libido and psychic energy. Gedo and Goldberg (1973) have described models of the mind in terms of vertical maturation and a new taxonomy based on development, stages of regression, and a supraordinate system of controls. Philip Holzman {1975) criticizes the research in psychoanalysis as deficient because of "inadequate clinical training of investigators, poor scientific training in psychoanalytic institutes and a narrow concept of research tasks." He correctly states in his teaching at the Chicago Institute that psychoanalytic theory is not systematized and that it is taught without an understanding of the proper place of each of its parts. What is needed is a marriage of sophisticated awareness of psychoanalytic ideas with investigative skills. Holzman in a recent discussion decried the frequent attempt to modify psychoanalytic theory on the basis of a single case, as is so frequently attempted in the literature. Developmental occurrences must be verified by methods other than from associations by adults in the analytic situation. 0

Editor's note: In 1995, many of these no longer exist.

History ofPsychoanalysis in Chicago


Many years ago I pointed out that validation of the assertions in any discipline requires confirmation by methods of outside disciplines. Improvement through psychoanalytic treatment may be an erroneous contention; too many other variables may be operative. This holds true for any variety of treatment: assertions are not enough; data and controls are needed. Perhaps we may have to agree with Hans Strupp {1973) who finds basic similarities in all forms of therapy (crisis, behavior, psychotherapy, psychoanalysis, witchcraft, etc.) consisting of respect, empathy, and time. As Holton (1973) states, there has been in the last decades a tendency to maximize the separation of disciplines. On the other hand unified theories have captured the interest of all scientists. This involves field theories and the idea of transactions or reverberating communications of part of larger systems. Holton's description of "themata" or fundamental conceptions as fundamental propositions, implicit and unrelated to objective spheres, in complementarity with the explicit concepts of a real world, applies to psychoanalysis. In this field, however, the separation has gone to extremes and "drive" theories have dominated as if the real world were only a concept. In Chicago 25 years ago I presented a discussion on transactions which met with complete silence, and its concepts were ignored until recently. Alexander as an exception had spoken out on "corrective emotional experiences," emphasizing the need for the analyst to play the appropriate roles which the patients had previously not experienced in their growth. Unfortunately, artificially "acting" such roles is never successful.

VIII I have presented a historical overview of psychoanalysis in Chicago from 1911 to 197 5. It contains very little ~bout the substantive changes in the field because it is more oriented to a description of the activities, successes, and failures of outstanding personalities. Viewed from a systems framework the early years were open, led by dilettantes who experimented with the "new psychology" in private practice, which they abandoned quickly because of their difficulties with transference problems. There ensued a decade of silence from 1912 until 1921 and another from 1921 until 1932, when Franz Alexander founded the Chicago Institute and continued as its director for almost 25 years. This was an era of excitement, creativity, liberality, and openness of communication. The specificity in psychosomatic research; the vector theory of surplus energy utilized early in development for erotic expression, play, and practice; dream studies emphasizing problem solving and hope; brief therapy; the dynamics of the female sexual cycle; and many psychoanalytic studies of



social and political problems characterized the busy and constructive faculty and Society members. There were many internal quarrels characteristic of all "well-analyzed" psychoanalyzed groups but these were resolved for a time. But when the American became stultified in its own narcissistic admiration of possessing the sole truth, and the establishment kept locking the doors and windows to protect its own pure science (Gold), the liberal Chicago Institute became a part of the national stance. It accepted the nonvalue systems of the establishment as the Chicago analysts became sated with progressive change. This was too much for many of us. Alexander left for California and I isolated myself from both the Institute and Society to breathe to exclusion the fresh air of an academic environment. In California, Alexander still contributed through his scientific pursuits, producing, with help two valuable books, The History of Psychiatry with Selesnick ( 1966) a11d The Scope of Psychoanalysis (1961). He closed his last work on psychoana~y,sis with a passage that amply describes his progressive leadership. ----Just because so much still has to be explored, we must not only tolerate but encourage individual differences, personal initiative of teachers and also of the students, instead of insisting on strict uniformity and conformity. We must return to local autonomy of institutes from a uniformly systematized centrally regulated educational system. In view of the great many existing uncertainties in the theory of treatment, we are far from being ripe for the degree of standardization we adopted some years ago. If we continue with the present educational policies, the best qualified group, the psychoanalysts, will lose leadership in developing Freud's heritage. Then not we but the rapidly growing borderline group of psychoanalytically oriented psychiatrists who are unhampered by rules and the dogmatic censorship of their confreres will accomplish the inevitable reforms necessary for training effective practitioners [pp. 585-586]. In 1956, the new administration developed a closed system, although peaceful in that the internal quarrels and disagreements with the American decreased. It was a closed shop maintained by the firm hand of Joan Fleming, who ran the show with power to appoint training analysts. Students were held strictly in line, teachers were audited, supervisors were supervised, and committees argued interminably about what was orthodox. Peaceful indeed, but a regressive stance completely different from the exciting past. Intelligent students adapted to the new social situation, but protected themselves from destructive internalization by keeping a distinctly nonparticipant observing critical ego.


History of Psychoanalysis in Chicago

In writing this brief history I am aware that, as in the past, I will be accused of being "ag~nsf' analysis. Not so, as my students and colleagues will testify. From within, and for long a part of the psychoanalytic school as student, teacher, and investigator, I have used the Chicago setting as a case example of ups and downs of psychoanalysis in general. It is a microcosmic example of the larger establishment with a magnificent past, a long period of decline and now perhaps a better future. Perhaps the rapid rise and fall, and now the slow movement upward, has superseded the unfounded expectations and excitement of the early years. Using another model, the Chicago Institute for Psychoanalysis was first an open system, became tightly closed, and now is beginning to open again. Perhaps psychoanalysis in Chicago as a model may become increasingly open and academic, and psychoanalysis may really become a contributory science! Chicago, August 15, 1975

References Alexander, F. (1942), Our Age of Unreason. Philadelphia: Lippincott. - - {1950}, Psychosomatic Medicine. New York: W.W. Norton. - - {1960), The Western Mind In Transition. New York: Random House. - - (1961), The Scope of Psychoanalysis, 1921-1961. New York: Basic Books. - - & French, T. M. {1946), Psychoanalytic Therapy. New York: Ronald Press. - - & Selesnick, T. (1966), The History of Psychiatry. New York: Harper & Row. - - French, T. & Pollock, G. H., eds. {1968), Psychosomatic Specificity. Chicago: University of Chicago Press. Basch, M. (1975), Psychoanalysis and theory formation. In: The Annual of Psychoanalysis, Vol. 1. New York: Quandrangle. Becker, C. L. (1935}, Everyman His Own Hist~rian. New York: Appleton-Century-Crofts. Benedek, T. ( 1952), Studies in Psychosomatic Medicine. New York: Ronald Press. - - & Rubenstein, B. {1963}, An investigation of the sexual cycle in women. Arch. Gen. Psychiat., 8:311-314. Bry, J. & Rifkin, A. P. (1964), Mental Health Book Review Index. French, T. M. (1952, 1954, 1958), The Integration of Behavior, Vols. 1, 2, 3. Chicago: University of Chicago Press. Gedo, J. & Goldberg, A. (1973}, Modelr of the Mind. Chicago: University of Chicago Press. Gitelson, M. (1962a}, Letter. Internal. j. Psycho-Anal., 43:373. - - (1962b}, Communication from president about neoanalytic movement. Internal. J. Psycho-Anal., 43:373. - - (1963), On present scientific and social position of psychoanalysis. Internal. J Psycho-Anal., 44:521. - - (1964), On identity crisis in American psychoanalysis. j. Amer. Psychoanal. Assn., 12:451. Graubard, S. R., ed. (1974), Preface. American higher education. Toward an uncertain future. Daedalus, I :ix.



Grinker, J. (1912), Freud's psychotherapy. Illinois Medical Jouma~ 11: 1-7. Grinker, R. R., Sr. (1958), A philosophical appraisal of psychoanalysis. In: Science and Psychoanalysis, Vol. 1, ed. J. Masserman. New York: Grune & Stratton, pp. 126-142. - - (1963), A psychoanalytic historical island in Chicago 1911-1912. Arch. Gen. Psychiat., 8:392-461. - - - (1965), Identity or regression in American psychoanalysis. Arch. Gen. Psychia.t., 12: 113-125. - - (1967), Open-systems psychiatry. Amer. J Psychoanal., 26: 115-128. - - (1969a), Psychoanalysis and the study of autonomic behavior. In: Politics, Personality and Social Science in the Twentieth Century. Chicago: University of Chicago Press. - - (1969b), Conceptual progress in psychoanalysis. In: Modern Psychoanalysis, ed. J. Marmor. New York: Basic Books. - - - (1970), The continuing search for meaning. Amer. j. Psychia.t., 127:725-731. - - - (1973), Psychosomatic Concepts. New York: Aronson. - - - (1975a), Psychiatry in Broad Pnspective. New York: Behavioral Publications. - - (1975b), Reminiscences of I)r. Roy Grinker.j. Amer. Acad. Psychoanal., 3:211-221. - - & Spiegel, J.P. (1963), Men~ Stress. New York: McGraw-Hill. ---Werble, R. & Drye, R. (1968}, The Borderline Syndrome. New York: Basic Books. Holton, G. (1973}, Thematic Origins of Scientific Thought. Cambridge, MA: Harvard University Press. Holzman, P. (1975} Psychoanalytic research. In: Psychoanalytic Research, Three Approaches to the Study of Subliminal Processes, ed. M. Mayman. Psychological Issues, Monogr. 3. New York: International Universities Press. Kahler, E. (1964), 1'11£ Meanirig ofHistory. New York: George Braziller. Knight, R. (1953), History of organized psychoanalysis.]. Amer. Psychoanal. Assn., 2: 197-200. Kohut, H. (1971), 1'11£ Analysis ofthe Self. New York: International Universities Press. Lasswell, H. D. (1935}, Verbal references and physiological changes during the psychoanalytic interview. Psychoanal. Rev., 22: 10-24. - - (1936), Certain prognostic changes during trial (psychoanalytic) interviews. Ps:Jchoanal. Rev., 23:241-247. - - (1938), What psychiatrists and political scientists can learn from one another. Psychiatry, 1:33-39. - - (1939), Person, personality, group, culture. Psychiatry, 2:533-561. Lustman, S. L. (1963), Some issues in contemporary psychoanalytic research. Tiu Psychoanalytic Study of the Child, 18:51-74. New York: International Universities Press. Lewin, B. & Ross, H. (1960), Ps-ychoanalytic &lucation in the United States. New York: Norton. McLean, H. V. (1965), Franz Alexander 1891-1964. Internat. J. Psycho-Anal., 65:247-250. Mora, G. & Brand, J. L., eds. (1970), Psychiatry and Its History. Springfield, IL: Thomas. Piers, G. & Singer, M. (1953), Shame and Guilt. Springfield, IL: Thomas. Pollock, G. W., ed. (1970}, Psychoanalytic Interpretations: The Selected Papers ofThomas M French. Chicago: Quandrangle Books. Stent, G. S. (1975), Limits to the scientific understanding of man. Science, 187:1052-1057. Strupp, H. (1973}, Toward a reformulation of the psychotherapeutic influence. Internat. ]. Psycho-Anal., 11 :263-365.


History of Psychoanalysis in Chicago

Afterword Fred P. Robbins In this article, Dr. Grinker has not only provided us with a historical account of the development of psychoanalysis in Chicago from 1911 to 1975, but also added an autobiographical account of how he participated in it. He also detailed the vicissitudes that accompanied this development. Dr. Grinker's keen observations and brilliant insights supplied us with an understanding of the problems involved. As an astute visionary he was able to see our theoretical shortcomings and recommended the directions we needed to take. In brief, he recognized the limiting effect of the orthodoxy which insisted that the oedipal conflict was the core of most symptomatology and the more severe pathology was the result of deeper regressions from the oedipal conflict. The most severe pathology was relegated to the psychoses or borderline states and therefore unanalyzable. There have been many changes in psychoanalysis, but only gradually before 197 5, and these changes have confirmed Grinker's views. Orthodoxy has partially released its hold, because of what one hopes is an increased understanding of the composition of the therapeutic process, and an understanding that the expectation of the resolution of the transference neurosis is a myth. This concept had created unrealistic expectations in patient and therapist. There are re-solutions but not resolutions. How well Grinker knew this when he described his colleagues as "neurotic." Year after year was vainly wasted by Blitzsten, Emch, Gitelson, and others in an attempt to reorganize the total character structures of their patients. These efforts were unrealized therapeutic ambition, as one could observe by the wide variety of neurosis and personality and character disorders of analytic graduates. Dr. Grinker's approach was based on what he designated as the transactional field theory. He proposed that there are multiple influences that bear on symptom and character formation. Among those influences were the anatomical, biological, genetic, developmental, social, and cultural. These fields were mutually interactive and therefore subject to exploration in the therapeutic process. Dr. Grinker felt that a more heterogeneous composition of the candidates would add an expanded theoretical and scientific understanding to our field. His vision is now being put into practice. The Institute has taken on the acceptance of Ph.D. candidates, both psychologists and social workers as well as specialists in other social fields such as linguistics, anthropology, history, etc. The curriculum is being changed to encourage a less orthodox approach, to widen the scope of psychoanalysis, and to make use of some of the



theoretical concepts involved in transactional field theory. His criticisms and suggestions for an expanded theoretical understanding are being validated. Though at that time he was considered a reprobate and curmudgeon, he is now being vindicated and appreciated as a visionary. I would like now to introduce an addendum from a personal point of view based on my residency in the postwar psychiatric program at Michael Reese Hospital and the coauthorship with Roy of the Psychosomatic Casebook (1954). During my residency I felt fortunate, as did my nine fellow residents, to have such an admirable teacher and mentor. His theoretical grasp and his ability to elaborate this understanding was helpful and stimulating. Roy's contribution to the weekly clinical conference was insightful, brilliant, and inspirational. We realized that we were in the presence of greatness, which helped us to tolerate his critical personality. He was, in our terms, "a super superego." We used the title of the Grinker and Spiegel book Men Under Stress to designate ourselves as "The Ten Men Under Stress." After graduation, I joined Roy as coauthor of Psychosomatic Casebook. For me this was a great learning experience from which I profited considerably. It was here that I was able to apply the multiplicity of the sources of symptom and character formation and question the reliability of specificity. Despite our challenge to the concept of specificity, Alexander invited me to join the staff of the Institute. Roy, of course, would not stand in the way of my opportunity. When I asked him how he felt about my joining the staff, the curmudgeon in him arose once again and in his typical manner he replied, "How thin can you slice baloney?" The remark was easily forgiven, a meager fee for all I had gained in my association with him and all I reexperienced, understood, and appreciated in reading this once rejected and now rightfully accepted article.



Henri Matisse: Love as Art A Psychohiographical Study


Henri Matisse revealed a cherished desire in Notes of a Painter from 1908, "What I dream of is an art of balance, purity and serenity, devoid of troubling or depressing subject matter, a soothing, calming influence on the mind, something like a good armchair which provides relaxation from physical fatigue" (Flam, 1978, p. 38). Armchairs or couches, however, were considerably more comfortable, or disturbing, when filled with a succession of stimulating women, such as Odalisque with Magnolias, 1923 (Fig. 1). Themes of female harem slaves reinforce the image of this painter as an untroubled, sexually liberated individual. Apparently spontaneous color-filled paintings of women appear to be the byproducts of buoyant hedonism. In fact, no work was more labored, no activity more obsessive, no women more ambivalently loved, no artist more intermittently depressed than in the case of this avowed artist of joy, Henri Matisse. Paintings of women reflect a life of familial tension, illicit passion, and/ or disengagement. Even with stimulating young women, desire for fusion through visual scrutiny and sexual union was eventually followed by emotional separation as he turned to his own more gratifying creative transformations. Seductive delight of observing and experiencing tactility in flesh was ultimately aestheticized and transformed into the more reliable delight of engaging in tactility of paint. Underlying ambivalence regarding relationships, and A version was presented to the Smithsonian Associates, Washington, DC, in conjunction with Georgetown University, at a seminar, "Passionate Love and the Couple: The Transformations of Love," with Curtis Bristol, Stefan Pasternak, Maria V. Bergmann, and Martin S. Bergmann, on February 13, 1993. The author of this chapter would like to dedicate it to Paul Gray, M.D. in recognition of his analytic dedication and empathy. 199


Henri Matisse: Love as Art

Figure 1. Odalisque with Magnolias. 1923. Oil on canvas, 25 5/8" x 31 7/8". David Rockefeller Collection. Cowart & Fourcade (1986), Pl. 162, p. 206. replacement by anxiously developed images has remained unexamined. Fear of early abandonment produced. a young person of protective dependency and self-styled "conformity, passivity, and boredom." These behaviors were replaced in adulthood by alternating fusion and disengagement, nonconformity, obstinacy, obsessive work, and narcissistic preoccupation with self. The desire for a continuous supply of female stimuli, yet creative and personal autonomy, produced rupture and discontinuity in conflict with opposing desires for continuity and calm. To protect his reputation and that of his family from rumors and speculations, he publicly denied the libertine existence implied in his bacchanalian paintings and professed the posture of responsible bourgeois gentilhomme. During the uproar over his paintings in the famous New York Armory Show of 1913, he was interviewed by an American journalist from the New York Times, Clara T. MacChesney, whom he welcomed into his home. She reacted in astonishment to their meeting: M. Matisse himself was a great surprise, for I found not a slovenly dressed, eccentric man, as I had imagined, but a fresh healthy, robust blond gentleman, who looked even more German than French. One's ideas of the



man and his work are entirely opposed to each other: the latter abnormal to the last degree, and the man an ordinary healthy individual. On this point Matisse showed some emotion. "Oh, do tell the American people I am a normal man: that I am a devoted husband and father, that I have four fine children, (upon asking to name them he remembered he had three), that I go to the theatre, ride horseback, have a comfortable home, a fine garden that I love, flowers, just like any man" [quoted in Schneider, 1984, p. 19]. But, as Flam (1986) notes, these statements may have served as a camouflage for: "Matisse was an intensely private man; he always took care to keep his private life isolated from his public life. It became apparent he often had intimate relations with his models. It did not, however, seem to me necessary to discuss the relationships in any length except in few instances. It seemed useless as well as tasteless to resurrect long-forgotten events whose main interest is in the category of gossip about the great" (p. 12). Flam remained discreet in detailing the nature of Matisse's alliances, noting them only in a paragraph or two in his most recent analysis of the three versions of The Dance (1931-1933) in 1993. He undervalues the function of the models and thereby colludes in the construction of the myth of this artist as one whose thematic fantasies were primarily fictional. Formalist art historians and guardians of the Matisse family archives have promulgated this vision of a man whose personal life was exemplary and unrelated to his life. To maintain this view, they restrict access to vital personal information. Erotic themes were mythicized to be the product of an immaculate visual conception-the artist an engaged monogamist. In fact, unconscious needs determined his complex personality, actions, and artistic decisions. Careful viewing and interpreting of Matisse paintings in four extensive exhibitions in the last 6 years (at The National Gallery of Art in Washington, DC in 1987, 1990, the Museum of Modern Art in New York in 1993, and the relatively unpublicized Matisse paintings in the 1993 traveling Barnes Collection) reveal anomalies and conflicts. Paintings of women, in dining rooms and boudoirs, from clothed daughter and wife to diaphanously veiled models, ranged in style and feeling from austere to sensual, realistic to abstract, spontaneous to labored. Adding to the discontinuity were enlarged photographic portraits of a seeming stranger, Matisse, 1930 (Fig. 2), rather than a "robust gentleman." The sober visage of the artist "stared out through his thick gold-rimmed spectacles, strong lenses shielding his eyes suggesting psychological distance from which he observed the world, radiating an extraordinary sense of energy, almost violence, held in check beneath a manner of great reserve" (Flam, 1986, p. 18). Contrary to the statement of Picasso, who had written on the back of one of Matisse's drawings in 1951, "no painter ever tickled such bursts of laughter out of paintings as Matisse


Henri Matisse: Love as Art

Figure 2. Matisse. 1930. Photograph by Man Ray. Courtesy of Lucien Trelliard, Paris. Cowart & Fourcade (1986), p. 46.

did" (quoted in Neret, 1991, p. 243), was an image of the "gloomy professor," a complex, vulnerable, anxious, frequently depressed individual. Matisse recognized these opposing forces when he noted that he was a romantic or passionate, but at least halfway a scientist or detached, hence the visual struggle, from which he often "emerged breathless but victorious." He assumed the grandiose task of visual integrator, balancing sensualism with rationalism, hitherto separate goals. Underlying this conscious struggle was the unconscious one in which he was often less than victorious. In his



aesthetic struggles as well as intrapsychic and interpersonal life he exposed his early scars. Considered a fractious individual, he was described as "the anxious, madly anxious Matisse" by his colleague Cross (Gowing, 1979, p. 46), and "the most complete egoist I have ever come across (who) ends by choking almost everyone else ofP' by Jane Bussy (Bussy, 1986, p. 81), daughter of an old friend. Even his son-in-law, Georges Duthuit, described him as "prey to obsessional anxiety" with a total lack of empathy, "an inability to relax," involved in his "killing labor," with an "absolute incapacity, if for a smile or a tear, to sit with his neighbor" and devastatingly as "a monster of selfishness, indifference and inhumanity" (quoted in Gowing, 1979, pp. 33-34). Unlike the creative author whose characters, plot, and mood evolve and may be semiautobiographical, the formalist artist freezes a single silent aesthetic frame. Thus, it is more difficult to read the artist's history behind the woman or the flower. Inner persona is not immediately decipherable in color and line. However, autobiographical content is latent in hundreds of paintings of women by Matisse. These reflect attachment styles from dependent to detached, passing to passionate. Early relationship to his mother was that of passive son who "wanted to please." As a student, his model became his lover and mother of his beloved daughter. She was replaced by his wife, young students, and a long series of models. "My models, human figures are never just 'dummies' in an interior. They are the principal theme in my work. I depend entirely on my model whom I observe at liberty ... and then I become a slave of that pose" (Escholier, 1960, p. 124). Sexual and creative stimulants, the models roused him from ennui. Required as muses, studio assistants, caretakers, and secretaries, they were rarely treated as equals. Intimacy and permanent connection, as well as passion for women, ultimately threatened his intactness, as he feared dependence, emotional "slavery," and boundary loss in the desire that had engaged him. Liaisons became but a way station to the transformative engagement in art. The process of work itself was often fraught with anxiety as rapture alternated with anguish, spontaneity with reworking, intuition with intellectualizing. The road to artistic paradise was both anxiety producing and anxiety relieving. In incubation, and again in deliberative organizing periods, there might be intense disequilibrium as Matisse destroyed previous concepts and formulated new ones. Fluctuation between integration and disintegration was courted, paradoxically, in the art process itself. Creative work was fraught with anxiety alleviated only by the final resolutions. The lifelong search for cohesion, the constant reactivation of narcissism through viewing of his art, may be fruitfully understood through application of aspects of self and object relations as formulated by Klein, Kohut, Kernberg,


Henri Matisse: Love as A rt

Fairbairn, and others of the English and American schools as well as Freudian insights. In love and in art, when old attachment and/or stylistic patterns did not satisfy the artist, causing him a spectrum of feelings from boredom to unbearable tension, Matisse abandoned that style as well as that individual, to find a new stimulus and new style. Stylistically, interest in a new model was often heralded by a sexually descriptive likeness to be replaced by one increasingly simplified as he disengaged or transferred his energies and satisfactions from the model to the canvas. Gradual separation and termination of an emotional alliance was vividly depicted by those paintings in which the model became abstracted, the face empty, the female in coat and hat ready to depart. When Matisse notes that he cannot distinguish between his feelings for life and the way he interprets it, it begs for further understanding of the concordance between the formative experience of those feelings, their interpersonal expressions, and his creative actions. Matisse's dialogue with art was self affirmative. Investment of art with the integrative cohesion desired in the self and object relations suggest the intensity of the need and its reparative function as perfected and cathected selfobject. In the early idealizing period of love, women and his intense feelings about them provided a transitional selfobject as they were viewed to be part of the self. They were not acknowledged as separate but used to sustain the self, before he replaced them with an even more reliable and gratifying selfobject, their painted image. The idealized aesthetic conversion was a necessary replacement for reality. In Analysis of the Self, Kohut writes that some of the most intense narcissistic experiences relate to objects used in the service of the self. In his work with narcissistic patients he noted they remained "fixated on archaic grandiose self configurations and/ or on archaic over-estimated narcissistically cathected objects" ( 1984, p. 3). Matisse alternated among the use of people, things, and his art as extensions of the self. As Klein and Kernberg note in individuals with earliest deprivations, the defense mechanismsof idealization and devaluation were split. Matisse was not able to retain idealization toward his model but, rather, devalued the contributions of the other almost in proportion to the idealization of his own objects.

Childhood and Chronology Matisses's attachment styles and defenses, his need to experience coherence and reversal of loss primarily through creative formulations of pattern, color, and tactility, lay in earliest childhood encounters and ordeals. What were these early circumstances that produced "the madly anxious Matisse"? How did this history determine his later incapacity for empathy? Why was



the clouded mirroring of self-sacrificing women replaced by the clearer mirroring of the art that they engendered? What function did these obsessive reworkings of tenuous lines and colored pigment serve? Henri-Emile Benoit Matisse was born on New Year's Eve, 1869, in the town of Le Cateau in Picardy, northwest of Paris, to Emile and Anna (nee Gerard) Matisse. Threats of the imminent Franco-Prussian War may have prompted Henri's parents to leave Paris and return to the home of the maternal grandparents for the birth of their first frail child. A second son, Emile-Auguste, was born in July 1872, but died before he was two, in April 1874. Two months after his death, in June 1874, while still engaged in mourning for her dead son, Anna bore her last baby and third son. He was given the reversal of the dead infant's name, Auguste-Emile. Althou~h the names of all three sons were customary variants of the father's, EmileHippolyte-Henri Matisse, as well as that of the paternal grandfather, this reversal of the name of the dead child for the succeeding one may have caused uncomfortable reverberations within the delicate Henri. The birth of his second brother and rival, this baby's subsequent death, perhaps unconsciously desired by the elder brother, and seemingly quick replacement, surely caused anxiety for the infant Henri. He was faced with survivor guilt, distrust about the invulnerability of his own body, as well as apprehension about potential substitution in the affections of his parents should another child be born. The mother's preoccupation with illness, birth, and death of one of her three babies in five years, must have resulted in a prolonged period of emotions, joy, sorrow, and fatigue with alternate withdrawal and overcompensatory protective behavior towards her two remaining children. There was impoverishment in the development of the idealized parent imago. Kohut identifies the potentially dysfunctional bipolar self, in which a person's skills, abilities, and ideals are left incompletely mobilized because of the mother's deficits. Cohesiveness of the bipolar self depends upon the integration of these two underlying archaic structures-the grandiose self and the idealized parent imago. Needs of this biologically and psychologically sensitive child were insufficiently met. The mother-child unit was deficient, exacerbated by the birth of two siblings and the death of one. The archaic grandiose self was untamed by empathetic mirroring, the idealized parent imago left in an imperfect state. He was reabsorbed into the maternal matrix, developmentally truncated, dependent upon a succession of others as catalyst for action. His alternately withdrawing and intrusive mother was the earliest female stimulator, inadequate reflector, cause of his archaic problems. This situation was exacerbated by Anna's involvement in the establishment of the fledgling family business. Henri's father had been a cloth broker and his mother a milliner before they returned to Le Cateau where they


Henri Matisse: Love as Art

opened their general store. Hours were long, particularly for the father, whom his son experienced as remote, severe, and judgmental. The incorporation of this punitive relationship may be noted later in the exacerbation of Henri's severity, self-criticism, and search for artistic perfection. His artistic and "beloved" mother was the more defensively idealized parent. From her, he said, he inherited his love of art and sensitivity to fashion and decoration. At 13 Henri continued school in the nearby town of Saint-Quentin, the center of the textile trade. The icole where he had his first drawing lessons trained fabric designers and may have honed his profound appreciation for style and pattern. Upon matriculation, his family initially considered a job for him in a pharmacist's shop, where he could rest when ill, but instead he procured a stint as clerk in a solicitor's office. His father encouraged him in this status position and, in 1887, Matisse traveled to Paris to further his study of law. After passing the examinations with honors he returned to Bohain where he spent the next years copying transcripts of cases. In spite of his analytical mind, he chafed as a novice assigned to these repetitive tasks which continued his subservience. Photograph ofMatisse with Mother, taken in 1889 {Fig. 3), offers subtle clues about their relationship. Since the father and younger brother are absent, it suggests the importance of this dyadic relationship. While his mother stands, her son assumes the privileged, but less dominant, seated position. Clearly, there is a relational or tie-sign in proximity and position, but mixed emotional signals. Robust Anna stands to Henri's left, body towards son, face towards spectator, hands resting loosely at her side, the left hand holding an umbrella. By her standing position aQd even by the symbolic umbrella, she establishes herself as protector. Henri's seated position, however, implies ambivalence more than relaxation, for although his body faces his mother, his face remains avoidantly averted. While the left arm lies in his lap, the right languidly holds a book, indicator of directed scholarship. The overprotective and admiring mother may view her son as an extension of herself, loved, obedient, and dependent. This eldest son was her new status symbolthe photograph a quiet triumph display. Revealingly, he said of himself when younger, "I was very submissive, I wanted to do what others wanted me to do" {Flam, 1986, p. 26). Dependency on his unreliable mother resulted in a dread of exhibiting himself as independent, without self-consciousness and shame. This had its psychosomatic costs. A few months after this photograph, Matisse was diagnosed as having chronic appendicitis, inoperable at that time. As a forlorn, "weak and passive" child he may have internalized his aggression, resulting in chronic gastrointestinal problems. The diagnosis of inoperable appendicitis (typhilitis perityphilitis) is a suspect diagnosis; left untreated, it usually results in burst appendix and death. "It may have been instead ileitis or ulcerative colitis,

Figure 3. Photograph ofMatisse with Mother. 1889. Russell {1969), p. 9.


Henri Matisse: Love as Art

which can be aggravated by psychological stress" (Flam, 1986, p. 484). This disease is traditionally accompanied by loss of blood, diarrhea, fatigue, and depression. Illness may have been mobilized by pathological conflicts and a wish for protective fusion with his idealized mother. Henri had become a partner in his mother's fostering of his dependency. Submission, and the deadness that resulted from this dependent relationship, suffocated his real self until his twentieth year. Convalescence for a year encouraged extended subservience and resulted in the unconsciously desired termination of a law career. The usual sense of invulnerability of young men was replaced with acute vulnerability having far-reaching effects on his future need for constant vitalizing activity and control. Henri waited for the arrival of the magic rescuer. It appeared in disguised form while he was recuperating, depressed, and inactive. A neighbor who painted "chromos," or copy of a reproduction of a painting, suggested that mother give him a similar gift. Choosing a scene of a water mill and entrance to a farm, he signed it with the reverse of his name, or Essitam, both claiming the work and punning on the reflective function of painting. This modest present introduced him to the pleasure of total immersion or fusion with an object, and the potential magic of creating his own image and idea. It changed the course of his life and that of modem art. Continued idealization of his mother, described by his wife as "adoration," a reversal of aggressive feelings, inhibited his coming to grips with ambivalence. The need and capacity for idealization, however, was eventually amplified and transferred to art. He recalls vividly the transformative experience of this first moment of painting in Notes of a Painter (1908): Before, I had no taste for anything ... I was filled with indifference to everything that people wanted me to do. But the moment I had this box of colors in my hands, I had the feeling that life was there. Like an animal that rushes to what he loves, I plunged straight into it, to the understandable despair of my father, who had made me study other things. It was a great allurement, a kind of paradise, in which I was completely free, alone, tranquil, whereas I had always been anxious and bored by the various things I had been made to do .... Before, nothing interested me; after that I had nothing on my mind but painting [Flam, 1986, pp. 27-28). This required the preliminary step of stimulating and admiring women who would activate the sense of grandiosity truncated in childhood. Their presence provided the ambience that allowed him to be like a young child relishing his new-found autonomy. The rest of his life was, indeed, spent with virtually nothing else on his mind but art. Others were triggering devices, used as motifs. The creative process was essential in achieving both peace and a feeling of vitality even though, paradoxically, it was frequently



accompanied by periods of anxiety. He said, approaching age 80, "I couldn't work and I felt old," and later, while working on the Vence Chapel he wrote: "When you are 82 years of age you'll think as I do. It is terrible to grow old. I hope that however old we might become we will die young. Young: that is to say, working" (Schneider, 1984, p. 740). Even if accompanied by destabilizing tension the finished work reliably and brilliantly mirrored the integrative powers of the artist. Surrounded in the studio and in his apartments by this protective armor he fought depression, age and death. The dogged pursuit of this new avocation began in 1892 at age 23. Intercession of his mother overcame a disapproving father who grudgingly provided him with a meager allowance to study in Paris. Unable to qualify for the strict requirements of the official school, he enrolled in the studio of an academic painter of salacious nudes, Adolphe Bouguereau. In a photograph of Matisse with three fellow students, he appeared unhappy and isolated. Three other colleagues stand and lean together with arms around one another's shoulders while Matisse sits sullenly grasping the edge of his painter's stool. Discontent required a change and he transferred into the more congenial atelier of Gustave Moreau, an eclectic Symbolist. Moreau encouraged his students to explore their fantasy life, as he himself did, as well as to copy the old masters in the Louvre. Thus Matisse was provided with a rich array of choices. Within the first year in Paris, perhaps following the time-honored student style of Cezanne, Seurat, Renoir, Monet before him, he formed a sexual liaison with his model, Caroline Joblaud. She bore him a daughter, Marguerite-Emilienne, in September 1894. At 25 years of age, with a woman and their child to partially support with odd jobs, he applied yet again to the Ecole des Beaux-Arts, where he was finally accepted, Often ill, desperately poor, and frequently unhappy about his life, he was sustained primarily by creative activity. As his graduation presentation for the annual Salon de la Nationale he submitted La Desserte, 1897 (Fig. 4), for which his model was his young lover, Caroline. He chose to exhibit this relatively conservative Impressionist painting, rather than bolder works, which he may have felt a rebellion against his father's values, as if to persuade his father that he was worthy of having his allowance continued, "at least he was not an anarchist or a revolutionary" (Flam, 1986, p. 486). Nevertheless it created a furor. In the corner of a dining room, the slim maid arranges the centerpiece of white flowers on a table tilted in typical Impressionist style. Isolated among the glint of cut glass and damask, she functions as surrogate for the artist as aesthetic arranger. She is not, however, the mistress of abundance, but disenfranchised, in service to others, as he desires her to be for him. Indeed, she must continue her work as model to aid in their support. Understandably, the exploitative--relationship did not prosper under these


Henri Matisse: Love as A rt

Figure 4. La Desserte. 1987. Oil on canvas. 39 1/2" x 51 1/2" Pl. 13, p. 97. conditions, and they separated. Near the end, in February 1897, he adopted their daughter, Marguerite, who remained his favorite child. There is no further mention of Marguerite's biological mother. By late 1897, after the liaison with Caroline had ended, he met, and perhaps to replace the loss, married within months, a 26-year-old darkhaired woman, Amelie-Noemie-Alexandrine Parayre, of Toulouse. Years later, incensed at the malicious description of her by Gertrude Stein quoted in the Autobiography ofAlice B. Tok/as as "a big woman with a long face and a big, obstinate hanging mouth," Matisse countered: "Madame Matisse was a very lovely Toulousaine, erect, with a good carriage and the possessor of beautiful dark hair that grew charmingly, especially at the nape of her neck. She had a pretty throat, and very handsome shoulders, She gave the impression despite the fact she was timid and reserved, of a person of great kindness, force, and gentleness" {quoted in Escholier, 1960, p. 8). Matisse's description concentrates mainly on those attributes which engaged him in painting. In protecting this image of her he also rationalizes his choice. But a solo wedding photograph of Matisse is remarkable for the complete absence of the bride. Eyes averted, he stands erect with top hat held stiffly at his side marking his new status, as though by costume he legitimized his new role. What the bride wore is unknown. That she was



supportive was immediately apparent. For she adopted and became a loving mother to his 4-year-old natural daughter, Marguerite. Within a year of marriage their first son, Jean Gerard, was born at Amelie's home in Toulouse. Ten months later, they returned to Paris where she opened a millinery shop, as had his mother. Amelie's submissiveness was evidenced by the sale, in 1899, of her sapphire engagement ring so that her husband might purchase, among other prescient works, Cezanne's Trois Bagneuses from the art dealer Vollard. Although a fortuitous investment, it was for Henri's exclusive use and benefit. He kept this Cezanne painting by his side for 38 years. One of his greatest early influences it remained a source of pleasure longer than his marriage. Admired artistic fathers were identified throughout his life as substitutes for his own disapproving one. They provided an alternate idealized parent, the artist's version of the family romance. By 1900, Matisse was working at art full time-Mme Matisse was compelled to support them, although again pregnant. Their two sons were born in quick succession, Jean in January 1899, and Pierre in June 1900. There were no further children, partially repeating the family pattern of Henri, where two survived. By winter 1902, poverty and the ill health of Henri and his wife obliged him to separate his family. He returned to his parent's home with older son Jean, while Amelie and 2-year-old Pierre lived with her sister. Matisse continued this pattern of periodic separation during the remainder of his marriage. While in Bohain, he argued with his depreciating father and returned precipitously to Paris, cut off from the small allowance. Deepening their economic straits, his wife's anemia forced her to close her shop. Filled with despair, Matisse almost stopped painting, but wrote to his friend Simon Bussy that the joy of painting had already made it possible to put up with a life that held great bitterness for him. In 1904, Matisse began his ascent with a one-person exhibit at the gallery of Ambroise Vollard. Gertrude Stein purchased his art with that of Picasso, and invited him to her intellectual soirees. That year, Matisse exhibited the neo-pointillist Luxe, Calme et Volupti at the Salon des Independants. Based upon the painting By the Sea, painted in summer 1904 at St. Tropez, of fully dressed Mme and their son, it was now combined with idyllic fantasies suggested in part, by Mallarme's poem of luxury and joy. Incongruously, Matisse joined Mme with five imaginary nudes who, having risen from the sea, dry their hair or lounge at the edge of the water. The son was tranformed into an androgynous nude with outstretched arms behind Mme. His figure recalls the crucifixion and combines elliptical echoes of Christianity with idyllic Arcadia. Capacity to imaginatively transform empirical information is a crucial feature of creative reality. Some Kleinians posit that reality does not consist solely of the rational secondary process of apprehending the world through logic and knowledge, in opposition to the more diffuse


Henri Matisse: Love as Art

primary process of intuition and fantasy. Rather, there is a dialogue between the external and internal in the development of reality. I speculate further that accessing, valuing, and integrating the fantasy thinking of childhood distinguishes the creative artist. Externalization allows fantasy to enrich reality, rather than be abandoned as irrational and infantile. For Matisse, fantasies existed as solutions or semiconscious compensations for partially submerged frustrated desires and replacements for the real world. These replacements established a new order of reality both for artist and spectator. The vibrant merger of the real and imagined was amplified during the summer of 1901 when, in the coastal town of Collioure he was joined by the younger, energetic painters, Andre Derain and Maurice Vlaminck. Stimulated by one another in the brilliant southern light they produced a fullspectrum maelstrom on the picture plane pejoratively called Fauvism, referring to them as wild beasts. (The origin of this term meant just the opposite and may be traced to a special review of the Salon d' Automne of 1905 at which Matisse's painting was exhibited.) The critic Vauxcelles wrote: "He has courage, because his entry will have the fate of a Christian virgin delivered to the wild beasts at the circus. M. Matisse is one of the most robustly gifted of today's painters. Vauxcelles does not use the word fauve to describe Matisse; rather he sees Matisse as a potential victim of the fauves; the Philistines and academics" (Flam, 1986, p. 143). Matisse continued to pursue these arbitrarily colored bacchanalian scenes in Lajoie de Vivre (or Le Bonheur de Vivre), 1906 (Fig. 5). This has, until the traveling exhibition of the Barnes Collection in 1993, remained much less known than its equivalent in iconographic complexity, Picasso's Les Demoiselles d'Avignon, 1907. Formally, Matisse's insistence that space and figure, negative and positive, were interactive and equally expressive may be considered parallel to the notion of the coexistence of inner and outer reality. Two years later, in specifying his theoretical basis in Notes of a Painter, 1908, he writes: What I am after, above all is expression .... Expression, for me, does not reside in passions glowing in a human face or manifested by violent movement. The entire arrangement of my pictures is expressive: the place occupied by the figures, the empty spaces around them, the proportions, everything has its share. Composition is the art of arranging in a decorative manner the diverse elements at a painter's command to express his feelings. In a picture every part will be visible and will play its appointed role .... A work of art must be harmonious in its entirety [Flam, 1978, p. 36]. This avowed goal acknowledges only the formal and manifest content in this monumental fantasy of Paradise. Naked figures outlined in various ribbons of color unselfconsciously exhibit themselves, as they recline, stretch, make music and love on the yellow grass within a glade of pink and orange trees.



Figure 5. La Joie de Vivre {Le Bonheur de Vivre). Paris, autumn-winter 1905-1906. Oil on canvas. 68 1/2" x 7' 9 3/4". Barnes Foundation, Merion, Pennsylvania. Elderfield (1993) PL 73, p. 153. Similar poses will be used in his work for the rest of his life. As he continues to orchestrate and redirect them, he becomes, rather than they, the major protagonist. Two languorous females dominate center plane, one frontal, the other reminscent of the odalisques of Ingres. Pan, pastoral musical god of fertility, surrogate for musician Matisse, fills this vibrant place with melodic sounds from his reed. In the tentative position of lower left, two larger lovers ambiguously embrace. Arm pressed in protective auto contact against his crouched body, the male appears disturbingly fetal. Passively, he allows himself to be embraced by the aggressive woman with sexually spread legs-as though Matisse ambivalently desires the bliss of genital contact. As in the Norwegian Symbolist Edvard Munch's prints of The Kiss in the 1890s, male and female heads become fused. Or might these legs denote something in addition to sexual availability? Perhaps, it was concrete evidence of a visually realized, but verbally repressed, fear or wish to be swallowed and united with the loved mother. Does he ambivalently long both for genital embrace and the maternal womb? In Music of 1907 (Fig. 6), he continues to express his ambivalent feelings. Four monumental figures, two ambiguously male and two female, engage in

Figure 6. Music. Spring-summer 1907. Oil on canvas. 29" x 24". Elderfield (1993), Pl. 100, p. 174.



music, dance, and contemplation within a simple green ambient. The monumental frontal male at left plays a small violin, again reflecting Matisse's musical passion and the alternate way he thought he might earn his living should his poor eyesight fail him. At bottom right, a second male, seated on the ground, in autocontact, as in the lower male in Le Bonheur de Vivre, may be listening or self-absorbed. Head down, he averts his eyes from the emptied genital area of the violinist. From the absence of male organs, it is possible the castrated violinist is a metaphor for secrecy of Matisse's extramarital sexual activities, or the illicit use of his private instrument. Thus, he disavows or denies his sexual promiscuity. Analytically, the violinist with missing genitalia may express the artist's conflicted feeling towards his own and his parents' sexuality, for in denying the paternal phallus he denies the procreative function and responsibilities of his father and also of himself. In denying the parents' sexuality he is allowed to be his mother's loved male, or the victor in the oedipal competition. He also recreates that truncated early period when needs were incompletely met. In opposing two wildly dancing females with the more passive discipline of males he both disclaims his own sexual promiscuity and illustrates theories of misogynist psychologists and writers of the late nineteenth century. Females were viewed as seductively active, animalistic, immoral, and realistic, finding morality and ego through partial appropriation of the male's ego strength, thereby weakening him. Men were postulated to be passive, ensnared by women for the procreation of the race, inherently cerebral and idealistic. An additional interpretation for the unclear gender of male figures and the desire for fusion of the two might lie in his less rigid recognition of gender boundaries or unclear sexual identity. If there was a specific stimulus for Matisse's erotic fantasies in 1905 she appears unknown. But around 1908, two students in the international art school he had opened in January at the suggestion of Gertrude Stein provided a renewed sense of vitality-the German Greta Moll, and Olga Merson, a Russian. Olga remained an intimate at least until 1911 when she was photographed with the family at Collioure. The relationships, strongly suspected by Mme Matisse, understandably caused her anguish. In his ingenious rationale for constant stimulation and renewal through viewing, painting, cohabiting with his models he admits the original impetus but converts the sexual proclaiming aesthetic or "religious" feelings: "What interests me most is the figure. It is by the figure that I can best express the almost religious feeling I have for life. Women are the burning center of my energy. I have to paint the body of a woman; first I give it grace, charm and then I must give it something more. I must condense the meaning of the body in finding its essential lines" (quoted in Escholier, 1960, pp. 81-82).


Henri Matisse: Love as Art

Many fantasies, thinly veiled autobiographical erotic themes, completed between 1906 and 1909, are in opposition to desexualized images of his clothed wife and daughter. Mme posed many times in costume, and Marguerite continued to be incorporated in paintings even with his model/ mistresses. His two sons were less frequently painted. Portrait ofPierre, 1909; the Family of the Painter, 1911; and The Music Lesson, 1917, are notable exceptions. Henri remained relatively distant from his sons, as his father may have been with him. As an adult, in an effort to incorporate Henri, Pierre became an eminent art dealer in New York specializing in his father's art. An invaluable source of information about him, he was valued as an extension of a father who seemed in life to have discouraged his intimacy. The large painting Conversation, 1911 (Fig. 7), is ambivalent and may be interpreted in at least two ways. In the highly charged colors and flatness it is influenced by Russian and Islamic works. Pierre Schneider describes it as a kind of "sacred" painting, that is, an equivalent to the religious art of the past in its intensity, but now that intensity is about painting itself. The painting records a diversion so tremendous one is inclined to call it a mutation. This is simply "the alien force" intruding in a picture that was

Figure 7. Conversation. Winter 1908-early summer 1912. Oil on canvas, 69 5/8" x 85 3/8". Hermitage Museum, St. Petersburg (formerly Sergei Schukin Collection). Elderfield (1993), Pl. 152, p. 225.



intended to be the modern equivalent of Van Eyck's double portrait. The intrusion transforms the painting into a kind of annunciation and eventually into a kind of epiphany. An epiphany of what? Painting of course: It is an image of the art of painting which talks as do sacred images in religious civilization. The Conversation records the "REVELATION" of the blazing window striking the man in striped pajamas like a bolt out of the blue [Schneider, 1984, p. 24]. I suggest thematically it might be termed a monologue or confrontation rather than conversation. Henri and Amelie face one another in an intense ultramarine blue room at Issy-les-Moulineaux. Between them the large square window reveals green garden, red tulips, and edge of his studio. Although dressed in nightclothes, they are symbolically in the neutral space of the first-floor living room rather than the private space of the secondfloor bedroom. Control of the visual and emotional space is unclear. By rigidly filling the vertical format, he might have claimed it. However, Amelie's size and queenly pose in the large armchair suggest either her passive acceptance of his self-centered talk or an impediment to his mobility. Thus, they were in a one-sided or confrontational rather than conversational balance. Although Amelie's seated position might record her intermittent back ailment it is used here as an emotional device. The title suggests a unit, but the lack of affectionate body contact suggests a creative or emotional impasse. There are no tie-signs; rather a bubble of space surrounds each, creating a territorial division. Henri's problem or stuck position is emphasized by the vertical white stripes on his blue pajamas and rigidly held arm. Either creative or /and marital tribulations are concisely visualized. Intrusive square of the window, a visual metaphor for the obsessively absorbing artist's world, suggests one source of conflict. As fame increases, so does his need to fuel it with world-wide exhibitions, travel, and writings-timeconsuming activities not usually shared with "timid" Amelie, who however, is dragged by her husband during this time "on exhausting walks meant to soothe his anguished thought ... they would take the train to Paris and stay overnight ... the artist's anxieties would return in force and he would be unable to sleep" (Schneider, p. 23). However, the creative tensions may have been exacerbated by another deterrent to connubial intimacy. This may be implied in the filigree railing tracing the word NON, rather than OUI, a denial response to Amelie's probing of the affair with Olga. Amelie had known from the adoption of Marguerite that Henri did not subscribe to normal requirements of family life, including commitment of time, energy, devotion, sharing of responsibility, and monogamous sexual interaction. Matisse's strength as artist, but deficiency as husband, lay in valuing work in preference to people. He ingeniously used the canvas to convert domestic strife into harmonic color compositions. Looking back years later on this work, he


Henri Matisse: Love as Art

noted that it contains that strength which he perceived as being alien to his life as a normal man. Tensions caused by affairs, emotional swings, psychological distancing, and primacy of his works were commented upon by George Duthuit, distinguished art historian, married to Marguerite: "One cannot discount the possibility that there were two personalities in Matisse at odds with one another, often locked in fierce combat: the landowner would snap his heels at the profligate, the professional and calculating mind would badger and quibble with the visionary: the prosaic painter would try and stifle the poetic artist" (Barr, 1951, p. 91). In January 1912, after closing his art school in Paris, Matisse and Amelie traveled to Morocco, source of inspiration for the nineteenth-century painters he admired, Ingres and Delacroix. Their young teen-age boys were left behind, perhaps in the care of 20-year-old Marguerite. Within a 4-month period Henri completed 60 drawings and a number of large paintings. One was of a young prostitute, Zorah, painted on the terrace of the brothel. Matisse was accompanied by Camoin, with the warning that they were must "enter like doctors" so they would not be confused with clients (Cowart and Foucade, 1986, p. 84). Seen clothed and kneeling as if in prayer, Zorah's flatness and cursory treatment belies the nature and actuality of her life, and suggests his inability to be stimulated by the impersonality of the bordello. He returned to Tangier alone 6 months after the first trip, from early October until late November. His wife and Camoin joined him after a flurry of letters and his friend's report that Amelie was unhappy to be left alone. The month-and-a-half separation was experienced, once again, as an indication of her secondary importance. Ambivalent feelings, reflected in a photograph taken after mid November 1912, Henri and Amelie in Tangier (Fig. 8), were undetected or denied by Camoin, who, 40 years later, sentimentally recalls, "His marriage was a happy one for him-Madame Amelie Matisse exceptionally devoted, working to let him free to paint! Charming, courageous and full of faith in her husband's talent" (Camoin quoted in Escholier, 1960, p. 91). However, this photograph of a sober husband leaning away from his recently arrived wife, who uses her walking stick as separator, suggests a negative signal. He feared, in sharing feelings and time, a loss of his autonomy or/and he was not capable of, or programmed for, reciprocity. There would be a consequent diminution of self, and reminder of painful early betrayals. Creation of vibrant paintings was not an infallible solution to periodic depression. However, when engaged in activity, depression was assuaged sufficiently to allow him to rekindle his energies. The resultant joyful and harmonious paintings were alter-egos, moods not exhibited in his overt behavior but the needed respite, or longed-for option. Years later, when



Figure 8. Henri and Amelie in Tangier. Winter 1912. Photograph by Camoin. Cowart et al. (1990). Catalogue, National Gallery of Art, Washington, DC, Fig. 136, p. 260. Picasso, who had purchased Matisse's Basket of Oranges, of the same Moroccan period, commented on the joy he felt expressed in it, Matisse revealed that he had been suffering from suicidal depression. Absorption necessary in working, squeezing bright colors from tubes of paint, arranging them on the palette, choosing brushes, moving the viscous oil paint over the surface of the canvas, modeling clay, peering at the animate and inanimate motifs, making decisions about translating three dimensions into two, or into a different medium, aided in mitigating recurrent feelings of emptiness and helplessness. Assiduity and innovation, rewarded by increasing public acclaim, the collective other, also reduced melancholia. "Harmony of feeling," his lifelong goal, was achieved primarily through continuous aesthetic problem solving rather than in intimate relationships. Emotional distance from Amelie was exposed poignantly in Portrait of Mme Matisse, 1913 (Fig. 9), completed upon return from Morocco. Mme is both seated but ready to depart in coat, stylish chapeau, and scarf. An

Figure 9. Portrait of Mme Matisse. Summer-autumn 1913. Oil on canvas. 57" x 38 1/8". Hermitage Museum, St. Petersburg (formerly Sergei Schukin Collection). Elderfield (1993), Pl. 168, p. 24.



anticipatory frontal position is reversed by her expression and dark empty eyes. On hearing the painting described by critic Walter Pach as brought off rather easily, Matisse replied that it had taken over one hundred sittings. This labored work required time both for the formal challenge and the need to introject and then externalize a totem of his wife which silenced and replaced her. Henri's disinterest is expressed in his abstraction. She burst into tears upon seeing the finished image immediately recognizing the emotional distance implied by it. Further degree of his disengagement may be surmised by its immediate sale to his great Russian patron, Shchukin. Matisse kept his favorite paintings for years. That same year, he was one of the famous and controversial artists invited to exhibit in America in the Armory Show of 1913, where he was both praised and vilified. His works were collected by Russian, American, and German collectors, and purchased by museums. Yet, he continued to court the acknowledgment of the critics by providing extended interpretations. Intellectualization and rationality were used in the service of "sensation" and "expression." In late summer 1914, after the mobilization for war with Germany, at age 44 with severe myopia, he tried to enlist but was rejected. Henri and Mme remained primarily in Paris during the war. By 1916 Matisse was one of France's most prominent artists. Although emotionally estranged from his family, he may have remained tenuously and legally married because of ambivalence, uncertainties of war, continued regard for the reputation of his wife and children, and minimal religious beliefs. It also satisfied his desire for minimal intimacy, his tendency to commit without passion yet tendency to hold on tenaciously, as well as the convenient alibi which the fiction of marriage provided from other entanglements. A photograph of the entire family at this period, taken in his studio so he need not lose a precious working moment, records the emotional toll on them as Amelie leans away from him and the sons' somber faces reflect the uneasy truce. Amelie is indeed the self-effacing and resigned wife described as "admirable" and "generously self-sacrificing," and at the same time "effectively practical." During the four decades of their marriage Camoin noted that "she gave herself to Matisse with the same consuming devotion that he gave himself to his art" (Camoin quoted in Escholier, 1960, p. 91). However, the discomfort for Henri was still untenable, and he moved to another studio away from this producer of guilt, source of tension, and inhibitor of sexual freedom. In this second studio on the left bank in Paris overlooking Notre Dame, the Italian model Laurette posed for him between 1916 and mid 1918 for about 50 paintings. In The Studio, Q,uai Saint-Michel, 1916 (Fig. 10), the presence of the bed on which she lies, a makeshift chair-easel and drawing


Henri Matisse: Love as Art

Figure 10. The Studio, Q,uai Saint-Michel. 1916. Oil on canvas. 57 1/2" x 45 1/4". Phillips Collection. Elderfield (1993), Pl. 206, p. 277. board, marks this as alternate sleeping space cum studio. Territorially private, it was isolated from the domestic space at Issy. Acquiescence of the nude bohemian model is indicated by the artist's empty chair and the implication that Henri vacated it to be with the model. In the narrative sequel, The Painter and His Model, 1916-17 (Fig. 11 ), the usual position of nude model and clothed artist was reversed, as the nude male scrutinized the draped female with whom a sexual relationship had been forged and recorded. As he included himself larger in foreground and repeated the model on bed and canvas, he reduced her to mere motif. Yet, included or fused with his canvas he suggested his lack of boundaries with it, if not with her. Reversal of the usual positions also implied that the active-male, passivefemale roles he assigned them corresponded to actuality. He wrote, "I have searched for myself everywhere, at these moments there is a doubling of

Figure 11. The Painter and His Model. 1916-1917. Oil on canvas. 57 1/8" x 38 1/4". Musee National d'Art Modeme, Paris. Elderfield (1993), Pl. 204, p. 275.


Henri Matisse: Love as Art

myself. I don't know what I am doing, I become one with the painting like an animal with what it likes" (quoted in Borel, 1990, p.4). This identification has its origin in the desire to recreate and replace the ecstasy of fusion with the mother and notes the difficulty of separation. There is a displacement of physical fusion in aesthetic merger. The model, a transient selfobject, serves as catalyst for more reliable highly colored two-dimensional paintings. The term "model" itself suggests the dehumanization of the other. Soon after this series he dismissed her and left Paris alone. He traveled south slowly, arriving in Nice in December 1917, seeking both warming sun and refuge from the continuing First World War. Initially, it poured for weeks and he remained ready to depart. Fortuitously, the skies cleared. Enchanted with the luminous quality of light he lived in elegant hotel suites on the French Riviera for most of the next 35 years. In Self Portrait, 1918 (Fig. 12), he uses the valise both as makeshift support and reminder of his mobility and autonomy in the face of nature's downpour. A majestic quasireligious quality is suggested as he fills the entire space with his commanding presence. Rather than conferring a blessing, however, his left hand holds the magic paint brush, and his strong right thumb penetrates the easel, asserting his phallic presence. Henri's withdrawal, if not failure in marriage, may have been reversed by the aggressive stance of this painting-an idealization of the 48-year-old artist in the professional and sexual prime of life. Matisse's entitlement to pleasure was confirmed by meetings in Nice with the aged Renoir who, with brushes strapped to his arthritic hands, clung to the pleasure of observing and recording the voluptuous female. In early winter 1919 Matisse hired 18-year-old Antoinette, younger than his daughter. She was painted many times in an impromptu chapeau fashioned by the milliner's son, Henri. Having received the "parental" approval of Renoir, he progressed through a number of works to convert her into an acceptable companion. He drew and painted her descriptively as an apparent innocent wearing a demure dress and a large feathered hat covering her loose flowing hair as in Woman in White, 1919 (Fig. 13), and then in The White Plume, 1919 (Fig. 14), she was transmuted from round-faced child to sophisticated femme fatale with high rouged cheekbones, and decollete dress pulled seductively from her shoulders. By artistic alchemy she became an acceptable lover displacing his incestuous desire. In another from the narrative series, The Painter and his Model, 1919, he sits at his easel in pajamas painting the nude Antoinette, recording again his privileged artist-model relationship. But by facing her away from him towards the window light, they avoid eye contact and emotionally intimate connection. Unable to continue the disproportionate relationship with this Jeune fille, he dismissed her in less than 2 years.

Figure 12. SelfPortrait. Nice, 1918. Oil on canvas, 25 1/2" x 21 1/4". Musee Matisse, Le Cateau-Cambresis. Elderfield (1993), Pl. 218, p. 298.


Henri Matisse: Love as Art

Figure 13. Woman in White. 1919. Oil on canvas. Stolen in 1973 from the Kunstmuseum, Gothenburg, Germany. Cowart & Fourcade (1986), p. 20.

Lacking the ability to form reciprocal and constant relationships in which there was a range of feelings, he was often somber, anxious, and angry. Turning to visual transformation, his rich fantasy life and desires were able to be realized. Duthuit recalls that his father-in-law worked from morning to night all his life to ensure apparent spontaneity, which was, however, "thoroughly rehearsed, he had an inability to relax, was involved in killing labor, had an absolute incapacity, if even for the space of a tear or a smile to sit down with a neighbor" (Gowing, 1979, p. 34). But an increasingly wide



Figure 14. The White Plume. 1919. Oil on canvas, 28 3/4" x 23 1/4". Minneapolis Institute of Arts. Elderfield (1993), Pl. 236, p. 313.

circle of admirers offered replacements for disrupted maternal love and attention, reversal of paternal disapproval, and an affirmation of his sense of genius. This collective other was a form of selfobject. At the termination of World War I, disengaged from wife and family, Matisse lived most of the year in Nice. After he dismissed Antoinette, he looked for a new model/stimulus. His next midlife liaison, with ballet dancer Henriette Darricarrere, generated an extended series of sensuous paintings from early fall 1920 until she departed to marry in 1927. In his semi-fictional biographical novel about Matisse, based upon an extended friendship several years later, poet Louis Aragon recalls that Matisse told him the discovery of the model was always love at first sight. "I saw her in an antique shop. She had come to sell a few things. So she must have been in


Henri Matisse: Love as Art

need of money. I kept her for five {six-seven) years" {Aragon, 1971, Vol. 1, p. 89). Matisse must have been persuasive and focused to convince this talented 19-year-old dancer and musician to abandon her career. But, in helping him actualize his fantasies she made a calculated exchange of transient applause for immortality. During this period, which he described as "paradise," sybaritic delight and involvement were graphically revealed in Odalisque with Magnolias, 1923 {Fig. 1), one of the many in the series of odalisques of the 1920s. Sensuality exuded from this caressed surface. It was one of the few periods in which there was free externalization of his passionate feelings and romantic idealization over a period of years. Open magnolias in the background become a metaphor for femininity. His rapture was indicated not only through the extended period of voyeurism in which he viewed and painted her seductive and uninhibited poses, but in the tactility of most of these poses. Ritualistic play, a replacement for that denied him as a child, is displaced to the model, for whom he set up the fantasy harem stage. The surface is filled with oriental decorative surface patterns to balance the stimulus of the gorgeous available semi-nude female. In recalling this glorious unburdened time Matisse is revealed in Aragon {1971) as initially capable of overwhelming sensuality: My luxury {is) something more precious than wealth, within everyone's reach-a certain quality of love, it means dressing or undressing the woman one loves in all purity of one's love, without affectation or exaggeration.Yes, I needed to have a respite, to let myself go and relax, to forget all worries far from Paris. The Odalisques were the abundant fruits at once a light hearted nostalgia, of a beautiful, living dream and of something that I had experienced almost ecstatically day and night, under the enchantment of that climate [p. 240]. These adult appropriate sensual and tactile pleasures incorporate elements which originated in the infant's first autistic-contiguous modes of bodily contact with its caretaker. Their original function to organize experience and connect to another is augmented in the mature adult. But now, through verbal acrobatics, Matisse both exaults and then promptly diminishes this pre-rational component as he "dampens" the deluge of sensations. He reasserts as the final goal that of exercising aesthetic judgment. "Look at these Odalisques carefully: the sensuality of heavy slumbering flesh, the blissful torpor of faces awaiting pleasure ... a great tension smolders, a specifically pictorial tension that arises from the interplay and mutual relations of various elements. I dampened these tensions so that an impression of happy calm could emerge from these paintings" {Matisse interviewed by Verdet, 1952, in Flam, 1988, pp. 229-240).



To protect himself from the devastating impact of an idealized other he found it necessary to reaffirm the function of decision making. Shifting to the view of visual and intellectual celibate, he denied consuming erotic sensations, and professed the desensualizing detachment of aesthetic attitude. In fact, it is precisely through this interaction between sensation and contemplation that his work progressed as he converted potentially destabilizing experiences. Yet, the original decisive absorption in sexual contact remains in these works. In the ascending scale of intimacy, those lovingly recorded delineations of rounded body, the views of eye to body, eye to eye, are at the intimate end of the sexual scale. The erotic signals of the exposed body in feline ease were meant to arouse bonding, to find and keep a mate. Henriette's full body sprawls against the supportive structure. She was available to his visual and sexual caresses. As his muse she mobilized his energies, endowed him with power, and rendered him powerless. His profound involvement in this sensual relationship is noted in the degree of palpability of the figures. There still remained, however, a measure of conflict in merger. Although the great number and variety of paintings of Henriette bears out his delight in sexual peering, their title as Odalisques implies an attempt to rescue himself from dominion, even to denigrate her. For the sole function of an odalisque, a nameless oriental harem slave, is the sexual delectation of the male owner, her catering to his every whim. The male fantasy of the female as object allows him to view, as Henry Miller writes of Matisse's odalisques in Tropic of Cancer, "the flesh veiled with a thousand eyes" {1961, p. 18). The fantasy also suggests the reverse, his unconscious fear of woman's potentially debilitating effect and female power. Matisse acknowledged that he experienced sexual pleasure, but extricated himself from the interaction by claiming that "it was all for art," a purification through aestheticism. Did this keep him the innocent darling of his mother? His love affair was with the richness of his own fantasies. Their palpability was, in fact, the basis for later criticism by formalist critics in reviewing his work on the occasion of his 60th birthday. They claimed the palpability indicated a relative diminution of quality and lesser ambition in these works. One of the last paintings of Henriette in spring 1927, Woman with a Veil {Fig. 15), was completed shortly before she left to marry that same year. He prepares for her departure by painting her pensive, withdrawn, dressed in bold plaids that cover the sensual body he knew so well. Matisse attempted to fill the void with a succession of models during the next 2 years-Lisette, Loulou, Zita, Helene, and Lily, often posed as odalisques. Although the paintings lack sensuality some drawings are erotic in character-the model in difficult and revealing sexual poses. Often the models were stretched out at his feet with arms lifted to reveal heavy breasts or legs spread. However,


Henri Matisse: Love as Art

Figure 15. Woman with a Veil Winter-spring 1927. Oil on canvas. 24" x 19 5/8". Museum of Modern Art, New York. William S. Paley Collection. Elderfield (1993), Pl. 276, p. 345. one of the largest works completed in 1929 suggests his feelings of flatness and emptiness at the assumed lessening of passionate entanglements. This may have been exacerbated by Mme Matisse's move from Paris to live with him in Nice in spring 1928. Trenchantly, in Woman with a Madras Hat, 192930 (Fig. 16), he is able to grapple with the pattern of the background and vigorous hat but leaves the woman's face and body tellingly blank, a white

Figure 16. Woman with a Madras Hat. Nice, 1929-1930. Oil on canvas. 70 7/8" x 59 7/8". Private collection. Elderfield (1993), PL 289, p. 355.


Henri Matisse: Love as Art

shadow. Emptied of solidity or specificity it is a reflection of his feelings of being discarded by Henriette, his beautiful young companion of 6 years. The large scale of the work appears as a reprimand, reminding the artist of his age, his vulnerability to loss, his abandonment to the negative rather than to the positive areas of life. After a decade of separation, the rapprochement with the resilient Amelie in Nice may have been based on the assumption that, at age 62, his sexual meanderings could be held in check. A semi-invalid, with an apparently incurable disease of the spine, Amelie occupied separate sleeping quarters. In a candid photograph, Mme Matisse and Husband at Table, Nice, 1929 (Fig. 17), they appeared incapable of mobilizing sufficient energy to assume a smile for posterity. Even though their newly married son and daughter-inlaw were present, it was a grim, joyless, and depressing repast. This was in telling contrast to the buoyant paintings, including four Odalisques, signs of Matisse's previous artistic and sexual activity, on the walls. Amelie must have practiced selective amnesia to digest her food in a room redolent with the presence of former rivals. Henri appeared uninterested in familial

Figure 17. Mme Matisse and Husband at Table. Nice, 1929. Photograph by Alexina Matisse. Barr (1951), p. 27.



interchange-perhaps these same paintings were constant reminders of sexual loss, in contrast to reminders of mortality in the presence of an aging invalid wife. Although Mme was very ill in January and February 1929, Henri left her for an extended trip to New York and Tahiti and back to the United States, which lasted about eight months. The failure to achieve pleasure in reciprocity, or to develop and hold a consistent image of a beloved over many long years, is characteristic of narcissistic individuals. An example of his self-absorption was expressed to Simon Bussy in response to an Oriental art exhibit: "I don't really want to go. I don't really take an interest in it. I only take an interest in myself. And so saying he blushed a rosy red. and buried his face in his hands. For he is perfectly aware of his own peculiarities and when he is with intimates he will own up to them with a curious and almost alarming mixture of shame and pride" {J. Bussy, 1986, p. 81). Life, however, was far from over for this artist aging in body but vital in creative imagination. During his second trip to the United States in mid 1930, Matisse was asked by the wealthy and eccentric American collector, Dr. Albert Barnes, to undertake a wall mural for the main room in his Foundation museum in Merion, Pennsylvania. Matisse accepted the commission after a year-long period of rumination, for it was an enormous area, 11' 8" x 42 feet. The mural was to be positioned high on the wall in three arches above French windows separated by pendentives. His choice of theme for this architectural structure was in daring opposition to its actual stability for he chose that of active female dancers. Henri worked on the mural for about a year-first on an uncompleted version abandoned and not found again until 1992, then on a version completed in 1932, before he realized that he had failed to use the template for the wall correctly and therefore the pendentive dimensions he had were incorrect and only half the actual size. Rather than simply obliterating part of the figures which appeared to flow under them, he chose to begin over again on a third version. Charcoal drawings were overlaid with colored paper shapes moved "like a game of checkers." At this point, in response to his wife's objections to Lisette, who continued to be model as well as nurse to Mme, he replaced her with another assistant. The young female assistant he hired in moving these colored shapes arrived, she wrote, in October 1932 and remained about 8 months (Delectorskya, 1988, p. 14). Lydia Delectorskaya was a beautiful 22year-old Russian-Siberian woman, who had lost both parents in the devastating typhoid epidemic of 1922. After high school, unable to speak the language and penniless, she moved to France. Within a year she married and divorced a Russian emigre whom she termed a "confirmed bachelor." She then worked briefly as a model but maintained she knew nothing about


Henri Matisse: Love as Art

art or Matisse when she began her work for him. Although she denied that there was any relationship at this period, Matisse commented that "he whistled while he worked" on this painting and the character of the dance motif changed. The work has been described by more than one critic as as a lutte d'amour, or struggle of love. Pierre Schneider (1984) suggests that this emphasis is attributable to Lydia: "The sudden flowering of erotic imagery probably reflects the growing importance of the painter-model relationship in Matisse's work and thought. Love concretizes the painter's identification with his model, which is the keystone of his aesthetic" (p. 61). The aggressive tenor may be attributable to unconscious sexual discharge in addition to, as Flam notes in analysis of the development of these three versions, an acumulation of pressures resulting from Matisse's anxiety over his errors, obsession in which he saw the mural "even in his dreams," coupled with mounting tension in his relationship with Barnes (Flam, 1993). In this last version of The Dance, 1932-33 (Fig. 18), eight monumental female figures like furious Olympian goddesses seem engaged in aggressive physical encounter rather than dance. In the two outer panels two of the three women are upright, and may indeed be reminders of the vigorous Spanish dancers who had inspired him years earlier in The Dance, 1909, as well as to the modern dance. Two of the figures have fallen or have been pushed to the ground. In the central lunette, a floundering female lies with arms outstreched as if to ward off the rapacious attack of the lunger circling above. It is a disturbing suggestion of the erotic appeal of viewing women in physical or sexual interaction. In 1928 Matisse had drawn Zita and another nude together twice as odalisques. This stimulating imagery was now recalled and fused with the dance sequence. Erotic and autoerotic components in Matisse's creative activity are suggested in his comment to Louis Aragon in one of many interviews from 1941 to Matisse's death: "The presence of the model counts not as a potential source of information about its makeup, but to keep me in an emotional state, like a kind of flirtation which ends in a rape. Rape of what? Of myself, of a certain emotional involvement with the object that appeals to me" (1971, Vol. 1, p. 236). When applied to The Dance there is confirmation of the need for the sensual stimulus of the model but it ends in the puzzling words, "Rape of what? Of myself." This self-reference may have an earlier genesis submerged in the manifest content of rapacious female dancers. As a child, alternately deprived and overstimulated by a mother with whom reciprocity was unavailable, discharge of stimulation was impossible. The dangers of rage and aggression were defended by repression and passivity. As an adult, when lie was stirred up, there was no satisfactory model for interaction. He resolved the anxiety by obsessive activity or passive-aggressive behavior. No matter what gratification he desires or



Figure 18. The Dance. 1932-1933. Center lunette. Oil on canvas. Entire mural, 11' 8" x 47'. Barnes Foundation, Merion, Pennsylvania. Elderfield (1993), Pl. 291, p. 367. receives from women, it is ultimately insufficient-it leaves him dead. These figures, then, are the final result of those earlier deprivations and the ensuing conflicts. They express stimulation and discharge through the aggressive action of the "rape," which is resolved on the canvas. As in a dream too, all figures are aspects of himself-he is both aggressor and victim. Lack of integration in personal relationships, however, resulted in his sobriety, melancholia, ambivalence towards his own sexuality. His audacious use of the assaultive term rape, made other times in connection with Fauve light which he describes as the "result of a rape-or the motifs conquest by violence," is particularly applicable to the theme of The Dance. The years spent on three versions, the permanence of their wall location, suggest the relevance of investigation into latent content. Art was an autoerotic activity, stimulating, frustrating, obsessive, and gratifying. The richness of his addictive fantasy


Henri Matisse: Love as Art

could not be satisfactorily matched by relationships. Conflicted relationships might be unconsciously alluded to and the tension deflected if not entirely alleviated in the selfobject activity and resolution of art. In addition, sexual alertness, illustrated by the libidinal drawings of the young models the previous few years, may have now been exacerbated by the appearance of this interesting Russian assistant with whom he was in constant contact. However, a visiting friend from his early days at Moreau's studio, watching Matisse working on one of the versions, commented that Matisse was the unhappiest of men in the midst of extraordinary luxury who worked himself to death on imperceptible changes. His insomnia worsened and he slept only four or five hours a night. Unfortunately, the combination of tensions came to a head when, upon completion and delivery of the mural to Barnes, Matisse insisted that he nail the first of the canvases to the frame and suffered either a tension or mild heart attack. Upon return he developed acute nephritis and was unable to continue work for months on one of the two earlier versions. Lydia's services were no longer explicitly required after the completion of the Barnes mural and during his illness and recuperation. But about 4 months later, in October 1933, she was brought back into the household as nurse to his wife and secretary and as studio assistant to Matisse. She maintains that only then did he become overtly aware of her presence. After a year, Lydia says, he happened to notice her head resting on her arms offering a visually compressed composition, an innocent gesture he then captured on paper. Jane Bussy (1986) noted that within the first 2 years "he knew Lydia was passionately in love with him" (p. 83). Her duties were extended to include that of professional model, and perhaps, lover. Lydia's book, inexplicably, covers only the period between 1935 and 1939. If she arrived, as she writes, in 1932 it must have been during the second version of the mural, and she remained until his death. Thus, there is no definitive way to know or to speculate from drawings, when the sexual relationship was actually initiated. But, by 1935 there are many black ink drawings of her in uninhibited nude poses as in the Nu Couche series (Fig. 19). These spontaneous pen and ink drawings of Lydia suggest the passion and intimacy of the relationship. In peering at her and then in forming a sexual union, Matisse converts the earliest behavior of touching, nursing, and gazing, used to achieve symbiotic union between mother and infant, into the artists' visual foreplay and genital fusion. Identification with the model may have been both threatening and desired, as he reveals to Lydia, "I'm no longer in control. At such times there is a real split in me: I no longer know what I'm doing, I identify with my model" (Delectorskaya, 1988, p. 200). But once again he switched to the objective critical mode, reordered and transformed this ambivalence towards merger into an aesthetic conversion, as in Pink Nude (Fig. 20). He had often



Figure 19. Nu Couche series, Nude in the Studio. 1935. Pen and ink. 17 3/4" x 22 3/8". Barr (1951), p. 250.

used this pose of a woman stretched out on a sofa, her head resting on a cushion, one leg raised or crossed over the other but never so abstractly. In striving for the ideal and still in response to his critics who valued aesthetic distance, he went through 22 versions in 3 months. In the small finished painting she appears as an audacious unmodelled, highly stylized, flattened, and desexualized nude. Monumentalized, her feet and arms spill out of the space. Angles of arms and legs are echoed in the rectilinear floor pattern. Although Pink Nude appears emptied of overt sensual connotation, he comments later on its transcended synthesis, "It is voluptuousness rendered sublime" (Fontaine in Delectorskaya, 1988, p. 9). No matter what the immediate sexual gratification he achieved with women it eventually left him feeling unfulfilled-he turned to his fantasies which remained more powerful. Lydia provided only the triggering stimulus, as had others before her. Additionally, he continued to employ her as studio assistant. She photographed each day's version, wiped out those areas


Henri Matisse: Love as Art

with which he was dissatisfied, and kept a record of his comments. These revealed his struggles in aesthetic decision making and allowed him to reflect upon and retain many options. It reaffirmed the value he placed on his own products, and assuaged the sense of loss and uncertainty he felt as he anxiously went on to the next phase. She notes he cursed all the time as he took up the artist's weapon. Both appreciative of her help and mindful of the value of documentation, he photographed Lydia at Work, 1935 {Fig. 21), relishing the record of his tenacity in searching for the exquisite solution. The multiple roles of Lydia, as nurse, secretary, assistant, and mistress, continued for some years. Lydia's arresting beauty and grace was attested to by others. "The master's great inspiration, for her plastic splendor, beauty and expression of face, intelligence and wit, remains undoubtedly Lydia Delectorskaya, the source of masterpieces" {Escholier, 1960, p. 155). This relationship went on under the same roof with the unsuspecting semiinvalid Mme Matisse, who occupied her own quarters. Jane Bussy {1986, p. 82) reports that "Lydia's exquisite features and the lines of her body had become known to the collectors of two continents. Then, somehow in 1938 {five or six years after Lydia entered their home) Madame became aware of the situation." Privy over a period of 6 months to Henri's daily emotional monologues with her parents about his domestic impasse, Miss Bussy implied that Marguerite was implicated in the denouement. The natural daughter, now a middle-aged married woman and mother, may have been jealous of

Figure 20. Large Reclining Nude/17ze Pink Nude. Nice, April-October 1935. Oil on canvas. 26 1/2" x 36 1/2". Baltimore Museum of Art. Elderfield (1993), Pl. 306, p. 377.

Figure 21. Lydia at Work. 1935. Photograph by Henri Matisse. Elderfield (1993), p. 360.


Henri Matisse: Love as Art

displacement in her father's affections by the younger woman. When her mother was informed: The storm broke with sudden and terrific violence. The almost motionless situation swayed backwards and forwards. At one time it looked as though Mme Matisse was coming out on top-Lydia was dismissed, turned out of the house, she was never to see Matisse again, she had secret meetings with him, she committed suicide once or twice by firing an empty revolver at the wall ... Madame Matisse (was) possessed with demonic energy, her incurable disease of the spine completely cured, (she) walked-or rather rushed about shrieking. She tore the clothes off her back, she threw the tables and chairs across the room ... she had hysterics every day-Mme Matisse finally departed and Matisse settled down to a new existence with Lydia, it was obviously the best solution. Matisse and his wife were driving each other mad [Bussy, 1986, p. 83). This tragic situation, apparently reported in detail, was regrettable. One can understand the furious sense of deception felt by his wife. Undoubtedly, Matisse would have preferred to let the situation remain unresolved and Lydia seemed to understand his minimal obligation to Mme, with whom she had forged an affectionate relationship. Henri's forced choice in favor of the young, sexually stimulating and potentially nurturing Lydia was undertaken only after much deliberation. It was inevitable given Matisse's age and emotional detachment from Amelie. He was temperamentally unsuited to feel responsiblity for his aged invalid wife. Self-referential, he required undemanding admiration which was not forthcoming from her. After becoming aware of this last deception with a woman she trusted, she had, to his indignation, yelled, "you are, perhaps, a grand artist, but you are a dirty cuckoo" (Bussy, 1986, p. 83). Mme Matisse and Henri officially separated in 1939; she returned to Paris while Lydia and Henri remained in Nice. Although it would appear that he had decisively disengaged, he may have been unable to tolerate the loss and finality of the legal decisions. In 1940, personal tensions combined with the "inconvenience" of the Second World War exacerbated his decline in health. He was diagnosed with duodenal cancer, not infrequently a development of ileitis. By winter 1941 his worsening condition required surgery. Matisse said to his doctors, "give me three or four years, I need to finish my work." There was little optimism, since after the operation Matisse had two pulmonary embolisms and an infection. Marguerite recommended a second operation from which there was a strong possibility he would not survive. Miraculously, he recovered, although relegated to bed or a wheelchair for the remainder of his life. It is apparent why the narcissistic Matisse would prefer a young beauty to an aged wife, but we might wonder why Lydia would devote 20 years of her



life to an invalid, albeit a famous one. As an orphan, married inappropriately and divorced, she may have had a limited sense of entitlement or consciousness of mature needs, a desire to replace idealized parents, plus a selfabnegating or even sacrificial personality. Matisse appeared to have chosen women who suppressed their own needs, thereby complementing him in codependency. Escholier (1960), who so admired Lydia's beauty, visited them years later and recalled, "She just appeared, lovely as twenty years before when I first met her. But, rather than the lady of the house, she gave the impression of a beautiful slave" (p. 165). During convalescence in a Catholic hospital after this operations, he was tended to by a devoted young religious nurse, Monique Bourgeois. While in a weakened and vulnerable state, he developed a childlike dependence on her. She recalls that one evening she failed to say good night to her famous patient since it was after midnight when she finished her hospital work: The mother Superior wanted to see me. I went to her bidding. "Sister Marie-Ange, what are you thinking of? Why haven't you said good night to M. Matisse? M. Matisse is asking for you most insistently and he won't sleep until you have been to see him." I found our great patient in tears. He was in a dreadful state, 'Sister Marie-Ange I must have hurt your feelings, sometimes I speak roughly. I really didn't mean to hurt you. If I have, forgive me. Because you didn't come this evening, like every other evening, I've spent some dreadful hours. Forgive me" [Escholier, 1960, p. 165). After she assured him that he was always "gentle as a woman" he was able to sleep. In regression, precipitated by illness, old fears were mobilized and he required the childhood bedtime rituals. How fearful the sick child must have felt if dear Mama failed to say good night. She was his talisman saving him from harm; without her reassuring evening sacrament he could not sleep, and might not awaken. For fear of losing her he had lost himself. A photograph, taken soon after his illness, revealed his weakened and dependent condition. It is understandable that he was profoundly grateful to his nurse who was both ministrator and occasional model. In his idealization of her in 1942 entitled Idol, he envisioned this tubercular woman as a glamorous femme fatale in fashionable white evening dress. He required the sustenance of female models, particularly when in ill health. Shortly later he said, "I am afraid to start working with objects which I have to animate myself with my own feelings. Therefore, I have arranged with some motion picture agents to send me their prettiest girls" (Barr, 1951, p. 256). Even restricted to bed, the 72-year-old artist remained compulsively active. Friends noted that sculpture, objects he passed, his dog, pets, birds, were handled, fondled, and cuddled as evidence of the continued importance of the earliest tactile connective mode. As a corpulent, aged man he


Henri Matisse: Love as Art

assumed, once again, the softer contours and lessened mobility of an infant or young invalid. The bed may have aided him to release a renewed flood of feeling, both recalling the early incapacity and undoing it, thus acknowledging the vital function of creative rather than physical mobility. He turned to a new medium, vibrant cut paper designs for a portfolio entitled Jazz and large-scale figures in the blue paper. As he was bed bound these figures of swimmers or dancers reversed his immobility and became air- or waterborne as in the The Flowing Hair, 1952 (Fig. 22). His room was decorated with a long frieze of blue paper swimmers reminding him too of the waters from which we come. At 78 years of age, the master devoted his energies to his largest project, the small chapel for the nuns at Monteil near Vence. It came about accidentally. In addition to their apartment in Nice, he had purchased villa Le Reve at Vence in 1943, since Nice was evacuated during the Allied bombing in World War II. Adding to the tensions of this catastrophe Mme Matisse and Marguerite had been captured by the Germans when they were working for the Allies in Paris, and held in concentration camps for 6 months. Matisse wrote to Camoin that "in order to bear my anxiety, I have worked without stopping. I have worn myself out, and now I must recharge my batteries. And in that state, or in spite of it, one must draw and paint with serenity" (Aragon, 1971, Vol. 1, p. 186). He may, therefore, have been particularly receptive to the next challenge. After the end of the war in September 1946, his former nurse Monique, who had joined the Dominican order as Sister Marie-Ange, was in Vence. Her assignment was in the same home for tubercular girls where she had been treated. Visits to her former patient were resumed. Lydia commented that when they spoke they had a curiously tender relationship, or, as Matisse called it, a kind of flirtation, a "floweration. It's a little as if we were tossing flowers at one another-petals of roses and why not, there is no harm in this tenderness which doesn't need words, goes beyond words" (Schneider, 1984, p. 670). On one such visit, Sister MarieAnge showed him her watercolor for a stained glass window for the proposed oratory of the convent destroyed during the war. Intrigued, he was inspired to elaborate on the original project by the Sister and a young novice, Brother Rayssiguier. Finally, the grandiose plans included stained glass windows, tile wall murals, objects for the service, priest's apparel and the architecture of the elegant chapel itself. An agnostic, he underwrote the cost of the entire project. Undeterred by his immobility, he used a long stick with a marking tool attached for full-scale sketches of murals. Sometimes, to everyone's great consternation, he left his wheelchair, and mounted to the top of a shaky ladder with his obese body in order to make changes more directly. The energy from his creative act of love, as well as self-love, was like a temporary cure from Lourdes. One of the most poignant, seemingly child-like



Figure 22. The Flowing Hair. Gouache on paper, cut and pasted. 42 1/2" x 31 1/2". Elderfield (1993), p. 46.

murals, Ave Maria, 1950 (Fig. 23), underwent many changes. It started as a graceful Gothic Madonna holding her infant son in the lap of her starspattered robe. The final version portrays a more austere Romanesque image with standing child held between his mother's elongated arms which surround him as a protective mantle. Or, in a double entendre, the arms form a symbolic vulva though which he was born. Even though Matisse depicted the child rather than the adult Jesus, there was a fusion of developmental stages, for the child Jesus forms a cross by his outstretched arms and


Henri Matisse: Love as Art


Figure 23. Ave Maria. Vence Chapel. 1950. Painted and glazed tiles. c. 10' x 21'. Barr (1951), p. 518. vertical body as if in anticipation of his crucifixion. As in dreams, what was, and what is to be, are fused into a single economical image. Thus, he symbolically offers himself to the world. Through his crucifixion, he became the savior-a powerful personal symbol for this artist who in his grandiosity, felt he too, had ultimately foregone loving arms to become a giver of light to the world. It functioned as a substitution, for this non-practicing Catholic, of the traditional religious transformational objects. As Ballas writes, "the self seeks relationships with such (transformational) objects, the earliest of which is the mother, because they offer a chance to re-create and reconstitute the self" (Ballas in Layton, 1992, p. 151). In one of his last photos, Matisse and Sister Jacques-Marie, 1953 (Fig. 24), the two are seen in the chapel. Uncharacteristically, he slipped his arm through hers, allowing himself a measure of affectionate contact as well as needed support. Thus, he recognizes her contribution to his physical and artistic life. Woman was once more the instrument and conduit through which he realized integrating and culminating experience. In a statement published in the Chapelle du Rosaire he professes: This chapel is for me the ultimate goal of a whole life and the culmination of an enormous effort, sincere and difficult. This is not a work which I chose, but rather a work for which I was chosen by fate. I foresee that this work will not be in vain and that it may remain the expression of a period in art, perhaps already surpassed, though I do not believe so. I trust that this part



Figure 24. Matisse and Sister Jacques-Marie. 1953. Photograph by Lieberman. Aragon {1971), Vol. 2, p. 185.

{which unites the past with the future of plastic tradition), which I call my revelation, may be expressed with sufficient power to be fertilizing and so return to its source [Barr, 1951, p. 288].

Revelations, the mysterious prophetic work and last book of the New Testament, deals with visions of triumphant good over the evil of persecution of God and the martyrs. Matisse used the religious term "revelation" as a metaphor for the capacity of his art, rather than religion, to exorcise the demons within and offer him a measure of equilibrium and peace. In his final work at Vence he has denied mortality and created his personal quasireligious Hallelujah chorus. On the occasion of the consecration of the chapel, too weak to attend, he wrote to the Bishop of Nice, Monsignor Redmond, that it had taken four


Henri Matisse: Love as Art

years of exclusive and assiduous work and represented the result of his entire active life. In issuing his statement to the press the Bishop misstated Matisse's belief in God by referring to part of an earlier document in which Henri had answered when questioned: "Whether I believe in God? Yes, when I work. When I am submissive and modest, I feel aided to do things beyond me: However, I do not feel any obligation because it is as though I were before a magician. I feel deprived of the benefits of the experience which ought to have been the reward of my own efforts. I am ungrateful without remorse" (quoted in Barr, p. 287). Such is the perception and power of agnostic narcissism as he reminded the world that it was not through God's help but through his own obsessive labors of 65 years that he reached "revelation." Visited by thousands each year, the chapel moves one to tears in its exquisite simplicity and fastidious attention to detail.

Conclusions Matisse's need, desire, and capacity to pick up his paint brushes and work compulsively were ultimately dependent upon the sensations of his earliest physical contact, the smiles and frowns, the degree of satisfactions and frustrations. Earliest autistic-contiguous experiences of tactile contact and patterns were retained. This pre-rational mode of processing, tapped and amplified, proved essential in his experiences as creator. This mode was incorporated into later developmental modes. The use and conversion of the earliest tactile experiences by this gifted individual appeared in his need of close and careful peering (he noted he often sat knee to knee with his model), the manipulation of the artists' tools in marking, caressing, scraping, and its use as a communicative device. Craving for the constant stimulation of fully saturated color and actively filled negative areas were reversals of earlier inactivity and elicited feelings of vitality. He had the extraordinary ability to make up for early deficiencies, garnishing bleak reality with his own rich fantasies, "devoid of troubling subject matter." For fully functional individuals, part of the forming of self, of wholeness, develops after repeated empathetic interaction with both parents. During Matisse's later infancy, nurturing may have been unreliable, the caresses reserved for those more needy. He required more mirroring for his unique genetic, biological, and psychological makeup. Kohut maintains that if sufficient empathy is lacking the child cannot develop a sense of a separate self. The infant's ideal universe, consisting of itself as sun-king, and mother as court revolving around it, was not fully realized. The two poles of archaic grandiose self and idealized parent imago did not develop sufficiently before



Matisse discovered art. There were also subsequent problems in libidinal and aggressive development. Capacities for fusing and separating, responding and withdrawing, incorporating and rejecting, were not fully integrated. Matisse's prolonged passivity and lack of early autonomy developed from fear of annihilation if he were to separate from idealized parents. Early needs to view himself as omnipotent were insufficiently realized. After a prolonged illness as a young man, and partial regression to the dependency of infancy, he continued his arrested development. This was achieved through the mother's approved gift of art, which, paradoxically, replaced her. He described this release from bondage in sexual terms, as with freed libidinal energy, he "lunged towards it (art) like a lover with the thing he loves." After his mother's death, in the 1920s, he was able to exercise his libido more fully and express it in art, resorting less to ambivalent hidden symbols. Early passivity, dependence, and emptiness may be traced to anxiety over infant separation and loss. This resulted in adult conflict between a desire for constancy and conversely, the overvaluing of independence. Ambivalence caused fear of intimacy, commitment, and repeated emotional separation from women in apprehension of emotional engulfment. Yet, there was a holding on with stubborn obstinancy to some individuals, expressed too in painting revisions until forced by unbearable tension to change. With others, he displayed a variety of loving styles-toward his sons he was said to be "tyrannical," toward his wife he displayed commitment without passion, toward his models passion without legal commitment, infrequent reciprocal intimacy, but toward his own work, passion, commitment, and the intimacy of continual dialogue. Depending on the magnetism or beneficial aspects of the partner, needs of his painting style and themes, fame and financial independence, state of health, the character of attachment changed slightly. They stressed one or another combination of attachment styles-desire for dependency and mothering, genital passion, or parallel play. The attachment cycle from infancy to old age was closed when the last woman, Lydia, Pushing Wheelchair (Fig. 25) functioned as nurse and caretaker for the last 20 years of his life. When conflicting emotions periodically caused extended periods of "severe trials," they were eventually resolved into new alliances and new art. Differences among his paintings, from descriptive and voluptuous to desexualized and austere, may be seen to be the direct or indirect result of personal relationships with a series of selfabnegating women. His fantasy of eternal symbiosis required the generating presence of women "to crystallize fugitive aspirations." Caroline, Marguerite, Amelie, Greta, Olga, Antoinette, Henriette, Lydia, were transitional objects replaced by their idealized image. Although aspects of creating were anxiety producing, the completed works provided a consistent source of affirmation

Figure 25. Matisse in Tiriade's Garden in Wheelchair with Lydia.June 1951. Photo by Henri Cartier-Bresson. Lefevre (1993), p. 93.



and pleasure. Each painting spawned others. These immortal objects, created through his own volition and imagination, smiled back at him with unbounded mirrored admiration. When constrained in work, even as an aged man, he complained: "Hell on earth is inactivity. Today has been terribly tiring, oppressive. I couldn't work and I felt old" (Schneider, 1984, p. 650). Near the end of his life, refuting the public persona of this supposed painter of happiness, he complained that if people knew what he had gone through, the anguish and tragedy that he had to overcome to manage to capture that light that had never left him, they would realize that this light, this dispassionate wisdom that seemed to be his, was sometimes well deserved, given the severity of his trials. Paradoxically, work was carried on in a state of constant alert for the avowed goal of serenity. Great artists have the ability to determine, as well as to reflect, the group's procreant desires. Matisse projected onto art, the surrogate mother, preoedipal fantasies of harmonic oneness, unconditional love, and tactile availability. The odyssey was fraught with dangers and he wished the adoring public to recognize his heroic battle. However, the ultimate glorious and integrative reward of his trials in the pursuit of harmonic constructs was revealed when, as aged creator invalid, he said to Aragon, "Let me die smiling" (Matisse in Tiriade's Garden, 1951, Fig. 26, p. 250).

References Aragon, L. ( 1971), Henri Matisse: A Novel, Vols. 1 & 2, trans. J. Stewart. New York: Harcourt Brace Jovanovich. Barr, A.H. (1951), Matisse: His Art and His Public. New York: Museum of Modern Art. Bergmann, M. (1981), The Anatomy of Loving. New York: Columbia University Press. Borel, F. (1990), The Seduction of Venus: Artists and Models. New York: Rizzoli. Bristol, C. ( 1991), Romantic love, passionate attachments and the greater achievements in the case ofC.D. Presented at the second national conference on romantic love, sex, and psyche, Georgetown University. - - - & Pasternak, S. (1993), Passionate love and the couple: The transformation of love. Presented to Smithsonian Associates, Washington, DC. Bussy, J. (1986), A great man. The Burlington Magazine, 128:80-84. Cowart, J. & Fourcade, D. (1986), Henri Matisse: The Early Years in Nice, 1916-1930. New York: Abrams. - - - Schneider, P., Elderfield, J., Kostenevich, A. & Coyle, L. (1990), Matisse in Morocco 1912-1913. National Gallery of Art, Washington, DC. Delectorskaya, L. (1988), With Apparent Ease ... Henri Matisse, trans. 0. Tourkoff. Paris: Adrien Maeght Editeur. Elderfield, J. (1993), Henri Matisse: A Retrospective. New York: Museum of Modern Art. Escholier, R. (1960), Matisse: A Portrait of the Artist and the Man, trans. G. Colville & H. M. Colville. New York: Praeger. Flam, J. {1978), Matisse on Art. New York: Dutton.

Figure 26. Matisse in Tiriade's Garden. June 1951. Photo by Henri Cartier-Bresson. Barr (1951), p. 32.



- - (1986), Matisse: The Man and His Art, 1869-1918. Ithaca, NY: Cornell University. - - (1988), Matisse: A Retrospective. New York: Levin. - - (1993), Matisse: The Dance. National Gallery of Art, Washington, DC. Gowing, L. (1979), Matisse. New York: Oxford University Press. Kohut, H. (1984), How Does Analysis Cure? ed. A Goldberg & P. Stepansky. Chicago: The University of Chicago Press. Layton, L. (1992), The self you see is the self you find: Recent works on the empty, satiated, and/or transformed self. Psychiatry, 55 (2). Lefevre, M., ed. (1993), Matisse: Une si profonde ligerete. Paris: Telerama Hors-serie. Miller, H. (1961), Tropic of Cancer. New York: Grove Press. Neret, G. (1991), Matisse, trans. L. Davidson. William S. Konecky. Russell, J. (1969), The World ofMatisse, 1869-1954. New York: Time-Life Books. Schneider, P. (1984), Matisse, trans. M. Taylor & B. Stevens. New York: Rizzoli.

Author Index

A Adamson, L., 64, 76 Ainsworth, M., 61, 73 Alexander, F., 70, 73, 169-170, 171, 172, 181, 191, 192 Als, H., 64, 76 Anderson,]., 100, 113 Aragon, L., 227-228, 242,245,249 Atwood, G., 2n, 11, 17, 21, 31, 70, 76

B Balint, M., 6, 10, 70, 73 Bames,J., 135, 150 Barr, A., 218,232,237,241,244,245, 246,249 Basch, M., 56, 73, 132, 150, 180, 192 Bateson, M., 63, 73 Becker, C., 158, 192 Beebe, B., 52, 58, 64, 66, 73 Bell, S., 61, 73 Belsky,J., 59, 73 Benedek, T., 84, 91, 174, 192 Bergman, A., 51, 54, 75 Bergmann, M., 199, 249 Blum, H., 4, 11 Borel, F., 224, 249 Boris, H., 42, 47 Bornstein, R., 109, 111, 113 Boskind-Lodahl, M., 43, 47 Bower, T., 57, 73 Brand,]., 158, 181, 193 Brandchaft., B., 17, 21, 31, 70, 76 Brazelton, T., 58, 64, 73, 76 Bridges, L., 59, 74 Bristol, C., 199, 249 Brodey, W., 85,88, 91 Bruch, H., 41, 47

Bruner,]., 58, 73 Bry,J., 161, 192 Bucci, W., 97, 113 Bussy,J., 203,236,240,249

C Carstens, A., 57, 73 Cassidy,J., 51, 66, 75 Cavell, M., 139, 150 Censullo, M., 64, 73 Channel, D., 103, 113 Cha.sseguet-Smirgel,J., 42, 47 Clark, R., 63, 75 Cloninger, C., 95, 113, 123, 130 Cohen, D., 63, 74 Cohen,J., 99n, 113 Cohen, Y., 56, 73 Cohn,J., 55, 58, 73, 76 Collins, A., 137, 150 Cooper, A., 54,, 73 Cooper, P., 43, 48 Cooper, S., 21, 31 Cooper, T., 43, 48 Cowart,]., 200,218,219,226, 249 Culver, C., 59, 65, 75

D Davis, P., 99n, 113 DeCasper, A., 57, 63, 73 Decety,J., 110, 113 Deci, E., 59, 73 Delectorskaya, L., 233,236, 237, 249 de Leeuw, R., 52, 63, 77 Demos, E., 55, 56, 59, 60, 61, 67, 73 Dewald, P., 70, 74 Dilthey, W., 16, 32


Author Index

254 Dorpat, T., 20, 31 Dreyfus, H., 22, 23, 31 Drye, R., 188, 193 Dudai, Y., 119, 120, 130 Dupont,J., 8, 11

E Eickelman, D., 132, 150 Eisley, L., 99, 113 Eissler, K., 4, 11, 18, 31 Elderfield,J., 213, 214,216,220,222, 223, 225,227,230,231,235,238,239,243 , 249 Emde, R., 54, 74 Erikson, E., 61, 74 Escho1ier, R., 203, 210, 215,218,221, 238, 241, 249

F Fenichel, 0., 51, 74 Field, T., 63, 74 Fifer, W., 63, 73, 74 Fine, B., 53, 75, 118, 130 Flam,J., 199,201,206,208,209,212,228, 234,251 Fleming,J., 70, 74 Fogel, A., 52, 63, 74 Fonagy, P., 62, 76 Forrest, D., 100, 113 Foucade, D., 200,218,219,226, 249 French, T., 70, 73, 172, 173, 181, 192 Freud, S., 53, 61, 62, 74, 82, 91, 96, IOI, 109, 113, 140, 142-143, 149 Frodi, A., 59, 74

G Gabriel, M., 111, 113, 122, 123, 125, 130 Gadamer, H., 16, 23, 31 Galatzer-Levy, R., 126, 130 Garcia, R., 63, 74 Gedo,J., 1, 2, 4, 5, 8, 9, IO, 11, 103, 113, 118, 131, 132, 133, 134, 143, 151, IBO, 192 Gehrie, M., l, 2, 4, 5, 6, 8, 9, 10, 11 Gentner, D., 101, 102n, 113, ll9, 127, 128, 130 Gianino, A., 56, 58, 64, 65, 74, 76 Gill, M., 132, 150

Gilmore, K., 131, 150 Gitelson, M., I 77, 178, 192 Goldberg, A., 20, 31, 103, 113, 180, 192 Goldstone, R., 119, 127, 130 Gowing, L., 203, 226, 251 Graubard, S., 158, 192 Greenberg, R., 63, 74 Grene, M., 13.S, 150 Grinker,J., 159, 160, 193 Grinker, R., Sr., 110, 114, 158, 159, 167, 173, 177, 178, 184, 186, 188, 189, 193 Grolnick, W., 59, 74 Gunther, M., 2, 11

H Had1ey,J., 102, 114, 122, 123, 125, 130 Halmi, K., 35, 47 Harmon, R., 57, 75 Harter, S., 57, 74 Hartmann, H., 132, 141, 150 Heidegger, M., 16, 31 Hendrick, I., 57, 74 Hersh, R., 99n, 113 Hoffman, I., 18, 31 Hoffman,]., 64, 73 Hoffman, L., 35, 47 Hoffman, M., 63, 75 Hoit, M., 14, 31 Holt, E., 132, 140, 150 Holton, G., 190, 193 Holzman, P., 189, 193 Hunt,J., 57, 74

I lngvar, D., 110, 113

J Jeannerod,J., 110, 114 Johnson-Laird, P., 132, 150

K Kahler, E., 161, 193 Kang, E., 111, 113 Kaplan, N., 51, 56, 66, 67, 75 Kaplan, S., 59, 60, 73, 76

Author Index Kent, E., 105n, 114, 119, 121, 122, 125, 130, 132, 150 Kemberg, 0., 40, 47, 56, 68, 74,204,251 Kesner, R., 103, 114 Klein, G., 132, 150 Klein, M., 6, 11, 74 Klein, Milton, 54, 68, 74 Klein, R., 57, 77 Knight, R., 184, 193 Kochanska, G., 66, 77 Kohut, H., 1, 2, 4, 77, 19, 37, 53, 54, 56, 58, 61, 67, 70, 74, 180, 193, 204, 251 Kovel, J., 23, 31 Kowslowski, B., 58, 64, 73 Kris, A., 69, 74 Krull, M., 84, 91 Kubota, Y., 111, 113

L Lachmann, F., 52, 58, 66, 73 Laplanche,J., 22, 31, 54, 74 Lassen, N., 99, 107, 114 Lasswell, H., 164, 165, 193 Laufer, M. E., 20, 31 Layton, L., 244, 251 Leavy, D., 111, 114 Lefevre, M., 250, 251 Lester, B., 64, 73 Levin, F., 97n, 100, 103, 106, 107, 108, 109, llO, 111, 114, 120, 128, 130 Lewin, B., 155, 186, 193 Lichtenberg,]., 52, 54, 75 Lustman, S., 176, 193 Lyons-Ruth, K., 65, 66, 67, 75

M McCarthy, M., .57, 77 McCorduck, P., 105n, 114 MacFarlane,J ., 63, 75 McLean, H., 181, 193 McQuiston, S., .57, 77 MacTurk, R., 57, 77 Mahler, M., 51, 54, 75, 83, 91 Main, M., .51, 58, 64, 66, 73, 75 Makari, G., 3, 11 Malatesta, C., 59, 65, 75 Markman, A., 101, 114 Martin, G., 63, 75

255 Marziali, E., 43, 47 Medin, D., 119, 127, 130 Meltzer, D., 43, 47 Meltzoff, A., 63, 75 Messer, S., 14, 32 Miller, A., 82, 91 Miller, H., 229, 251 Miller,]., 132, 151 Miller, M., 20, 31 Mitchell, S., 21, 31 Modell, A., 1, 4, 11, ll8, 130, 132, 140, 141, 144, 150 Moon, C., 63, 74 Moore, B., 53, 75, 118, 130 Moore, M., 63, 75 Mora, G., 158, 181, 193 Moraitis, G., 10, 11 Morgan, G., 57, 75 Moriarity, A., 59, 75 Morris, A., 43, 47 Murphy, L., 51, 59, 75, 76

N N eret, G., 202, 251 Newell, A., 128, 130

0 Olds, D., 99, 114 Orenstein, M., 105, 114 Ornstein, A., 2, 11 Ornstein, P., 2, 11

p Papousek, H., 57, 75 Papousek, M., 57, 75 Paris,)., 43, 48 Pasternak, S., 199, 249 Peery,]., 64, 75 Person, E., 62, 76 Peterfreund, E., 54, 75 Piers, G., 179, 193 Pine, F., 51, 54, 75 Pittman, T., 109, 111, 113 Pollock, G., 132, 151, 172, 173, 192, 193 Pompian, N., 105, 114 Pontalis,J., 54, 74 Poremba, A., 111, 113


Author Index

Posner, M., 99, 107, 114 Pulver, S., 53, 75

R Rapaport, D., 100, 103, 104, 114, 131, 132, 133, 143, 150 Ratterman,]., 101, 113, 119, 127, 128, 130 Ratterman, M., 101, 114 Redding, S., 57, 75 Reich, A., 67, 75 Reiser, M., 96, 114, 121, 130 Reppert, S., 63, 75 Reps, P., 132, 150 Ricks, M., .51, 75 Ricoeur, P., 16, 31, 129, 130 Rifkin, A., 161, 192 Rizzuto, A., 96, 114 Robbins, F., 115, 195 Rosenblatt, B., 97, 114 Rosenfeld, E., 100, 113 Ross, H., 155, 186, 193 Ross,J., 82, 91 Ross, W., 135, 150 Rothstein, A., 54, 67, 75 Rovine, M., 59, 73 Rubenstein, B., 174, 192 Russell,]., 207, 251 Ryan, R., 59, 73 Ryding, E., 110, 113 Ryle, G., 103, 114, 136, 137, 138, 151

s Sabshin, M., 132, 151 Sacks, 0., 119, 130 Sadow, L., 132, 151 Sagi, A., 63, 75 Salton, G., 99, 114 Sander, L., 54, 59, 64, 75 Sandler,]., 62, 76, 97, 114 Sass, I., 14, 32 Schafer, R., 17, 31 Schaffer, H., 58, 64, 76 Schlessinger, N ., 115, 132, 151 Schneider, P., 201,209, 216-217, 242,249, 251

Schorske, C., 84, 91 Schwaber, E., l, 2, 11, 106, 115 Selesnick, T., 191, 192

Servan-Schreiber, D., 99n, 113 Shepard, B., 59, 65, 75 Simner, M., 63, 76 Simon, H., 128, 130 Singer, M., 179, 193 Sjohlm, H., 110, 113 Slayton, D., 61, 73 Smaller, M., 107, 115 Smith, H., 51, 76 Soref, A., 54, 55, 60, 76 Spence, M., 63, 73 Spiegel,]., 188, 189, 793 Spruiell, V., 100, 115 Squire, L., 108, 115 Stechler, G., 59, 76 Steele, B., 65, 76 Stenberg, G., I 10, 113 Stent, G., 182, 193 Stem, D., 20, 31, 52, 54, 5.5, 58, 64, 65, 66, 73, 76

Stolorow, R., 2n, 11, 17, 21, 31, 70, 76 Stone, L., 1, 4, 11, 51, 76 Strupp, H., 190, 193

T Taylor, D., 59, 73 Terman, D., 19, 32 Tesman,J., 59, 65, 75 Thelen, E., 52, 63, 74 Thum, D., 105, 114 Tolpin, M., 53, 58, 61, 76 Tompkins, S., 52, 76 Trevarthen, C., 52, 57, 58, 60, 63, 64, 76 Tronick, E., 55, 56, 58, 60, 64, 65, 66, 73, 74, 76, 77 Truby, H., 63, 76

u Uzgiris, I., 57, 74

V Van Rees, S., 52, 63, 77 Vida,]., 7, 11 Vietze, P., 57, 77 Vogt, B., 111, 113 Vuckovich, D., 96, 114


Author Index

w Waelder, R., 132, 151 Wakefield,J., 22, 23, 31 Walsh, W., 115, 137, 138, 151 Watson,]., 57, 58, 77 Weaver, D., 63, 75 Weinberg, M., 66, 77 Weinstein, L., 10, 11 Weiss, S., 84, 91 Werb1e, R., 188, 193 White, A., 103, 115, 132, 151 White, R., 57, 77 Williams, M., 43, 48 Wilson, A., 10, 11 Winnicott, D., 1, 4, 12, 19, 32, 65, 77, 86, 91

Wise, S., 64, 76 Wolf, E., 7, 12, 53, 54, 61, 70, 74, 77 Wolff, P., 52, 63, 77 Woodson, R., 63, 74 Woolfolk, R., 14, J2

y Yarrow, L., 57, 77

z Zahn-Waxler, C., 66, 77 Zeki, S., 1091 115 Zetzel, E., I, 72 Zola-Morgan, S., 108, 115

Subject Index

A Academy of Psychoanalysis, 177-178 Adaptation, 11 7 Adler, H., 162 Adolescent process, 20 Affect, 118, 123 Affective experience, 129 recall of, 109-110 Affective matching, mastery motivation and, 58-59 Affective personality disorders, 34 Alexander, F., 166, 178 background and education, 163, 169 Chicago Institute and, 155, 163-164, 171, 174, 186 child psychiatry and, 173 leadership of, 167-168, 191 length of therapy and, 181-182 personality of, 169-171 problems with orthodoxy and, 175-177 on psychoanalysis, 191 psychosomatic research of, l 71-173, 188 training/education and, 182-183, 185 Ambivalency. see Matisse, H. American Psychiatric Association, 177 American Psychoanalytic Association, 158, 160-161, 167-168, 177 Analysand mind of, 18 subjective viewpoint of, empathy and, 1-3 Analysis, psychotherapy and, 181-182. see ll.lso Child analysis Analyst. see also Empathy parent alliance, in child analysis, 89-90 subjectivity and, 2n Analytic Institute, 185-186 Analytic psychology, Stent on, 182 Analytic relationship, 30

transference and, 21, 24-25 Anorexia nervosa, 33 mother-child relationship and, 41-42 treatment, 35-38 Anxiety, Matisse and, 203-204. see also Leaming Aragon, L., 227, 234 Archaic problems. see Matisse, H. Archaic structures, 205 Archaic transference, mother/father, 2-3 Aristotle, 102-103, 104, 132, 149 epistemology and, 134-137 Attachment. su Love

B Barnes, A., 233-234 Benedek, T., 168, 174, 188 Berlin Psychoanalytic Institute, 163, 169, 173 Bipolar self, 205 Blitzsten, L., 167, 174-175 Borderline personality organization. see Eating disorders Bourgeois, M., on Matisse, 241 Bulimia nervosa, 33 separation-individuation conflicts and, 42 treatment, 35, 38

C Cezanne, P., 211 Chicago Institute for Psychoanalysis, 155195. see also Alexander, F.; Grinker, R., Sr. Academy of Psychoanalysis and, 177-178 analytic fees and, 164 Analytic Institute and, 185-186 Benedek and, 168, 174, 188

260 Blitzsten and, 167, 174-176 first brochures of (1921), 161-163 first faculty of, 166 founding of {1932), 163-164 Freudian viewpoint and, 160-161 Gitelson and, 173, 175-177 Horney and, 166-167 Kohut and, 180 Lasswell's research and, 164-166 length of analysis and, 181-182 orthodoxy vs. liberalism and, 168-169, 173, 175-178, 184, 191, 194 Piers's directorship of, 179-180, 186 Pollock's directorship of, 179-180, 185186 pre-Institute theory and (1911-1932), 159-160, 190 psychoanalytic research at, 164-166, 171172, 180, 188-189 psychoanalytic theory and, 181, 189-190 psychoanalytic training and, 184-185 quarters of, 168-169 Schoolman and, 161-162 special projects of, 187 students and, 183-184 teaching programs of, 179, 180, 186 T. French and, 173-174, 186, 188 University of Chicago and, 163-164 Chicago Neurological Society, 159 Chicago Psychoanalytic Society, 167 Child analysis, resistance to, 91 analyst/parent alliance and, 89-90 child development, parental stress and, 8788 clinical examples of, 79-82 defense transference and, 86 externalization by parent, repressed memories and, 85-86 idealization of parents and, 83 identification with the aggressor and, 8687 Oedipus complex and, 82-84 regression and, of analyst and parent, 8485 Child development, parental stress and, 8788 Child psychiatry, Alexander and, 166, 178 Cognition, 119, 127 Cognitive behavioral treatment, eating disorders and, 35, 37

Subject Index Cognitive development, 105 Cognitive psychology. see also Representation mind/brain activity and, 99 similarity judgment and, 100-102, 112, 118 Cognitive system, core of, 129 Countertransference sadomasochistic. see Empathy Creativity, 132n

D Demos, E., on structure-building, 61-62 Derain, A., 212 Descartes, R., 139 Development, 134. see also Self development caregiving object and, 64-66 cognitive, 105 of insight, 165 oedipal stage, mother-child relationship and,41-42 Developmental research, 52, 55, 57 psychoanalytic theory and, 49, 66-69, 72 Dorpat, T., on Freud, 20 Duthuit, G., on Matisse, 218

E Eating disorders borderline personality organization and, 33-36,38-39,43 clinical illustration, 145-14 7 dominant dynamics of, 40 early trauma and, 43 femininity and, 41-43 hospitalization and, 35, 37 intrapsychic relationships and, 43-44 limit setting, 37-39 mother-child relationship and, 41-42 multiple symptoms and, 39 outpatient treatment and, 37-38 psychoanalysis and, 35, 38-39 psychoanalytic psychotherapy and, 35-38, 40, 41 transference and, 40 treatment disruption and, 39-40 treatment resolution and, 47 treatment strategy, initial, 36 Ego, 28, .53

Subject Index Ego psychology, 53 character pathology and, resolution and, 29 Freud and, 18 object relations theory and, 46-47 Ego theory, psychoanalysis and, 52-53 Emotions, 171-172 Empathic data, the natural sciences and, 14 Empathic immersion, l 7 Empathy, 19, 89 analysand's subjective viewpoint and, 1-3 analyst responsiveness and, 4, 6-10 sadomasochistic countertransference and, 5-6,8-9 separate self and, 246 Empiricism. see Aristotle Epistemology, 131-132. m also Aristotle; Freud, S. background and definition, 133-134 beliers and, 148-149 clinical examples, 145-148 Kant and, 137-139, 149 psychoanalysis and, 139-140 Exorcism, case study, 147-148 Externalization, 85-86

F Fleming,]., 179, 180, 191 French, T., 173-174, 186, 188 Freud, A., 173 Freudian analytical psychology, Stent on, 182 Freudian viewpoint, Chicago Institute and, 160-161 Freud, S., 96, 133, 181. see also Hermeneutic philosophy Dorpat on, 20 ego psychology and, 18 epistemology and, 132, 137, 139-141, 148149 transference and, 139, 142 instinctual predestination and, 53 J. Grinker on, 160 learning theory and, 96, 104, 107, 110, 132, 143 Miller on, 20 narcissism and, 53 Oedipus complex and, 82, 84 psychoanalytic theory and, 142-143 religion and, 141, 144

261 R. Grinker, Sr., on, 166-167 transforence and, 139, 142

G Gabriel, M., on learning patterns in rabbits, 125 Gadamer, H., on the henneneutical problem, 23 Gitelson, M., l 73, 175-1 76 on psychoanalysis, 176-177 Grinker,J. on Freud, 160 on psychotherapy, 160 Grinker, R., Sr., 158, 162, 164, 180, 190 on the Chicago Institute, I 78-179, 183 on conflict with Blitzsten, 175-1 76 on discussion with Freud, 166-167 "Open Systems" lecture or, 167 on psychoanalytic education, 186 on T. French, 173

H Hamill, R., 160 Hartmann, H., 141, 144 on Weltanschauungen, 133 Hermeneutic philosophy analytic relationship and, transference and, 21,24-25 case material, 24-30 discontinuous setr development and, 20-21 environmentalism and, I 7-18 Freud and, 15-16, 18-20,22 Gadamer on, 23 interpersonal relationship and, 19-20, 2324, 28 Kohut and, 19 ontological model of meaning and, 16-17, 30 epistemological model of meaning and, 15-16,22,30-31 psychoanalysis and, 13-15 psychoanalytic theory and, 30 synthesis of, clinical process and, 22-24, 30-31 Homey, K., 166-167 Hysterical conversion symptoms, 172


Subject Index

Idealized parent, 86, 205, 211, 241, 247 Identification, 104,133 Infant development. set!. also Infant research adult narcissism and, 57, 66 innate capacities and, developmental fate of, 56 perfection and, the pursuit of, 67-68 self cohesion and, selfobjects and, 53 self-orientation and, 68-69 "social referencing" and, 21 treatment implications and, 70 Infant omnipotence theory. see Infant research Infant research. see also Developmental research attachment and, environmental influences on,51 "competent11 vs. "classical" infant and, 51-

52 infant development and, 52-53 personality organization and, 51 primary narcissism/infant omnipotence theory and, challenges to, 54-55, 5758, 59, 66, 72 psychoanalysis and, 52-53 psychoanalytic theory and, 49, 55 Infan tile personality disorder, 34 Insight, development of, 165 Intersubjectivity, 21 Introjection, 104, 133

J Jefferson, T., 157 Joblaud, C., 209-210 Jones, E., 1911 paper of, 159-160 Julius Rosenwald Fund, 163

databases, psychoanalytic situation and, 117 declarative, 103, 119-120 intelligence and, 105n procedural, 102-103, 119-120 retrieval of, I 08-109 transference and, 118 ways of knowing, neuroscientific observations, 102-103 Kohut, H., 246 bipolar self and, 205 Chicago Institute and, 180 hermeneutic philosophy and, 19 object ties and, 143-144 on pathological narcissism, 54 theory of the self, 53

L Lasswe II, H. physiological processes and, 164-166 Learning. see also Freud, S.; Mind/brain related topics-, Similarity judgment anxiety and, 106-108, 112 Gedo's developmental model. 134, 143 "learning windows" and, 95-96, 105-107,

112 neuroscience and, 9.5, 107 optimal Leaming, 132n psychoanalytic model, hypothetical, 109lll, 142 Rapaport's model, 103-105, 107, 134, 143 Libido, 189 Love/attachment, 49, 53 caregiving object, 50, 62-63 narcissism and, 62, 67, 72 self development and, 64-66


K MacChesney, C., on interview of H. Matisse, Kant, E., 36, 96, 132 epistemology and, 137-139, 149 Kavka,J., 161 Knowledge. see also Epistemology; Learning; Memory acquisition, 104-105, 131 belief systems and, 144-145

200-201 MacCurdy,J., 160

Machines WM Think (McCorduck), 10.5n McLean, F., 164 Mapping the Mind (Levin), 100 Mastery motivation, 52-53, 57 affective matching and, 58-59

Subject Index continuity of, 52 frustration/gratification and, 59-62 narcissism and, 59-61, 67, 72 Materialism. see Empiricism Matisse, H., 199-250 ambivalency of, 199-200, 208, 213, 215216, 22 l, 236,247 A. Parayre and, 210-211, 218-219, 221, 224,227,231-233,240 archaic problems of, mother-child unit and,205-206, 224,234,246-247 beginning ascent of (1902), 211-212 childhood,204-208 Joblaud and, 209-210 MacChesney on interview of, 200-201 conscious/unconscious struggles and, 201203 Conversation, Schneider on, 216-217 Duthuit on, 218 early studies of, 209-210 emotional distancing and, 199,204, 218219, 221,224,226, 235-236 erotic themes and, 215-216, 221-223, 228-230,234 on expression, 212 on first painting of, 208-209 on God, 246 Aragon on sensuality of, 228 Delectorskaya and, 233-234, 236-241, 247 love and, stylistic patterns and, 204 Bourgeois on, 241 Moroccan period, depression and, 218-219 Nice period, H. Darricarrere and, 224, 227-229,232 old age of, 240-242, 249 on painting women, 215 Picasso on, 201-202 the process of work and, anxiety and, 203204 purification through aestheticism and, 228229 relationship to father, 206, 216 on revelation, 244-245 Memory free association and, 109-110, 112-113 mind/brain activity and, 100-101 priming and, 109-110, 112 neuroscience and, 119, 129

263 remembering and, 108-109 representations and, 97 Merson, 0., 215 Meyer, A., 160 Miller, H., 229 Miller, M., on Freud, 20 Mind/brain activity, 95, 139. see also Mind/ brain related topics Aristotle and, 135 cognitive psychology and, 99 conneclionism (neural net theory) and, 99100 information processing and, 107 memory and, 100-101 neuroscience and, 99 psychoanalysis and, 140 representations and, 96-99 transference and, 142 Mind/brain databases, 133-134. see also Similarity judgment Mind/brain models, 125-126, 129, 142, 189 Gabriel's model, discriminative learning and, 123, 125 Hadley's model, the limbic system and, 122-123, l24f Kent's model, 121f priming/similarity judgment and, 122123f, 126-127 similarity judgment/transference and, 122 priming/similarity judgment and motivational states, 119, 126 subprocesses and their properties, 120t Mind, philosophy of. see Epistemology Minds of Men and Machines, The (Kent), 105n Mohr, G., 186 Moll, G., 215 Mother-child relationship, 41-42. see also Matisse, H. Murray,]., 68 Muse um of Modem Art, 20 l

N Narcissism. see also Infant research; Love/ attachment; Mastery motivation; Narcissistic pathology Freud on, 53

264 infant development and, 57, 66 pleasure in reciprocity and, 233 Narcissistic pathology. see also Infant development; Mastery motivation Kohuton,54 onset of, 56 psychoanalytic treatment implications, 6972 Rothstein on, 54 self development and, 53-54 Narcissistic personality disorder, 34, 40 Narcissistic transferences, selfobject transference and,53 Neuroscience learning and, 95, 107 mind/brain activity and, 99 priming and, 119, 129 psychology and, 118 representation and, 9.5, 96, 99 Neuroscientifi.c observations, knowledge and, 102-103 Neurotics, treatment of, 159 New York Psychoanalytic Institute, 164 Neyman, C., 173

0 Object loss, 104, 143 Object relations theory, 53 ego psychology and, 46-47 Obsessive-compulsive personality disorder, 35 Oedipus complex, 82-84 On Aphasia (Freud), 96, 101 Our Age of Unreason (Alexander), 169

p Pathological narcissism. see Narcissistic pathology Patrick, H., on psychoanalysis, 159-160 Perceptual organization, 119 Personality disorders, 44. see also Borderline personality disorder narcissistic, 34, 40 treatment of, hospitilization and, 35-36 type and severity, treatment of, 34-35

Subject Index Phemister, D., 164 Physiological processes, Lasswell and, 164166 Physiological systems, 172-1 73 Piaget,J., 100, 133 Picasso, P., 212, 219 on Matisse, 201-202 Piers, G., 155, 179, 186 Platonic idealism/vitalism, 136 Pollock, G., 175-176, 179-180 Primary process, 142 unconscious fantasies and, 20 Priming. see also Memory; Mind/brain models; Similarity judgment neuroscience and, 119, 129 Projection, 85 Psychiatry E. Schoolman and, 162-163 psychiatric community, Chicago Institute and, 164 Psychoanalysis. see also Hermeneutic philosophy Alexander on, 191 eating disorders and, 35, 38-39 ego theory and, 52-53 epistemology and, 139-140 history of. see Chicago Institute for Psychoanalysis infant research and, 52-53 mind/brain activity and, 140 neurosis and, 180 philosophy and, 177 science and, 178 self theory and, 52-53 Weltanschauung and, 140-141 Psychoanalytic education, R. Grinker, Sr. on, 186 Psychoanalytic institutes, 155 Psychoanalytic psychotherapy. see also Eating disorders psychopathic transference and, 40 Psychoanalytic situation knowledge databases and, 11 7 representation/learning and, 95-96 Psychoanalytic theory, 14. see also Developmental research; Leaming Chicago Institute and, 181, 189-190 Freud and, 142-143 hermeneutic viewpoint and, 30 infant research and, 49, 55

Subject Index linguistic trend in, 97 psychodynamic psychotherapy and, 180181 Psychoanalytic training, Chicago Institute and, 184-185 Psychoanalytic treatment narcissistic pathology and, 69-72 Psychodynamic psychotherapy, psychoanalytic theory and, 180-181 Psychological systems, 172-173 Psychology analytic, Stent on, 182 depth psychology, 181 neuroscience and, 118 similarity judgment and, 119, 129 Psychosomatic research, of Alexander, I 71173, 188 Psychotherapy, 159 analysis and, 181, 182 Putnam,]., 160

R Rapaport, D., 102, 133. see alro Learning Religion Freud and, 141, 144 science and Aristotle and, 135, 149 belief systems and, 144-145 Renoir, A., 224 Representation Bucci's models of, 97n cognitive psychology and, 96, 98- l 00 "connectionism" (neural net theory) and, 99-100 learning and, psychoanalytic situation and, 95-96 memory and, 97 mind/brain activity and, 96-99 neuroscience and, 95-96, 99 Response specificity theory, 173 Rothstein, A., on pathological narcissism, .54

265 Schoolman, E. Chicago Institute and, 161-162 psychiatry and, 162-163 Science. see alro Religion magic and, case study, 145-146 psychoanalysis and, 178 Scope of Psychoanalysis, The (Alexander), 191 Secondary process, 142 Seduction theory, 83-84 Seitz, P., 176 Self-cohesion, 53, 144, 205 Self development, 246. m also Infant development discontinuous, 20-21 love/ attachment and, 64-66 narcissistic pathology and, .53-54 Self-esteem, 53 Selfobjects, 19, 53, 224 Selfobject transference idealizing, I narcissistic transferences and, 53 Self-orientation, 68-69 Self psychology, 53 Self theory Kohut and, 53-54 psychoanalysis and, 52-53 Sexuality, 142 Similarity judgment. see also Cognitive psychology; Mind/brain models compared to transference, mind/brain databases and, 127-128 priming and, transference and, 101-102, 112, 118, 128-129, 134 psychology and, 119, 129 Social sciences, the, 13 Socratic idealism/vitalism, 136 Somatic symptoms, 172 Stein, G., 210,215 Stent, G., on analytic psychology, 182 Stern, A., 163 Subjective viewpoint of analysand, empathy and, 1-3 Subjectivity. see also Analysand analyst and, 2n

s T Sandler,]., on the "infant-as-agent," 64-65 Schneider, P., on Conversation, 216-217

Taneyhill, L., 160

266 Therapeutic alliance, 1 Transference. see also Eating disorders; Hermeneutic philosophy; Selfobject transference analyst/parent alliance and, 89-90 analytic relationship and, 21, 24-25 archaic, mother/father, 2-3 defense, 86 eating disorders and, 40 Freud and, 139, 142 knowledge and, transfer of, 118 priming and. see Similarity judgment psychopathic, 40 selfobject transference, I, 53 Tropic of Cancer {Miller), 229

Subject Index Unconscious conflicts, 46-4 7 Unconscious fantasies, primary process and, 20 University of Chicago, 163, 164

V Vegetative responses, 171-172

w Weltanschauungen, 140-141, 177 Western Mind in Transition, The (Alexander), 170



Unconscious, the, 142-143

Young, G., 160