The PANY Bulletin

Psychoanalytic Association of New York
Vol. 40, #1, Spring 2002

Doing Something in an Era of Nightmares
by Alice L. Maher, M.D.

I don't want to be an analyst any more.

That's not to say that I don't love psychoanalysis. I do. The analytic perspective changed my life in dramatic ways. I love the field and the people in it, and I desperately want to remain an active part of our community. I'm convinced that specific permutations of our model have the potential to contribute to societal change in ways that the field has yet to envision. But as an outgrowth of my personal struggle, both in analysis and in the unique "secret sharer" relationship that followed, I've reached certain conclusions about myself, and I've been stimulated by a set of questions about the field, that I can't adequately address if I'm trying to remain on the usual path.

Over time, I've become convinced that a huge and essential shift in the analytic paradigm needs to be made, and it needs to be made in a particular arena, using a specific new way of looking. Those of you who know my work, know that it's been about the nature of the creative process, a hidden but potent dynamic that I've related to the "love affair with the world" of audiences and children. As my life and work have evolved, I've concluded that the vector of my own passions leads me in that direction as well. I'd like to slowly transition away from work with individual patients—people who must, of necessity, remain separate from one another—and move toward embracing the problems of the community as a whole.

I'm referring to the recent and extraordinary panel on The Apocalyptic Imagination when I say that we do live in an era of nightmares. We as analysts need to stop daydreaming about it and actually make genuine attempts to change. I'd like to embark on a first, clumsy attempt.

This essay contains a summary of the problem as I see it, my view of the dynamic origins of that problem, and outlines of a new direction.

I'm convinced that the problems the field is having these days have less to do with bad press, managed care and insufficient marketing, and more to do with the fact that psychoanalysis has become defended against itself in significant ways. Despite well-rationalized protests to the contrary, the fact is that our multiple theoretical models are not internally coherent, and analysts espouse them for defensive as well as theoretical reasons. The outside world senses this internal disorder in the field, and is appropriately suspicious. As a group, we're regressing to subtle theoretical arguments and defensive "I'm OK, you're OK" positions in relation to our colleagues. Meanwhile we're not adequately addressing the real and important challenges presented to us by the outside world—people whom we're asking to hand over their lives, their time, their passions, and a very large percentage of their income.

The word "transference neurosis," which I was taught was the phenomenon that distinguished psychotherapy from psychoanalysis, is rapidly disappearing from the analytic lexicon. I fear that the field, despite its top-heavy theoretical framework, is slowly but inexorably moving in the direction of a merger with psychotherapy. Like motherless children, we've become too anxious, too guilty, too conflicted, and too fearful of our own power to be able to articulate new questions and to fight for theoretical synthesis, safely and together. We're not free enough, excited enough, or confident enough to make leaps of imagination, to genuinely excite and challenge each other, and to envision a synthetic paradigm and a clear path. We fear the dangers and we fear the beauty, so we stay safely, blindly, in the middle.

The dangers are real, much more so than most of us would like to admit. When analysts speak of "outcome studies," they refer to people whom they feel benefited from the process, and those who did not. The nature of that "lack of benefit" is rarely mentioned. The fact is that if psychoanalysis genuinely wants to be considered a science and a medical profession, it needs to study not just minute details of individual process notes, but the side effects and death rates that inevitably arise out of any potent medical treatment. I fear that the field would rather lose its potency than examine the dangers of possessing it.

Here are just a few examples from my own experience, with individuals not related to members of our Institute.
A dear friend committed suicide during his candidacy as his analyst continued to withhold medication, preferring to interpret aspects of his unconscious rage. A very successful man had a significant learning disability which was completely denied by his analyst. He emerged from the process with a sense that he possessed a defectiveness too horrifying even to be spoken about; he became seriously depressed and his career derailed. In adolescence, a woman experienced her analyst as interpreting everything in terms of her wish for his penis; she returned to treatment years later, still a virgin, terrified of men and penetration. Yet another woman adored her analyst so much that she married a man she didn't love so that she could make him proud, and later found herself attracted only to very old men. All of these people had very well respected training analysts, people whose names most of us would recognize. And what about all those generations of misunderstood homosexuals? If a surgeon amputates the wrong body part, "Oops, I made a mistake (the patient must have reminded me of my mother)" wouldn't be good enough, would it?

Analysts themselves often harbor very strong feelings about their own training experiences, with analysts and teachers who worked using decades-old perspectives and their unique personal interpretations of them. As things stand now, when we leave the nests of our analysts and move on into an ever-changing world, we're left to fly alone, with only the watchful eye of the Institute ensuring that we don't stray too far from the party line, too afraid that our questions and our differences will be perceived as rebelliousness, deficiency, or unresolved conflicts—a threat to the integrity of the community. Many of us live with anger, guilt, anxiety, mistrust, a too-strict, warded-off superego, and no safe place to play or to challenge. Or we feel the opposite—little or no passion; it's just a job description, as good or as bad as any other.

Just as we look away from the dangers, so too analysts have trouble actively confronting our beauty, perhaps even more so. People emerge from the wombs of the great analysts with a second chance for a new life, and that's something profound and extraordinary. But no one comes forth with those testimonials; our adopted and transformed children are rendered mute at the moment of their birth. As a field, we don't take enough pride in, and push hard enough to explore, the nature of our own greatness as it originates inside the unique personhood of the analytic artist; there's a way in which it seems forbidden even to imagine doing so.

Motherless children.
I maintain a powerful conviction that the anxiety and fragmentation that exist in the field today arose as an outgrowth of Freud's inability to imagine the nature and origin of his own creative drive and creative capacities, analyze that constellation, and integrate that understanding into his theoretical model.

Freud didn't change himself, or his patients, very much. He changed the world.

Freud utilized his relationship with Fleiss in a way that was very different from the transference paradigm that he offered to his students and his patients, and more like the "secret sharer" relationships that catalyze the creative productions of artists. He may have been analyzing aspects of his oedipal and preoedipal experiences during that period, but he wasn't mourning their loss in the same way that his analysands were expected to. In a sense, he was doing the opposite and "going for the gold." Freud had years of passionate intercourse with his parental substitute/analyst, and out of that union gave birth to psychoanalysis. He nurtured that creative product passionately throughout his life, constantly transforming his perspective, with flexibility and a unique cognitive style, as his infant paradigm developed and took on a life of its own.

But clearly, Freud much preferred to emphasize the "scientific" aspects of his creative vision. He didn't want to see those elements of his libido—and he probably shouldn't have, because it might have derailed the work. But in choosing that path, he divided his self-representation in half analyzing certain aspects of himself, while acting out and remaining blind to the dynamics that lay behind his passion and his genius. As a result, he was unable to integrate into his model a description of the drives, and the capacities, that motivate The Creator. He laid down his arms against the problem of the artist, and he had no idea what women wanted.

The children of psychoanalysis are suffering profoundly from that lack.

As a result of that laying down of arms against awareness of that aspect of himself, I believe that Freud set up a theoretical framework that doesn't allow room for genuine creativity to emerge in his children without very problematic compromises. In a sense, he unconsciously set up his model to ensure that his descendants could not transcend him without fragmenting. As a group, our freedom to dream has become massively constricted.

When analysts are on the couch, we're taught that every word we speak has infinite meaning. But outside of that arena, we're taught to value "critical thinking"—comparing and contrasting disembodied intellectual ideas. It's as if as soon as we emerge from the consulting room, our ideas are instantly divorced from our personhood—needing to exist, from that moment on only as neutral sublimations (or the alternative, unresolved pathological constructs). That may be true for some of us, but it's not true for those who have a genuine passion to create—to give new shape to a hidden potentiality.

Like Freud, analysts who are driven to present their ideas are often people who know some important things because of who they are, but who are unconsciously inclined to "lay down their arms" against other aspects of the problem for the same reason. (Kohut is a good example, as well as the individuals on all sides of the homosexuality debate.) This premature split between the personal and the intellectual interferes with the development and presentation of new ideas, as well as with the audience's freedom to actively reach to embrace them, or to struggle against them. This, in turn, interferes with the ability to deepen our understanding and synthesize differences.

Because psychoanalysis has no theory of creativity, it has no arena in which original ideas—ideas that arise out of our own bodies and our own dreams—can be given voice, explored and developed, safely and over time. There exists no forward-moving force, no mechanism for a new-and-improved unconscious fantasy to transition into, and actually become, a new reality.

This essay is not the place for me to develop and present my theory about the nature of that forward-moving force, but I can't resist briefly outlining it. It's a phenomenon that I would label (for want of a better, less adult and feminine-sounding word), a "maternal" instinct. It's a force that arises in infancy, in relation to language development, long before the concept "baby" and the idea of time exist in the psychic apparatus. It's the no-thingness that exists on the other side of the vaginal tunnel and the world of consciousness and language. It's a capacity that exists in both men and women, but there's a way in which anatomical differences contribute to the separation of woman's intuitive-emotional and language capacities from that of men in unique and fundamental ways.

That thing/no-thing duality, and the wish to reconcile it develops into a force that drives us to imagine newness and potentiality, to work to breathe life into those imaginings, and to nurture those dreams at the point that they emerge out of our bodies.

Analytic theory tends to speak of babies as "things" that a child either has or doesn't have, rather than as the end point of a complex, power-driven process, necessitating different modes of symbolization, different intuitive capacities, and a different form of love. The creation of new ideas arises out of a similar matrix.

I believe that human passions and abilities are directed toward men, women and children, in greater or lesser proportion. The drive to give birth to something new, to name it, and to love and nurture it, is an instinct that needs to exist on a theoretical par with sex and aggression as a motivating force in human nature.

The field of psychoanalysis needs to refind just the kind of potency that it originally imagined itself capable of, the potency that it deserves to have. But before it can do that, it needs to refind its "mother," its creator. Once that happens, it can take the risk of looking head on at its defenses against itself, and begin to play with possibilities. At that point, new answers and new syntheses won't be so terribly hard to find.

For example, if we can begin to think of the process as a kind of powerful medical "chemotherapy," then we simply have to find a way to identify risk factors and side effects as they emerge in the treatment, and a mechanism for addressing them without compromising the passionate engagement that results in genuine transformation. One possibility that immediately comes to mind might simply be a more detailed "informed consent" regarding the inevitable countertransference influences and theoretical biases that could potentially interfere with the process, spoken with confidence rather than apology. ("I will stand very firm in what I believe to be true, but if, over a significant period of time, my position continues to feel wrong to you, this is what it might imply, and this is what the next step should be…")

And what about exploring the way that Great Analysis transforms in the same way that we explore the way that Great Art transforms—with an "applied analytic" search for the origin of that gift from inside the body, the psychic apparatus, the personal history and the defensive structure of the Great Analysts? The human race longs to penetrate and devour things of great beauty, right? Perhaps the leap in understanding of the way that analysis transforms, and a technique for marketing it, won't arise out of research studies and comparisons of different theories, but by painting beautiful portraits of our own gifted people, and allowing the human race the freedom to imagine their existence.

Plus, if a "baby" transference could be added to the list of potential objects of desire, could we not unite the classical and the intersubjective models by looking at the rather scary "mind-reading" wishes and capacities that are essential if a person is to be able to respond to the communications of a "blank-screen" infant?

My point in presenting these rather provocative ideas right now is to say that simple, creative solutions exist, if only we could be freer to imagine them.

I could easily ramble on, but I hope I've demonstrated the fact that I need to make a huge leap right now. I want to write a book about psychoanalysis, demonstrate the way in which my ideas arose out of my own experience, and add this perspective to the analytic paradigm. Ultimately, my goal is to develop a new technique, a space for psychoanalytic "pregnancy." I'd like to coax the field into imagining an environment of safety wherein new ideas can develop and be challenged; a "play space" where difference and newness can be appropriately differentiated from unresolved psychopathology, without premature closure and without the "genetic defects" that arise from defense and inbreeding; a place where analysts can step outside the box without leaping into the abyss.

But until that happens, I can't continue to play the role of a priest preaching from the pulpit on Sunday mornings while questioning the existence of God the rest of the time. I feel too compromised and too closeted, and I can't grab the transference energy from my patients or the enthusiasm of the candidates if I have these kinds of questions about the nature of what I'm doing. I'd like to embody my own theory of newness, and work to carve out an original space for myself and my new way of looking—perhaps in the creation of a kind of "research faculty" or "scholar-in-residence" role, analogous to the "research candidate" track that presently exists for non-clinicians. I'd like to sit in on classes and committee meetings if I'm permitted to do so, and ask the rest of you to understand why I'm doing it, challenge the parts that don't make sense to you, open your minds to the parts that do, join me if you'd like, and respect me for making the attempt.

Addendum:
For reasons unknown to me, my analyst, Sanford Stevens, never got the usual PANY eulogy when he died at his home in Florida several years ago. I only found out when I accidentally noticed his name in the Times obituaries. I don't know anything about him at all, except as he existed, and still exists, in the back of my head. Nevertheless, I'd like to share my own personal "eulogy," which seems quite appropriate to do right now. It's a poem that I wrote at an American Psychoanalytic Association workshop on the poetry of Sharon Olds a few years ago. One could easily call it a creative "free association," since we were given just five minutes to write a poem of our own, on any topic, using her style and/or a theme or phrase from one of hers. I wrote this in four-and-a-half minutes, using the poems "Satan Says," and "When I Look Back."

When I look back on my analysis, I see honesty
The honesty of knowing what he didn't understand, and finding
a way to communicate it without suggesting that it was
my psychopathology or his countertransference
Before Satan arrived on the analytic scene, to free him and
confuse him as he has me.
I left without closure, thinking, Hey, it's OK if I don't have all
the things Freud said I had and all the things I was
taught I was supposed to have,
But I had something for which nobody else had words
Yet.

Like a necessarily "stupid" mother (who ought to unconsciously intuit rather than give conscious voice to her children's fantasies), Dr. Stevens recognized the existence of that wordless space inside of me, helped me to find it inside myself, and took a position in relation to it that stimulated an ongoing process. It was a position that provided me with the confidence to change my self-representation, 16 years post-termination, from analyst to artist. What I hope to accomplish may not work and I know that, but I'll be forever grateful to him for that gift.

It's a gift that may or may not have been labeled "real" analysis, but it's one that I've come to value tremendously. It's a gift that I'd like, eventually, to pass on to others.