Article: ‘Ontological Psychoanalysis or “What do you want to be when you grow up?”‘ by Thomas Ogden (2019)

In his 2019 paper, ‘Ontological Psychoanalysis or “What do you want to be when you grow up?”‘, Thomas Ogden describes two dimensions of psychoanalysis: epistemological psychoanalysis and ontological analysis. He is careful to point out that these dimensions frequently overlap, and neither ever exists in pure form, but that they do nevertheless involve quite different modes of therapeutic action. Epistemological psychoanalysis, as practiced by Freud and Klein, has to do with knowing and understanding; while ontological psychoanalysis, in Winnicott’s or Bion’s hands, is more concerned with being and becoming. The titular question, ‘What do you want to be when you grow up?’ is the key (but probably often implicit) question posed by the ontological analyst, and Ogden implies that the analysis is only approaching its goal once the patient is able to answer the question truthfully and wholeheartedly: ‘Myself’.

Though he never states it explicitly Ogden leans very heavily towards the ontological analysis side, which we infer from his wonderful descriptions of the ‘playing’ that both analyst and patient engage in. This conception of ‘playing’ Ogden gets from Winnicott, who describes it as a transitional experience, somewhere between fantasy and reality, whereby the child/patient and mother/analyst engage in an interaction in which it would make no sense for the mother/analyst to ask of the child/patient: ‘Did you conceive of this object or was it presented to you?’. Ogden suggests that therapeutic healing happens when the patient and analyst are able to play together from within the patient’s transference-countertransference enactments.

This is a very appealing idea, and Ogden describes some beautifully sensitive clinical cases to elucidate what he means by this joint form of playing within the analytic sessions.

I also loved Ogden’s description of the end goal of psychoanalytic therapy, what sounds to me like ideal psychological health:

“…for Winnicott and Bion, the most fundamental human need is that of being and becoming more fully oneself, which to my mind, involves becoming more fully present and alive to one’s thoughts, feelings and bodily states; becoming better able to sense one’s own unique creative potentials and finding forms in which to develop them; feeling that one is speaking one’s own ideas with a voice of one’s own; becoming a larger person (perhaps more generous, more compassionate, more loving, more open) in one’s relationships with others; developing more fully a humane and just value system and set of ethical standards; and so on.”

But I couldn’t help having the nagging thought that such a strong emphasis on ‘being and becoming more fully oneself’ might resonate more with Western audiences with their freedom- and self-actualisation-oriented moral compasses than other groups, and that it might be missing something as a result.

Listening to Distress

In his paper ‘Managing distress over time in psychotherapy: guiding the client in and through intense emotional work,’ Peter Muntigl (2020) explores how difficult it can be to respond well to clients’ disclosures of distress in therapy, but he focuses on the distress as experienced by the client, rather than what reactions this might provoke in the therapist. It assumes that the therapist is perfectly able to listen openly and evenly to the client’s distress, without having any subjective responses to it that might interfere with the therapeutic process. This is imagining the ‘ideal’ therapist; unfortunately, most therapists practicing today are far from this ideal – they are human, after all. Of course it goes without saying that it’s the psychological well-being of the client that takes priority in the therapeutic encounter, but I don’t think that goal will be reached if we ignore the challenges that face the therapist. If we don’t prepare ourselves for these challenges, we will be poor therapists! A study by Da Silva & Carvalho (2016) found that intense emotions experienced by medical clinicians while in the presence of their patients impacted the physical-patient relationship, so this is surely the case with mental health professionals (but I can’t seem to find the research outside of psychoanalytic case studies?).

The two difficulties identified by Muntigl are 1) The difficulty that therapists may have in responding to the client’s past or present feelings in an appropriately congruent manner – the therapist’s responses may not necessarily fit with client’s understandings of their distress. And 2) The therapist having to manage distress as it is occurs on potentially two levels: as it is reported (when the client tells of a distressing experience that happened in the past), and as it is expressed in the present (e.g. the client crying whilst telling of this past experience) – this 2^nd difficulty being, should the therapist attend to the presently felt distress, or explore what the past feelings of distress meant?

But I think more needs to be said about the first challenge that Muntigl identifies. He describes the difficulty that confronts the therapist as being, how to respond accurately to the client’s distress? How to find a way to validate their distress without seeming to confirm the helplessness that the distress might also signify for the client? “Therapists may sometimes need to individualize their response to best suit their client and to know when empathy is called for and when it is not” (pg. 2). And he writes of a related issue being: “The difficulty for therapists … to offer clients enough security through which they may risk more directly confronting their upsetting experience” (3). But while he describes the conversational tight-rope the therapist must tread in avoiding provoking the client’s displeasure or disagreement, we never hear about the countertransference responses that may or may not be occurring in the therapist. What internal conflicts might the therapist be dealing with as they listen to their patients distress? We must not pretend that these don’t exist, even in the best therapists who have been through years of intensive psychotherapy themselves.

I would be interested to read about how clinicians remain open to listening to reports and expressions of distress. We all know it’s hard to listen to someone telling us about a difficult experience – it provokes all kinds of reactions in us, both empathetic ones and those that are less so. I’m guessing, or hoping at least, that most therapists go into the profession because they want to support a patient’s healing process. So that initial motivation should be there, but that doesn’t necessarily make it easier to do so…

Has anyone read any good research on this subject? Nancy McWilliams, in her book Psychoanalytic Diagnosis, writes of the various countertransference feelings that frequently arise in response to different presenting problems (e.g. clients with narcissism provoking feelings of boredom or frustration in their therapists), but I would love to read further on how exactly therapists overcome these countertransference reactions…

I’m guessing that alongside having had your own intensive psychotherapy, another answer to this question might be having regular supervision – a place where you yourself can go to ‘off-load’. But I think other, micro things must be going on in the therapists’ minds to regulate these difficult countertransference reactions, and I would love to know more about them!

References

Da Silva, J. V., & Carvalho, I. (2016). Physicians experiencing intense emotions while seeing their patients: what happens?. The Permanente Journal, 20(3).

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process. Guilford Press.

Muntigl, P. (2020). Managing distress over time in psychotherapy: guiding the client in and through intense emotional work. Frontiers in psychology, 10, 3052.

Schopenhauer’s Porcupines – by Deborah Anna Luepnitz

For anyone wanting to understand how psychoanalytic psychotherapy works from within the consulting room, this book is brilliant. Whilst telling the intimate and detailed stories of work with her patients (who have all consented to her doing so, of course), Dr Luepnitz also draws on and elucidates complex psychoanalytic concepts from Winnicott, Freud, and Lacan, without it feeling tacked on or dryly pedagogical.

It is quite clear that these concepts are no longer cloistered within psychoanalytic circles. I am sure that most experienced practitioners, of all psychotherapeutic types, are fully aware of and sensitive to the ‘transference’, ‘splitting’, and ‘projective identification’ dynamics (to name a few…) that arise in their therapeutic work.

But what I think makes this book so special is how it demonstrates how psychoanalytic work not only brought to light and labelled these processes, but how the bulk of its therapeutic power lies in directly working with and through those processes as they arise within the therapeutic encounter. Dr Luepnitz guides us through not only what happened in her work with her patients, but also gives us the most admirable and diligent example of self-reflexivity by the therapist. Nothing she felt, said, or did, with her clients was left un-considered. And we see in each example, especially, how precisely that care and thought that she gave these experiences was what lead to the therapeutic ‘breakthrough’ and resulted in significant benefit to the patient.

For an example, with a Black female patient called Pearl, Dr Luepnitz finds herself wanting to break her policy of requiring patients to pay for missed sessions, with the thought: ‘How can I charge this poor black woman?’, but with reflection she then realises that this was more of a counter-transference problem on her behalf, a ‘simple rescue fantasy,’ and not one that she should act on, for the mutual benefit of both parties. I will quote at length now, as I don’t think these dilemmas could be worded more clearly:

‘As we have seen in other cases, a “resistance” to making the unconscious conscious belongs to the therapist as well as to the patient. For both, there is a yes and a no, always. I saw my not charging Pearl as a bit of resistance to doing the work. That is, sensing that Pearl was expressing anger or resentment through her no-shows, I nonetheless chose to let them pass, rather than invite her criticism. It was an act of self-protection. […] All therapists at some moment with every patient construct a kind of protective lining to shield themselves from what is going on in the patient’s head. One wants to know and yet also does not want to know… Unique to psychoanalytic training is the emphasis on disciplining oneself to face rather than disavow one’s resistances.’  (193-194)

Undoubtedly, and as she herself admits at the beginning, the limitation to this case-study approach is that she’s only describing the ‘positive cases’. It is unlikely that someone who got no benefit from her treatment and had a terrible experience would then agree to her publishing the details of their analysis. So, this book doesn’t go any way in proving or even supporting the idea that psychoanalytic psychotherapy is better or worse than any other kind. But I think we all have much to learn by seeing such honest and detailed therapeutic work between such a remarkable analyst and her equally remarkable patients.

Working towards What?

Do you know what your goals are? And if so, are you certain that if you achieved them you would be happier, or more satisfied, than you are now?

I think many of us might answer negatively to at least one of those questions, and I’m surprised that CBT thinks that most of us know what our goals are, but that we just have difficulty working towards them.

I’m closer to thinking that most of us would be able to work towards goals that we have identified that are meaningful to us (they would be inherently aligned with us and therefore more likely to be motivating), but our difficulty is more often rather in identifying what is important to us.

So while CBT sounds like it’s a therapy that believes in the agency of the individual, I think more exploratory approaches like psychoanalysis or psychodynamic approaches have more faith in the individual’s agency to achieve their goals.
CBT assumes that we know what our goals are, just need help achieving them with a boost of willpower.
Psychoanalysis assumes that we are pretty good at going after what we want, but we often need help clarifying and unearthing those ‘truer’ or more authentic values and goals.

What sparked this thought was a guilty feeling, because I have recently started twice-weekly psychoanalysis, whilst clinician-me delivers six 30-minute sessions of Low Intensity CBT to clients suffering from similar (if not far more debilitating) mental health difficulties than patient-me. I know that if I switched roles, if I approached myself as PWP, and was told by PWP me to identify ‘Goals’ to work towards across 6 weeks in ‘therapy’, I’d be stumped. It would be totally meaningless, and potentially even distressing. What I am beginning to identify – slowly, tentatively – in psychoanalysis, is that sometimes seeking and going after goals is a blind race towards, or perhaps more accurately away from, something else as-yet-unidentified. And we don’t necessarily know what we should be striving towards or moving away from until we have stopped for a moment to reflect, and I don’t mean for a matter of moments or even days, but a stretched-out kind of reflection that happens best in the presence of a non-judgemental other. I think I am learning that healing (sometimes) can come from a moment of pause, or stillness, where for a couple of times a week you don’t need to press forward towards an unending improvement.

Admittedly, this will not apply to everyone. Despite my belief to the contrary, many of my clients say that they have found our sessions helpful and they even seem to ‘recover’ as according to the PHQ-9 and GAD-7. So, clearly, the approach taken by psychoanalysis as opposite to CBT is not for everyone, sometimes we do just need that boost of motivation, or a few handy techniques for stopping worrying so much. But maybe it’s a question then of time of life, sometimes we need CBT goal-oriented help, and at other times we need just a space to think and speak.

Brief Interpersonal Dynamic Therapy

 

Though working in IAPT, a CBT-dominant mental health service, if you have read any of my posts before you’ll know that my temperament aligns far more naturally with the dynamic, interpersonal and exploratory therapeutic modalities. This means I often find myself in unpleasant moral dilemmas where I worry that I am short-changing my clients by sticking faithfully to the ‘Behavioural Activation Protocol’, but have zero other training that could better guide me with my clients.

So, I’ve started to read the textbooks of other psychotherapies, for some pointers of what kind of approach I have a better fit with, and to inspire ideas as to where my career path goes next…

The first book I’ve finished is Alessandra Lemma, Mary Target & Peter Fonagy’s Brief Dynamic Interpersonal Therapy: A Clinician’s Guide (2011), and it felt like balm to my CBT-crushed soul. The book is a treatment manual for practicing clinicians to deliver short-term, focussed, psychodynamic therapy for complex cases of depression and anxiety. (And they define short-term as 16 sessions! What would they call my 6 thirty-minute IAPT sessions I wonder?).

This is an interesting concept, because psychodynamic clinicians are usually allergic to manuals and time-constraints, seeing the complexity and variety of human nature as bound to doom any standardised approach to failure.

There are three key points about this kind of therapy that make it far more appealing to me than CBT.

Firstly, the importance given to interpersonal processes, both past and present. DIT structures itself around an Interpersonal-Affective Focus (IPAF), which it does by identifying one dominant and recurring unconscious interpersonal pattern. For example, an individual might find that, for whatever reason, they tend to see themselves as ‘a flawed woman’ and significant others as ‘critical and superior’, which, played out enough times in various relationships, would quite naturally lead to depressive symptoms. The logic behind this is the idea that because we are social animals that depend so strongly on others, most forms of psychological distress will likely be caused by, and then maintained, in some disrupted interpersonal functioning. Maybe we experience some form of interpersonal trauma, which then makes us fearful of getting emotionally close to someone, so we withdraw, but then feel lonely and depressed. From my limited clinical experience thus far, it does seem like the vast majority of psychological distress is usually due to, or resulting in, problems in relationships. Because of this focus, a key DIT technique involves working within the transference relationship, as this is a ‘live’ relationship in which those patterns are likely to surface, and hence can be a useful place to begin exploring those patterns in a safe and non-judgemental space.

Second, the attention to affect. To most fruitfully use the transference and countertransference processes that occur within the therapeutic relationship, DIT takes a far more detailed and exploratory approach to the individual’s affect on a moment-by-moment basis during the sessions, as these affects are likely to give important clues about their interpersonal patterns. The thought here is that the better able we are at identifying our affects, the more control we will have over them in future, as we might be able to shift the perspective and not get so wrapped up in the more automatic/unconscious affective patterns that might otherwise control us.

And third, the move away from symptoms and towards a more holistic view of what makes a life worth living. (The absence of symptoms does not a meaningful life make!) DIT understands symptoms as existing further along the line from where the problem started. Symptoms, such as anxiety or panic, might be manifestations of faulty interpersonal/affective patterns as they are enacted in situations that are not well suited to them, so are more like the tip of the iceberg. CBT approaches tend to treat panic symptoms as if that were the only thing going on in that person’s internal world (they might well be), whereas psychodynamic approaches are more interested in why and how that symptom started. They attend more to an individual’s underlying personality structure, which typically might not even bring a person into therapy in the first place (most of us take our personality as a given). The idea here is that by working at the deeper levels of human psychology, the therapeutic benefits will hopefully be more long-lasting, as the anxiety or panic won’t just pop up later on in another form. I think this narrow attention of CBT on presenting symptoms only, especially the low-intensity CBT in IAPT, might explain the 50% relapse rates (within a year) of the clients who ‘recover’. And we must not forget that those clients who ‘recover’ are only ~50% of those ‘completing’ treatment.

I’ll finish this post with a quote from the book summarising the main aims of DIT, being to:

• ‘Identify what he/she feels, encouraging the patient to stay with a current feeling as it emerges in the session.
• Communicate what he/she feels more effectively.
• Build greater facility in connecting his/her feelings, thoughts, and actions, and how these relate to others’ internal states and behaviour.

The therapist thus strives to help the patient to identify the way in which his/her feelings are guided by the particular self and other representation that is activated in a given relationship. The patient’s conscious affect, though important given that this is what the patient feel’s troubled by … may yet conceal latent affect that may be even more disturbing to the patient.’ (pg. 158).

Avoiding Advice

Something I’ve been struggling with in my Psychological Wellbeing Practitioner training and clinical work so far is that we are told that the ‘therapy is in the materials’ rather than in ourselves as clinicians. Our role is to guide our clients through self-help material that is appropriate to their psychological distress, and help them to problem-solve any difficulties that they might have along the way. Rightfully, due to our lack of training in delivering any kind of therapy proper, we are told to concentrate on the CBT-based tools and techniques that we are supposed to be imparting to our clients. It is (also rightfully) emphasised to us that the focus should be on ‘collaboration’ rather than any kind of didacticism in our delivery.

However, it feels that by focusing so much on the content and tools that we are providing our clients with, I too easily slip into ‘offering advice’, which I think is usually so antithetical to any kind of meaningful therapeutic intervention! I really do try not to do it, but find myself on occasion saying, ‘What about trying this…’, when discussing how to change a sleep routine, for example. (I feel no temptation to offer any more significant life advice, thank god). One way around this that our supervisors have recommended is to ask questions based on the materials/information you’ve given your client, for example, ‘Why do you think I asked you to read that Booklet?’, ‘Can you explain to me the rationale behind Behavioural Activation?’. But I think those questions can be useful to check or consolidate learning, rather than genuinely encouraging the client to arrive at their own conclusions and answers…

I think this is related to my major qualm with CBT-based approaches in general, the fact that though they profess themselves to be less hierarchical than psychoanalytic or psychodynamic approaches are seen to be (in that old-fashioned idea of psychoanalyst having all the answers but remaining silent), they can end up being more unequal in power dynamics. In the psychoanalytic approach, regardless of whether the analyst thinks she has all the answers, she at least gives the patient space to think things through in their own way, following their own patterns of thought, rather than shoving tips and tricks down their throat in a limited number of sessions. The CBT clinician can end up asking patronising questions (like those above, ‘Can you confirm that you’ve understood all the information I have imparted to you today?’), rather than genuinely engaging with the client’s way of understanding the world, and taking it on its own terms. The CBT clinician is Wise Teacher, who benevolently takes on board the patient’s particular life circumstances to adapt the techniques to them, but nevertheless remains the one with all the information the client needs to live a better life. I guess these power dynamics risk becoming problematic in all kinds of therapies, because essentially, the client is coming to a trained ‘expert’ for help. But I think it’s important that we remind ourselves of the pitfalls of this kind of imbalance as often as possible, and do everything we can to stop offering advice. I’m mainly speaking to myself here.

Book Review: ‘Man’s Search for Meaning’ by Viktor Frankl

This book is divided into two parts. The first part is an autobiographical account of Viktor Frankl’s time in concentration camps during the second World War, and the second part is a more academic exposition of the type of psychotherapy that he created, Logotherapy.

He begins the book with an admission that ‘This book does not claim to be an account of the facts’, which is an interesting start, given that I think most people opening a book about the Holocaust are going into it prepared to be smacked in the face with some cold hard truths, and (hopefully) a willingness to take the survivors’ at their word. My comment isn’t to suggest that Frankl is painting a fictional picture, but he is reminding us that even factual accounts of events, especially those involving immense suffering, will always be shot through with the strong emotions colouring a first-person account. Which makes it then all the more surprising, and initially disorienting, to find in the pages that follow an absence of emotion, to the point where it can feel quite like watching a scientist observing the facts. This is soon explained however, when Frankl writes that: ‘Cold curiosity predominated in even in Auschwitz, somehow detaching the mind from its surroundings, which came to be regarded with a kind of objectivity’ (29). He describes this as a self-preservation mechanism, and we come closer to understanding just what happens at the limit of human cruelty and suffering experienced in concentration camps all over the world.

What the book goes on to teach us, is that positive transformation can be achieved even through the most horrendous experiences of suffering. This is a hard idea to take. Our immediate reaction might be to reject that kind of inhumane suffering forthright as an absolute evil (which it is), but what Frankl pushes us to confront is the possibility that so long as someone is still alive, there is still hope. Something can be made of the situation, even if it is only a kind of ‘spiritual’ and inner transformation. And what he wants us to take from that fact, those of us so far from having any comparable kind of experience of hardship, is that our experiences of difficulty can also be transformed into something meaningful and positive. This is another surprising move of the book – as we might feel uncomfortable trying to place the two different kinds of suffering side by side in this way – especially when ours might feel trivial in comparison.

But that is exactly what he asks us to do, to use his experience as something we can learn from to live our lives in more meaningful ways. And this is how we arrive at Part 2, on Logotherapy, which is a therapy designed to help the individual discover, and live by, the unique meaning that they can create for their lives. Frankl explains that there are three different ways we can discover meaning: ‘(1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering’ (155). (Note the importance of the word ‘unavoidable’ to qualify suffering here, Frankl is adamant that self-inflicted suffering is masochism, without the potential for self-actualization). Where logotherapy differs from Freudian psychoanalysis is that according to Logotherapy, ‘man’s search for meaning is the primary motivation in his life and not a “secondary rationalisation” of instinctual drives’ (105), and this has close links with Nietzsche’s idea of the will to power – but Frankl edits the phrase to will to meaning.

The first way we discover meaning, ‘creating a work or doing a deed’, is fairly self-explanatory and well-established, so Frankl doesn’t dwell on it. The second, ‘experiencing something or encountering someone’, Frankl explains by delving into the meaning of love: ‘Love is the only way to grasp another human being in the innermost core of his personality … by his love, the loving person enables the beloved person to actualise these potentialities’ (116). I think it is still an open question as to whether this kind of ‘therapeutic’ love can exist within a psychotherapeutic relationship (my inclination is towards the negative), but that’s something I’ll write about in a future post. It sounds like Frankl is talking predominantly about real-world love experiences here, so maybe he’d agree with me. The third way to find meaning, ‘through suffering,’ is what Part 1 had described for us, as he was somehow able to transform his experience of suffering into something with meaning. However, I would like to tentatively suggest that perhaps point 1 (‘creating a work or doing a deed’) also has a role to play in what enabled Frankl to find meaning through suffering (point 3). From what we learn in the autobiographical part of his book, it seems as though Frankl’s role as a doctor towards the end of his time in the camps was at least partially what helped him survive, both physically and psychologically. At one point, given the chance to escape, Frankl decides to stay in the camp hospital and tend to his dying patients.

I like the idea of life as guided by those three ways of creating meaning: Works and deeds, experiences and relationships, and the strength to try to step back from our suffering to see what good can come of it, even if that might only be an increased ability to empathise.

I’ll finish by sharing some of my favourite quotes from the book:

‘Yes, a man can get used to anything, but do not ask us how.’ (30)

‘An abnormal reaction to an abnormal situation is normal behaviour.’ (32)

‘A thought transfixed me: for the first time in my life I saw the truth as it is set into song by so many poets, proclaimed as the final wisdom by so many thinkers. The truth – that love is the ultimate and highest goal to which man can aspire.’ (49)

‘This intensification of inner life helped the prisoner find a refuge from the emptiness, desolation and spiritual poverty of his experience, by letting him escape into the past.’ (50)

‘Humour was another of the soul’s weapons in the fight for self-preservation. It is well known that humour, more than anything else in the human make-up, can afford an aloofness and an ability to rise above any situation, even if only for a few seconds.’ (54)

‘Suffering completely fills the human soul and conscious mind, no matter whether the suffering is great or little. Therefore the “size” of human suffering is absolutely relative. It also follows that a very trifling thing can cause the greatest of joys.’ (55)

‘No man should judge unless he asks himself in absolute honesty whether in a similar situation he might not have done the same.’ (58)

‘The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity – even under the most difficult circumstances – to add deeper meaning to his life.’ (76)

‘It is a peculiarity of man that he can only live by looking to the future – sub specie aeternitatis.’ (81)

‘Thus it can seem that mental health is based on a certain degree of tension, the tension between what one has already achieved and what one still ought to accomplish […] What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task. What he needs is not the discharge or tension at any cost but the call of a potential meaning waiting to be fulfilled by him.’ (110)

Book Review: ‘The Adolescent Psyche’ by Richard Frankel

This book is filled with wisdom, and I think it would be helpful for any mental health professional working with adolescents (regardless of their preferred brand of therapeutic approach) so I’ll attempt to summarise its main points:

The Freudian psychoanalysts were wrong to treat adolescence as primarily a return to infantile id drives/impulses (only with different conflicts against a more strongly developed superego), and instead it should be seen on its own terms, as a distinct developmental period. We should take the transformations of puberty and the tumultuousness of the experience as meaningful in itself, and with its own progressive functions (telos), rather than as some kind of a backward step. And to do this we should use a phenomenological approach, staying close to the actual experiences of adolescents, rather than theoretically hypothesising what we think is happening…

The best starting point for understanding adolescence is seeing it as time of paradox and conflict – the adolescent is pulled in both ways at once: back towards its childhood, but also towards adulthood and the wider social world (beyond the family unit). This paradoxical position, or point of tension, defines what it is like to be an adolescent. Adolescents are both a child and an adult at once, and they are constantly negotiating between the archetypes representing these: the puer (youth) and the senex (older adult). What I think Frankel takes from Donald Winnicott is also the idea that the boldness and bravery of adolescence is something society needs as a creative and refreshing force; we should appreciate their ‘fierce and stubborn morality’ and their way of refusing ‘false solutions’. Winnicott wrote somewhere that ‘Infinite potential is youth’s precious and fleeting possession’. What typically society tends to dislike about adolescence is something that we should rather appreciate and value in itself – ‘Could we imagine that the instinctual turmoil of adolescence creates a special sensitivity and receptivity to the world and that this can manifest in the pleasure with which ideas are entertained, engaged and undertaken?’ (98)

Adolescents in our era have a particularly difficult time also because there are no, or few, community-organised initiatory rites designed to mark the transition period. Primitive societies usually did have some kind of ritual/initiation designed to mark the young person’s entry into the adult world, which meant that it could be a fairly quick and organised process. Frankel quotes Michael Ventura here: ‘Tribal adults didn’t run from this moment in their children as we do; they celebrated it. They would assault their adolescents with, quite literally, holy terror: rituals that had been kept secret from the young till that moment – rituals that focused upon the young all the light and darkness of their tribe’s collective psyche, all its sense of mystery, all its questions, and all the stories told both to contain and answer those questions’ (69). Because these initiatory rites are an ‘archetypal human need’, our adolescents can’t just skip them, but rather must invent a kind of replacement for these community-organised ones on their own, and evidence of their attempts can be seen in youth gang culture, self-mutilation, substance-abuse, and impulsive/risky sexual behaviour.

Frankel offers Jung’s insights as more helpful and relevant to working with adolescents than Freud’s, primarily because Jung sees the self as a ‘self-regulating system’ (5), in contrast to Freud’s Id which is always in need of externally-imposed prohibitory forces. If parents and clinicians of adolescents remember that the best way to stop someone – particularly an adolescent – doing something unhelpful is to speak to with their own ‘inhibitory’ sense, and get them to arrive at the desire not to do it themselves (rather than simply acting as that external prohibitory force), then they’ll be better able to help them.

Final point that I want to share is Frankel’s suggestion that art and cultural artefacts should have a much larger role to play in clinical work with adolescents. In connection to the idea that inhibitory forces must be engaged with adolescents having a particularly difficult time, Frankel writes that: ‘The inhibition of action produces imagination. Experiencing an inhibition is feeling into the imaginative pattern that contains the impulse towards action. Engaging an instinctual impulse imaginally, feeling where it is rooted in the body, may reduce the need literally to take action. Thus imagination is one of the most effective tools we have in working with adolescents who are prone to impulsive behaviour.’ (169) In order to connect meaningfully with adolescents, we must be prepared to meet them on their own level, which might not necessarily be the ‘literal’ adult world. We must instead stay empathetically attuned to the deeper meanings in their narratives – and art might provide that fruitful meeting-ground.

Book Review: ‘Re-Visioning Psychology’ by James Hillman

If a book had the power to redeem 2020 for me, this one would be it. It’s so refreshing to read a book that manages to change your mindset or show you old things in a new and surprising way, and this one succeeds at both. At the same time, the book gave form and substance to ideas that had been floating around my mind since my disillusionment with psychology (as it is typically taught) during my undergraduate degree and beyond. It reminded me of one of my favourite quotes of Montaigne: ‘We are all patchwork, and so shapeless and diverse in composition that each bit, each moment, plays its own game.’ 

James Hillman was a psychologist and Jungian psychotherapist who founded the movement of ‘archetypal psychology’. The approach is an invigorating blend of philosophy, religion, myth, art, history, classicism, literature, depth psychology, rhetoric, and more…  

The general idea of the book – if it could be summarised easily, which it cannot – is that we humans are both myth-makers and made-by-myths. There is not one ‘I’ within us that directs and controls us, nor something so coherent as an ‘ego’ à la Freud. Hillman complains that ‘diversification of personality, and its differentiation and vivification have been suppressed. “Integration of personality” has become the moral task of psychotherapeutics.’ (2) Instead, we are better thought of as a composite of various mythical archetypes or Gods that have been carried through culture down the ages, and at times we are led by some more than others. Some situations call for certain Gods rather than others, as all are characters each with their own strengths and weaknesses, and a distinct way-of-being. Before I go further, it is worth noting that none of this should be taken literally – literalism is one of the most insidious culprits that Hillman identifies as holding too much power in our era, and that is why he relies on the Ancient Greek mythical personas as the ‘archetypes’ that govern our soul. Hillman defines archetypes in a helpful way for those of us unfamiliar with Jung’s work, as ‘the deepest patterns of psychic functioning, the roots of the soul governing the perspectives we have of ourselves and the world.’ (xix). 

For psychology to return to ‘the soul’, we must remain cognizant of the power each of these various Gods holds within ourselves and allow each space to exist freely, and in relation with the others. That is the benefit of both dreams and pathologies, both give voice to the characters that typically we may suppress when we aim for an integrated (but false) ‘wholeness’ under the ego or subjective ‘I’. I found this idea hugely liberating, and therapeutic in itself somehow. Thinking of our psychopathologies as means through which our internal ‘Gods’ are communicating with us to alert us to some kind of mis-alignment either within ourselves, or between ourselves and our environment, felt novel and comforting. The idea lets us both try to cure or resolve the conflict while allowing us to accept it on its own terms. His own words capturing the role our psychopathologies play are more bombastic, which makes for far more exciting reading: ‘do not forgive me the means by which the divine powers connect and become real: my complexes, which are my sacrifices to these powers … Forgiveness of the confusions in which I am submerged, the wounds that give me eyes to see with, the errant and renegade in my behaviour, blots out the Gods’ main route of access.’ (186) 

Hillman’s approach in general also aligned with my feeling that psychology as a discipline had lost some of the creativity that is necessary to capture the immense complexity and richness that each of us hold within us. That was precisely why I turned to studying literature at postgraduate level after my undergraduate degree in psychology – and I was unsurprised to find that Hillman too had an academic background in literature. But literature and the arts are by no means the only disciplines that can enrich psychology, psychology can only gain by incorporating concepts and approaches from other disciplines, if only because humans (with other interests) are its subject.  

There is far more in the book than I can adequately capture in one post, so I do really urge you to find a copy of this book and read it for yourselves.  

Which book has been your favourite of 2020? 

Book Review – ‘Madness and Modernism’ by Louis Sass (2017 Ed.)

This ground-breaking work revises traditional understandings of schizophrenia as ‘a form of encroaching dementia, regression, or dominance by instinct and the irrational’ and instead views it as ‘involving unusual forms of self-consciousness together with associated alienation and withdrawal – not only from the surrounding world and other human beings, but also from one’s own thoughts, feelings, and bodily presence.’ (Preface).

It is a work of ‘comparative phenomenology,’ which uses modernist art and literature as a tool to help us better understand schizophrenia. By placing both next to each other, Sass draws out some striking similarities to illuminate a potential logic that might underpin them both.

Sass argues that both modernist art and schizophrenia can be understood as evidencing ‘hyperreflexivity’ and a concomitant ‘alienation’. The range of material that he covers, and the detailed analyses of case studies of individuals with schizophrenia, make this book a brilliant attempt at better understanding a mental disorder that has, since its conception, baffled psychiatrists and researchers.  

My own academic background is in both psychology and literature, so I was extremely excited to see the disciplines used productively together to help us understand, phenomenologically, madness – and, by bringing its opposite into relief, sanity as well. Sass doesn’t try to explain the aetiology of schizophrenia, other than gesturing towards the likely conclusion that it will involve several primary and secondary factors, in unpredictable combinations, and this is a good thing. His aim is to understand, rather than explain, and this book does a fantastic job in making sense of symptoms and behaviours that have typically been distinctive by their complete incomprehensibility. I thoroughly recommend this book to anyone interested in phenomenological psychopathology and/or modernist art.

I’d be very interested to know whether any other scholar has attempted a study of contemporary, 21^st century art and thought, in its relation to another form of madness? It seems that Sass is right in identifying the parallels between 20^th century modernist art and schizophrenia, but times have changed, and I wonder what the contemporary parallel could be? The present day has moved interestingly away from the ‘modernist/postmodernist’ zeitgeist that Sass studied, into new territory, and I think one deserving the same kind of scrutiny that Sass gave the 20^th century!