Wrestling with Destiny

The promise of psychoanalysis

Lucy Holmes

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135627959
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Can psychoanalysis help people control their destinies?

Using empirical evidence from neuroscience, Lucy Holmes makes a powerful argument that it can. This book considers the various ways in which destiny is linked to the repetition compulsion, and how free association in psychoanalysis can literally change the mind in ways that can help people reshape and take control of the future. Freud's psychoanalysis is revealed here to be startlingly modern in its consonance with the latest findings in the study of the brain.

The compulsion to repeat can propel human beings toward destinies they would never have consciously chosen. The tenacity of this human tendency can inhibit our ability to meet life's challenges. These challenges include our gender; an inability to master the complexities of loving and the strains of marriage; fears regarding the impertinence of being successful; the unconscious, reptilian pleasure we derive from going to war and raping the planet; and the inexorable decline and decay of our mortal flesh.

This book argues that the evolved talking that occurs in the psychoanalytic process can change the chemistry and structure of the brain in a way that helps the talker face these challenges and take charge of his or her own destiny. The author presents a cogent hypothesis spanning brain and mind to clarify how the basic rule of psychoanalysis - "just say everything" - can actually cure. This will appeal to mental health professionals such as psychoanalysts and psychotherapists, and students at the post-graduate level, as well as the general interested reader.

1

WHY TALKING CURES

People whose lives are not going the way they would like them to, often come to my office for a consultation, and at some point during the interview, ask me how I can possibly help them change their destinies. I usually tell them, “talking helps.” More than not, this thought is met with profound mistrust. The potential patient will say something like “I hope you’re not one of those therapists who doesn’t say anything. I’m not paying you to listen to me talk. I could do that with a tape recorder.” These skeptics want my guidance, my advice, the solution to their problems or the secret to happiness, which they seem to fantasize I am willfully withholding from them. They doubt my competence and my ethics if all I am going to do is sit there and try to understand them. For years, when potential patients questioned the psychoanalytic process or refused to lie on the couch, I questioned myself. Their misgivings made me feel like a fraud.

I am a little more experienced now. After almost thirty years of working with psychoanalytic patients and conducting extensive research on my successes and my failures, I can say with some conviction that Freud was right all along. Saying everything is the key to a successful analysis, and the best weapon we have in our battle with destiny and the repetition compulsion.

When I consider the patients that I have been able to help, I realize that all these talkative success stories have had one thing in common: they all had practically no resistance to speaking freely – but for very different reasons. A woman I’ll call Sherri, who has been my patient for twenty-five years, is an ambulatory schizophrenic. She comes in for her session, immediately gets on the couch and talks nonstop for the full fifty minutes. She doesn’t like me to interrupt her. Indeed, when I ask a question, she stops talking and looks very distressed. For twenty-five years, I don’t think I have said more than a hundred words to her. For the first few years, Sherri’s talk was mostly what we call “word salad,” the incomprehensible meanderings of psychosis. She did make me understand that she was a single mother and had a young son named Jake. She came to treatment because she had turned a full can of paint over the infant boy’s head, very nearly killing him. Sherri and Jake were alone in the world. The boy’s father was a very wealthy man with whom Sherri had spent one night. In the third year of treatment, still babbling nonsense on the couch, Sherri went to court and won a monthly settlement from this man for child support. He was furious, but DNA testing confirmed that he was indeed Jake’s father, and he paid. In the fourth year of treatment, when the boy was almost five years old, Sherri contacted Jake’s paternal grandmother. She knew that Jake’s father was an only child, and that Jake was his only child. She wrote the grandmother a letter introducing her to Jake, her only grandchild, and enclosed pictures of the boy, who was adorable. She included drawings Jake had made in kindergarten. This began a ten-year relationship with the grandmother. The old woman encouraged her son to get to know his son Jake. She paid the tuition for private school for the boy, and when she died, she left Sherri and Jake enough money to put the boy through an excellent college.

It was when the grandmother died that Sherri began to make more sense in the sessions. She had come to love this woman, and grief seemed to make her coherent. She mourned, and she worried about what her life was going to be like when Jake went off to college, and she was all alone. Though she was much less psychotic, she still made it very clear that she wanted no contact from me. I sat in silence while Sherri talked, went back to school, and got a job as a temp of some kind in a neighborhood public school. She will be finishing her master’s degree this year and hopes to get a permanent job as a full-time teacher in this school in September. I’m sure she’ll do it – they love her there and think she is charmingly eccentric and rather gifted in relating to the children.

I am quite proud of this case. I consider Sherri one of my great victories in the war against an unhappy and entrenched fate, though I didn’t do anything except stay out of her way and try to understand her. I am convinced she made such phenomenal progress because she is conflict-free about talking.

Another talker who has demonstrated dramatic growth in analysis is a patient I worked with as a student and for ten years after I finished my studies. I wrote a paper about the case (Holmes, 2002). This man had a fascination with death. He loved to dream about it, witness it and act it out in various ways. For years, he tried to kill me off in the session by speaking in a deadly flat monotone. He droned on and on, and like Sherri, he wanted no contact with me. Indeed, the schizoid, unstoppable verbiage was a way to insure that I could not talk or even be experienced as alive. I often slept during his session, and if I was able to stay awake, I had all kinds of uncomfortable somatic sensations – my head hurt, I felt nauseated or sweaty or breathless. I worked with this man for seventeen years, and the change was remarkable. He is now able to experience pleasure for the first time in his life. His affect is animated and labile. He has gone from a boring and low-paying job as a librarian’s assistant to a position as the editor of a prominent food magazine. He has been in a satisfying relationship with his partner for over ten years now. Late in the treatment, he seemed to want me to talk a little more. I was reluctant to do it. I felt this man had saved his own life with his persistent, defensive monotone – his talking had cured him.

There are other cases that provide evidence for the power of the word – the woman named Sally who came into treatment so distressed and frantic about her husband leaving her that the words tumbled out of her in a waterfall of grief, rage and despair. She refused to lie on the couch, but she had absolutely no problem with the “saying everything” contract, and in the five years I have known Sally, she has divorced her husband, found a new relationship and, most importantly, gone from seeing herself as the perpetual victim to using her aggression creatively to get a better job, make new kinds of friends and pursue her talent as a painter. She is very grateful to me and has referred me quite a few patients. I haven’t been able to help any of them as much as she claims I helped her. I think it is because most of these referrals have a resistance to talking. They question the process. They don’t believe that talking can really help. They want guidance. They don’t think they’re getting their money’s worth unless I say brilliant things to them. When I get worried that one of them is really going to leave, I try to accommodate her request and say something brilliant. Sometimes I am successful at that, and then the patient and I are very gratified, but it doesn’t really change anything. No matter how brilliant I am, the patient stays stuck. What makes Sally different from all her friends is her understanding that she needed to talk. I consider all her friends to be pre-analytic, in that my goal with them is to resolve their resistances to speaking freely. Until that happens, I will have to focus on these patient’s lives when what I want to do is focus on their minds. They will expect insight, symptom relief or behavioral changes, with no understanding that what we should be working on is the expansion of free association (Kris, 1992).

So how does it work? Ever since Freud’s patient Anna O coined the phrase “the talking cure,” psychoanalysts have been instructing their patients to just say everything. Freud (1910, p. 32) described free association as “the basic rule” of psychoanalysis. He insisted that the patient

must say whatever comes into his head, even if he considers it incorrect or irrelevant or nonsensical, and above all, if he finds it disagreeable to let himself think about what has occurred to him. So long as this ordinance is carried out we are certain of obtaining the material which will put us on the track of the repressed complexes.

As early as 1895, Freud described language as energy discharge, and toward the end of his life (1938), he was still convinced that language binds the mobile energy of the drive to stabilize mental representations.

Years later, Spotnitz (1985, p. 92) affirmed Freud’s idea: “In saying everything, the patient engages in discharge and operates to produce the deactivation of certain nervous system patterns, and the activation and discharge of new patterns.” Patients strive to understand themselves, but this should not be the goal, according to Spotnitz. “His mental energy should be wholly dedicated to saying whatever he thinks, feels and remembers at the moment” (p. 169). Meadow (1996a, p. 140) had the conviction that growth can occur only when a patient is allowed to say everything to an analyst who listens without judgment or evaluation. She urged the analyst to concern herself with creating an environment where a patient can give up her resistance to talking in the presence of the therapist (1996b, p. 236). From Meadow’s point of view, the key to reversing pathology lies in discovering why the patient cannot say what she cannot say (1996c, p. 242).

Words bridge the gap between the body and the mind, between the neurological and the psychological (Kris, 1990). They are a derivative, an ideational representative of instinctual forces (Rapaport, 1944). Talking has the potential power to evoke somatic states and bridge intrapsychic elements, thereby transforming the patient. It is both a hallmark of the rationality of secondary process thinking and a bridge to the more primitive primary process. Indeed, in the word, primary and secondary processes are reconciled (Loewald, 1980a, 1980b). The patient’s primary process thinking is being reactivated, but he is communicating the primitive impulses in language, thus imparting to the primary process important characteristics of secondary process thinking (Lowenstein, 1963).

Free association combines an increased awareness of self with a liberating disregard for reality (Rosegrant, 2005). It breaks with the usual state of affairs within the psyche, where elements of both ego and id are repressed. Saying everything invites the patient to direct his perceptions toward these warded-off elements. This shifts the balance of forces between autonomous and defensive functions within the ego and between the ego and the id (Lowenstein, 1963). Language, like the ego, is both a structure and an evolving process. The operations of both take place mostly on a pre-conscious level. Speech creates ego. The ego is both a language determined and a language determining structure (Edelheit, 1969).

Psychoanalysis has from its very beginnings rested on the theory of free association as the fundamental process that can transform a fated person into a liberated subject in charge of her own destiny. Analysts like me are convinced that talking cures because of the patterns we observe in our patients, that is, the patients who have no resistance to talking freely are the ones who get better. Our research has been the qualitative study of the people with whom we work.

Today, because of the advent of modern neuroscience, we are able to verify Freud’s structural theory and the value of free association in a manifest way. Recent discoveries about the brain, its structure and how it works, made possible by new technologies that enable us to study the brain, are providing physical and scientific corroboration of the psychoanalytic theories postulated by Freud, Spotnitz and many others. At a time in history when psychoanalysis is being criticized by psychopharmacologists, behavioral therapists and life coaches for being quaintly old-fashioned, even irrelevant in modern mental health, the new neuroscience is validating its fundamental principles. Certainly detractors of psychoanalysis have a point when they say analysis is a long and expensive process. And yet, neuroscience, which studies the brain’s structure and, more importantly, watches it in action, has revealed that psychoanalytic theory and practice are startlingly modern.

Freud’s theories about the instincts, the id and the ego were only theories, as much poetry as science, when he first wrote about them early in the twentieth century. It would take over fifty more years before science could validate Freud’s ideas by actually examining brain structure and watching how it works. It was neuroscientist Paul MacLean (in Restak, 1979 and Shepherd, 2005) who first described the evolution of the human brain as expanding in a hierarchal pattern along the lines of three basic structures which constitute three different chemical compositions that determine different intelligences, memory systems and subjectivities. In other words, the human brain is actually three discrete brains. These three brains have evolved methods of communicating with each other. Brain One, consisting of the brain stem and cerebellum at the base of the brain, was the first to evolve. It is reptilian in nature and essentially no different from the brain of a dinosaur. It is mechanical and unconscious and is the seat of what we would call instinct. Freud called it the id, and it is where repetitive patterns and the refusal to try something new reside.

The mammalian brain, or the limbic system, was the next area to develop. Wrapped around the reptilian brain, the limbic system allows sight, smell and hearing to operate together, and it creates a primitive memory, what neuroscientists label implicit memory. It also makes the nurturance of offspring possible. Emotions are generated in the limbic system but do not become conscious there. To become aware of our feelings and to tie them with cognition and thoughts, we need the third brain, the cerebral cortex. Developed in only the last hundred thousand years and probably hastened in its development by the advent of language, the relatively small cerebral cortex is the center of rationality and reasoning, what analysts would call secondary process thinking. This third brain is where consciousness resides. The mammalian limbic system is the site of the unconscious functions of what Freud called the ego, while the cerebral cortex is the home of conscious ego operations and the site of morality and ethics that Freud named the super ego.

The triadic structure that neuroscientists observe today is eerily reminiscent of the structural theory of id, ego and super ego that Freud wrote about in 1923. Even more interesting is the fact that what modern scientists are finding out about the functioning of the brain corroborates Freud’s instinct theory. One of the most striking things about the three brains is that the neuronal connections from brains one and two upward are a great deal stronger than those from the cortex downwards. The electrical impulses scientists can observe pulsing up from the lower two brains to the cerebral cortex are the physical manifestations of what Freud called the drives. The relatively small cerebral cortex is constantly being bombarded by these electrical impulses from the lower brains, and experiences them as sexual and aggressive instincts and primitive feelings. The smallest and most evolved part of the brain is often no match for these impulses. That’s why it’s so hard to use logic and insight to change a feeling. It’s also why people so often act like animals. One goal of analysis is to strengthen the cerebral cortex to free the patient from the repetitive, obsessive behaviors that are characteristic of the lower two brains. I believe this is achieved by the constant conversion of primitive impulses and feelings into words. This is similar to the goal that Freud (1932a, p. 80) stated for analysis: Where id is, there ego shall be.

Jaak Panksepp (1998) studied the brains of cats and rats, and one of his most important findings is that feeling is older than thought. There were emotions in the brain millions of years before there was mind to interpret them. We are used to believing that feelings are caused by events or thoughts, but that is not true. Feelings arise out of neuro-biological circuits in the limbic system; they are the effect, not the cause of arousal systems in the brain. Feelings are not actually felt until they are experienced by the upper cortex. These circuits are inherited by the species and by each individual organism. No specific thoughts or behaviors are directly inherited, but dispositions to feel, think and act in various ways and in various situations are. Although these dispositions do not necessarily dictate our destinies, they powerfully promote certain possibilities and diminish others.

While basic emotional circuits are among the tools provided by nature, Panksepp believes that their ability to control our destinies depends on the nurturance or lack of nurturance that the world provides. Emotional systems, like the body, can be strengthened by use and weakened by disuse. The psychoanalytic environment and the corrective emotional experiences it provides strengthen our control over our emotional circuits in a way that ensures that, instead of being buffeted around by our feelings, we are in charge of our personal fate.

Neuroscience is also giving us new ideas about memory. Human beings are laying down memories from the very beginning of life. Scientists now know that even our experience in our mother’s womb influences the structure of our brain, activating and strengthening some neural pathways, while de-activating or atrophying others. This makes each brain and each individual unique from birth. But intrauterine and infantile memories are totally different from later memories. Neuroscientists are now differentiating what they call implicit memory from explicit memory. Implicit memory is laid down very early in life, before the cerebral cortex has developed enough to make language possible. It is not cognitive; it is visceral. Implicit memory is not experienced as thought. Rather, we feel it as simple reality, as unchangeable truth about our lives. Though they are largely unconscious to us, toxic implicit memories, mistaken ideas about the way the world works laid down by childhood trauma or neglect, can run our lives in a way that ensures a tragic destiny.

Explicit memory, on the other hand, is a product of the cerebral cortex. It becomes possible when the growing child has developed sufficiently to speak, and to experience himself in time and space enough to begin to remember (Badenoch and Cox, 2010). When a child can say, “I remember going to the circus last summer,” he has developed explicit memory. Implicit memory, though much more primitive than explicit memory, is the dynamic that often determines a malignant fate. The work of psychoanalysis is the constant conversion of unconscious implicit memory into words; and in that process, the implicit becomes the explicit. When the misperceptions about actual reality are articulated, they come under the influence of the cerebral cortex, and when this happens the patient is no longer controlled by the painful past. He is free to move forward in health and creativity.

In The Internal Triangle (Holmes, 2008, p. 125), I called implicit memory (though I didn’t know the term then), being in “the mind of the mother.” I described a female patient who had a very anxious mother and who obsessively perceived the world as a dangerous place. If she got into an elevator, she was terrified it would fall. When she flew, she was sure the plane was going to crash. She was the victim of the implicit memories laid down in the womb of a very unhappy mother. Another beautiful and talented woman, whose mother had never wanted children and told my patient so on a regular basis, described herself as a “piece of shit who never should have been born.” She had mistaken her mother’s ideas about her as actual reality. Though implicit memories often control our destinies and make it hard to perceive reality objectively, they are not really conscious till psychoanalysis makes them so. When they are verbalized, they come under the influence of the cerebral cortex, where they can be acknowledged, understood, worked through, and finally held in loving acceptance in the mind as ghosts from the fairy tale of our infancy, which used to terrify and control us, but now seem harmlessly diverting and, ultimately, irrelevant.

Modern neuroscientific findings regarding brain structure and functioning and the nature of memory have given me new ideas about how psychoanalysis can change one’s destiny. The psychoanalytic contract to “just say everything” constantly invites the patient to convert the electrical impulses pulsing up from the reptilian brain and the feelings traveling along neuro-biological circuits in the mammalian brain to be converted into language. In this process, we are inviting access by the cerebral cortex to those two bullies, the lower brains. And, I believe, we are strengthening the young and often overpowered upper brain against the instincts and primitive feelings that are all too often acted out in the world in a way that ensures a star-crossed destiny. When messages from the lower brains are put into words, instincts lose their primitive power, and feelings can be felt and verbalized, rather than acting as mandates to often destructive action. When patients are able to verbalize implicit memory, which has heretofore been powerfully controlling but largely unconscious, they put those memories under the jurisdiction of the cerebral cortex, where they can be acknowledged as feelings and thoughts, but not scripts to control our lives. As analysis progresses, communication from the lower two brains gradually becomes data, not commands. The patient can evaluate this data and then decide how she wants to deal with it. At this point, the cerebral cortex is firmly in charge and the patient takes control of her own destiny.

This is by no means an easy process. There are many pitfalls along the way. When patients decide to behave in ways that go against the familiar pathways of their repetitions and implicit memories, they experience all sorts of unpleasant feelings. There is typically an enormous amount of an...

Table of contents

• Front Cover
• Half Title
• Title Page
• Copyright
• Dedication
• CONTENTS
• Permissions acknowledgements
• The Appointment in Samarra
• Introduction
• 1 Why talking cures
• 2 Anatomy as destiny
• 3 The oppression of women
• 4 The capacity to love
• 5 How to get a divorce
• 6 Fear of success
• 7 Bombed and wasted
• 8 Creative aging
• 9 Cure
• References
• Index