The Annual of Psychoanalysis, V. 26/27

Jerome A. Winer

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134900978
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

Volume 26/27 begins with publication of The Annual's first prize essay, Samuel Abrams's "How Child and Adult Analysis Inform and Misinform One Another." This is followed by a series of papers originally prepared for a symposium honoring John E. Gedo. These papers span the clinical topics of obsessiveness, sublimation, dreams and self-analysis, and analyzability, and also delve into applied psychoanalysis and art history, with two studies of Vincent van Gogh and another of Alberto Giacometti. These papers not only convey the impressive range of Gedo's own interests, but embody the high scholarly and clinical standards that Gedo has long held, both for himself and for the field in general.Section III offers original contributions to clinical analysis in the form ofthe consideration of the role of affective engagement in the analyst's "usability"; thoughtful assessment of the perils of parental projection in child analytic work; and comparison of a failed and successful supervision in the same psychoanalytic case. Section IV examines psychoanalysis and the arts, with two further studies of van Gogh, an analytic reading of Nabokov's Lolita, and more general examinations of psychoanalysis in relation to dramatic art and film analysis. The volume closes with two provocative scholarly essays bearing on the roots of psychoanalysis: the correspondence between Mabel Dodge and her analysts Smith Ely Jelliffe and A. A. Brill as a vehicle for reviewing the issue of extra- and postanalytic contact between analyst and patient; and anexamination ofFreud, Lacan, and the uneasy relationships among literature, psychoanalysis, and the female subject.

Volume 26/27offers readers a rich harvest of contemporary insights about psychoanalysis, including its history and evolution, its continuing clinical refinement, and its scholarly applications outside the consulting room.

II

GEDO SYMPOSIUM PAPERS

Introduction

FRED M. LEVIN

ARNOLD WILSON

Section Editors

The essays in this section were originally gathered by Fred M. Levin and Arnold Wilson in honor of the seventieth birthday of John E. Gedo. Several were presented at a symposium sponsored by the Chicago Psychoanalytic Society and the Chicago Institute for Psychoanalysis on October 18, 1997, celebrating the intellectual legacy of John Gedo. The conference was titled “The Fusion of Science, Art, and Humanism.”

Other essays published in this section were invited or came about de novo as a result of a groundswell of interest from friends and colleagues. Each author has in one way or another—personally and professionally—been profoundly influenced by John Gedo, and each author took this opportunity to express appreciation for him and his work through the medium he most passionately respects—lucid scholarship about matters psychoanalytic, in all its diverse permutations.

All went through peer review by The Annual’s Editorial Committee. Some of the essays are primarily concerned with psychoanalysis and neuroscience, and they will appear in Volume 28 of The Annual of Psychoanalysis, together with other essays dealing with similar matters.

Traditional disciplinary boundaries seem to disappear in Gedo’s oeuvre. If there is any single theme, it is Gedo’s clarion call for a hierarchical model for psychoanalysis, one that promotes a healthy and necessary ecumenism, thereby limiting the shortcomings of any single preexisting school of thought. John Gedo remains a man with a great and abiding scholarly passion for his cherished field. He has no more fervent wish than for psychoanalysis to emerge in the next millennium as a formidable intellectual, social, and cultural magnet. He knows that psychoanalysis can only flourish and live on by dint of the strength, vigor, and flexibility of its ideas, not merely as a consequence of the number of patients treated with its famous method. In fact, the body of Gedo’s research is precisely aimed at providing such a framework for psychoanalysis, respectfully retaining all that was of value in the past, but always recognizing valuable novel insights. Only time will tell whether psychoanalysis will live up to its promise.

The force of the essays in this volume, however, does suggest the possibility of a happy outcome—that an intellectually alive, scientifically sound, psychobiologically sophisticated, hierarchically ordered, and culturally enriched psychoanalysis is making a strong bid to maintain itself as a decisive contributor to the contemporary world of ideas.

Obsessiveness in Context

DAVID A. FREEDMAN

Obsessional neurosis is unquestionably the most interesting and repaying subject of analytic research. But as a problem it has not yet been mastered. It must be confessed that, if we endeavor to penetrate more deeply into its nature, we still have to rely upon doubtful assumptions and unconfirmed suppositions [Freud, 1925, p. 113].

Where do obsessional phenomena fit into the spectrum of psychological reactions? Are they, like schizophrenic reactions, automatically pathological? Or is it more appropriate to think about them as one would think of blood pressure or anxiety—that is, as parameters of functioning that characterize most—if not all—of us but that sometimes and for some people can run amuck? Sandler and Hazari’s (1960) findings indicate that the latter might be the more appropriate perspective. On the basis of the responses of 100 patients to selected items from the Tavistock Self-Assessment Test (Sandler, 1954), they distinguished two clusters of characteristics, both of which they felt fall under the overall rubric of obsessional. Individuals in their “A” group were systematic, methodical, and thorough: They led well-ordered lives, were consistently punctual, disliked leaving tasks half done, were attentive to detail, found interruptions irksome, and had a strong aversion to dirt. These traits were often a source of pride and self esteem and were ego syntonic. The authors noted that these individuals bear a strong similarity to the “anal reactive” character of psychoanalysis. The type “B” individuals appeared less well integrated. They were afflicted by the intrusion of unwelcome thoughts and impulses. Such traits, however, were not necessarily symptomatic in the sense that the patients complained about them. They also occurred as character traits in “chronic worriers.” Sandler and Hazari also note that in characterizing someone as obsessive one is as likely to be praising that person as to be criticizing. When, for example, one is in need of major surgery, it is likely that the patient will be reassured by the knowledge that the person doing the operation is careful and meticulous, follows very rigid procedures, and worries a great deal about getting things right. A sophisticated, dynamically oriented psychiatrist might even find it reassuring to know that his surgeon is a little picky and routinized in his daily activities, and that he is prone to migraine headaches and has some concern with the regularity of his bowel movements. An illustrative anecdote: A surgeon of great renown and even greater competence was also known for his intolerance of anything that did not meet his standards. He also suffered from severe migraine headaches. In the course of a confrontation with a hospital administrator, the latter finally screamed in exasperation, “The trouble with you is that you are a goddamn [further expletives deleted] perfectionist.” To this the surgeon quietly replied, “That’s right, I am a perfectionist. But tell me, when you have to be operated on would you prefer it to be done by a perfectionist or by someone who is going to shit in the wound?” For the moment I pass over the choice of metaphor. Suffice it to say that this man’s obsessional characteristics were both ego syntonic and of value to the world at large. We do not, I suggest, want to ban obsessionality. Unlike smallpox and AIDS, it is not an execrable disease to be wiped from the face of the earth. We do want, however, to consider how and why obsessional modes become established in the individual, and what leads to their sometimes becoming maladaptive (like blood pressure or blood sugar, both of which may be too high or too low, but which at appropriate levels are indispensable for life)? And how, when they become clinically important, can obsessional phenomena be most effectively treated?

An Etymological Digression

Taurinum obsessor idem es obsessus [Hugo, 1831].

According to the Unabridged Oxford English Dictionary (1933), the word obsessional derives from the Latin verb obsidere. Its original meaning was to sit at or opposite to, to beset or besiege as in a military operation, that is, it very explicitly referred to an external, alien-threatening force with respect to which one might say a community was compelled to take defensive action. Over time, the obsessing agent became less precisely defined as to location, and the object of the obsession became less clear. By the mid-sixteenth century, the very specific meaning “siege” in a military sense had been extended to include, and ultimately largely to be replaced by, the connotations of to haunt or to harass as by evil spirits. Pari passu, to be obsessed, also came to be applied to any experience of this type to which an individual, as well as a community, could be subject. As recently as the mid–nineteenth century, however, one could still be “beset by foreign, backstairs and domestic influences, by obsessions at home and abroad.” The earliest entry that uses the word obsession to refer to the private, entirely internalized, and idiosyncratic experience of one individual is dated 1893 (H. Crackanthrope, Wreckage 99): “The thought of death began to haunt him till it became a constant obsession.” In the Supplement (vol. Ill, 1982), however, both by definition and illustrative example the word comes to take on the connotation of a process recognized to be going on within an individual. Not surprisingly, it is also at this time that the illustrative examples begin to come from the psychoanalytic literature. How the original meaning of obsession, which had to do with the operation of an external and alien force, was replaced by the implication of an intrapsychic process remains to be clarified. Neither do we understand the conceptual link which makes it possible for the designation “obsessional” to be used in a laudatory as well as a critical sense (cf. Sandler and Hazari, 1960).

Obsessiveness and Religion

Freud noted (1907) the many and striking similarities that obtain between obsessional behavior, as it is observed in the individual, and religious practice. He suggested that “one might venture to regard the obsessional neurosis as a pathological counterpart of the formation of a religion, and to describe that neurosis as an individual religiosity and religion as a universal obsessional neurosis” (pp. 126–127). Six years later, he wrote in “Totem and Taboo” (1913):

Any one approaching the problem of taboo from the angle of psychoanalysis, that is to say of the investigation of the unconscious portion of the individual mind, will recognize after a moment’s reflection that these phenomena are far from unfamiliar to him. He has come across people who have created for themselves individual taboo prohibitions of this very kind and who obey them just as strictly as savages obey the communal taboos of their tribe or society. If he were not already accustomed to describing such people as “obsessional” patients, he would find “taboo sickness” a most appropriate name for their condition. Having learned so much, however, about this obsessional sickness from psychoanalytic examination—its clinical etiology and the essence of its psychical mechanism—he can scarcely refrain from applying the knowledge he has thus acquired to the parallel sociological phenomenon [p. 26].

The relevance of Freud’s analysis is supported by the following excerpts from the New Catholic Encyclopedia (1967): “The term scrupulosity refers to the efforts of the individual to cope with the strictures of his religion. It can, therefore, be viewed as referring to an adaptive dilemma situated somewhere between the external threat implicit in the Latin obsidere and the wholly internalized problem of the obsessional individual.” The authors of these entries also struggle with the relation of scrupulosity to pathology.

In the section on psychoneurotic disorders, the following appears: “Obsessive concern with matters pertaining to the moral life together with a compulsive meticulousness in confession and in the avoidance of objectively sinful acts is called scrupulosity. It is a pathological exaggeration of what in ordinary usage is considered healthy, normal, scrupulous, honest and meticulous attention to the details of one’s occupational and professional tasks” (p. 979). In yet another entry, the phenomenon is addressed in a more general sense.

Scrupulosity: … The scrupulous person’s life journey has been aptly likened to that of a traveler whose pebblefilled shoes make every step painful and hesitant. Scruples render one incapable of making with finality the daily decisions of life. This psychic impotence, providing a steady source of anxiety and indecisiveness, is especially prevalent in ethical or pseudomoral areas. It causes ordinary, everyday questions to be viewed as impenetrable and insoluble. Decisions require a disproportionate amount of time and energy, and are always accompanied by feelings of guilt and doubt.

Never at peace, the mind compulsively reexamines and reevaluates every aspect of a matter about which scruples center. With increasing doubts and mounting fear the mind is so blinded and confused that volitional activity becomes difficult or impossible. The will is unable to act without immediately reacting against its previous decision. There is a more or less constant, unreasonable, and morbid fear of sin, error, and guilt. The mind demands mathematical certitude in moral matters, and when this is not forthcoming, there is a fear reaction that is both unreasonable and unholy [p. 1253].

In an earlier edition (1911) of the same work, the author finds it necessary to reject explicitly the notion that scrupulosity may be a special state of grace: “The idea sometimes obtaining that scrupulosity is in itself a spiritual benefit of some sort is, of course, a great error” (Vol. 12, p. 640).

The Traditional Formulation

In her summary of the deliberations of the 24th International Congress, A. Freud (1966) proposed that obsessional defenses set in when “the ego matures more rapidly than the drives” (p. 117), and she supported the “widely accepted precondition” that the constitutional preference for the use of such defense mechanisms as reaction formation, intellectualization, and isolation characterizes obsessional individuals. Essentially the same formula is repeated in a number of authoritative accounts of the obsessional neurosis (e.g., Brun, 1951; Lewin, 1955; Nunberg, 1955; Alexander and Ross, 1972).

None of these authors distinguishes between the obsessional neurosis and the more general problem of obsessional phenomena as they occur in other contexts. At least for the following reasons, such a distinction would seem to be desirable: Both the term “constitutional increase of instincts” and the hypothesis that an individual may have a “constitutional” preference for particular defense mechanisms—for example, reaction formation, intellectualization, and isolation—are open to question. Although the relevance of constitutional factors, in the sense of gene derived, can never be gainsaid, their role is not easily delineated. To the extent that this is the case, how, in the older individual, does one differentiate between what is in the genes and what is the result of early, preoedipal experience? Freud (1925) pointed out that instinctual urges, however strong they may be, are not necessarily dangerous in themselves. They “only become dangerous insofar as they bring real external danger with them” (p. 126). It would appear to follow that observations concerning strength of instincts can have no explanatory value in and of themselves.

Even very weak instincts may be the source of danger if they are met by very strongly negative external and/or introjected reactions. Conversely, in the absence of such negative reactions to their expression, very powerful drives may remain ego syntonic and without pathognomonic significance. To characterize the conditions that are favorable for the development of an obsessional neurosis, let alone obsessions in general, as those in which the ego and superego are too far advanced to tolerate the anal-sadistic trends, begs this issue. It also offers no explanation either for the postulated rapid maturation of ego and superego functions, nor does it account for the particular intolerance of the “obsessional individual” for his anal-sadistic propensities. Whatever its heuristic value in particular cases, the hypothesis of regression from oedipal conflict to an earlier anal posture does not address the roles of either gene-determined maturational processes or that of the environment. The possibility that both the specific circumstances under which the developing youngster enters the “anal” and the nature of his environment’s response to his efforts to adapt to newly emerging functional characteristics may eventuate in obsessional phenomena well before the oedipal period is given short shrift.

Another objection can be raised on metapsychological grounds. The assumption of a special and direct relation between the superego and the drives has been a cornerstone of the structural theory at least since the publication of “The Ego and the Id” (1923). It would seem to follow from this direct relation that the superego cannot “mature” more rapidly than the drives. Furthermore, if one accepts that the term ego refers to a conglomerate of functional capacities united in the sense that they, operating in concert, constitute the executive agency, which adapts to pressures from the drives, the superego, and the external world, the proposition that it “matures more rapidly than the drives” would not seem to be meaningful. At best, one could say that pressure from some source other than the drives must be influencing its adaptive efforts disproportionately.

A variety of clinical observations seem to be incompatible with the assumption that obsessional phenomena occur only as the result of regression from a more advanced stage to the anal-sadistic level. Fenichel (1945) expressed the opinion that cases do occur in which an obsessive neurosis is not...

Table of contents

• Cover Page
• Half Title page
• Series Page
• Title Page
• Copyright Page
• Acknowledgment
• Contents
• Contributors
• I The Annual Prize Paper: The Psychoanalyst as Clinician
• II Gedo Symposium Papers
• III Clinical Psychoanalysis
• IV Psychoanalysis and the Arts
• V The Roots of Psychoanalysis
• Author Index
• Subject Index