Abstract
Traumatic Ruptures: Abandonment and Betrayal is the most recent volume in Lewis Aron and Adrienne Harris’s Relational Perspectives Series. The book’s chapters deal variously with “traumatic ruptures” in psychoanalytic treatment: the impact on an analysand of the analyst’s death; the reaction of a therapist to a patient’s suicide; and, most important, the fallout for candidate patients and colleagues from a doctor’s fall from grace. Indeed, this collection may well be the definitive volume when it comes to describing and analyzing the collateral damage done to training analysands, candidates, colleagues, and institutes caused by the sexual boundary violations of prominent analysts and by the institutional cover-ups that often ensue.
The linking of death and an analyst’s fall from grace may seem counterintuitive. However, it makes sense when we consider our patients’ parent transferences in the context of the inevitable disillusionments encountered in what Erikson (1950) termed “the growth and crises of the healthy personality.” In this vein, the theologian Reinhold Niebuhr (1987) reflected on two successive disappointments that inevitably come with growing up: “There are two crises which children face: one is in their youth when they find out that their parents are not as powerful as they thought; the second is in their adolescence when they find out that the parents are not as good as they thought they were” (p. 47).
When it comes to representations of our mothers and fathers, such “necessary losses,” to borrow a turn of phrase from the analytically trained writer Judith Viorst (1984), go hand in hand with emotional growth. In our own canon, following Freud’s notion of “the ego” as the precipitate of forsaken object representations (1923), Mahler (1975) theorized that separation-individuation from the mother of symbiosis and the establishment of a bedrock sense of self in early childhood are in essence a mourning process. Subsequently, according to Erikson (1950) and Blos (1985), a third and final individuation and the development of the self-representation, the synthesis of a more complex psychosocial identity, and the construction of an independent “ego ideal” at the conclusion of adolescence require the de-idealization of a father hitherto represented as omnipotent and flawless.
Ideally, this bittersweet passage is an internal process, with the disappointments and disillusionments that facilitate it occurring gradually and moderately enough that the young person can take them in and use them to forge his own moral compass. But with traumatic ruptures in real life—actual parental death or disgrace—the individual is thrown into emotional disarray, often retreating defensively into a more childlike view of the world. This disavowal brings with it feelings of irrational shame and guilt, reaction formations, compensatory overidealizations, and infantile helplessness and dependence. Indeed, it is most often these emotional wounds that a neurotic person brings to the analyst for healing.
Alas, if the therapist in whom the analysand has vested hope for the future then violates that basic trust and/or disappears in one way or another, the retraumatization that occurs can be unbearable. An analyst’s death, the volume’s contributors imply, is like a mother’s prematurely disrupting what Mahler called the “dual unity” before the individual is ready to give it up, while the analyst’s expulsion for ethical violations is like losing what Erikson called “the morality of childhood,” in the person of the father, before a young adult is equipped to replace this with “the ethics of an adult.”
It may be partly an artifact of the book’s focus, but the volume as a whole conveys the impression that boundary violations are, as Owen Renik once remarked (personal communication), “endemic to the field.” Not that many analysts die on the job, but more than a few transgress. Relentlessly unmasking these travesties and tragedies—these unnecessary losses—and the subsequent lies of omission perpetrated by the powers that be, Traumatic Ruptures takes us on a voyage through a discipline, one to which we have devoted our lives, at its worst.
Like a good analysis, the volume “eases us in slowly” before getting down to basics. The first chapter of part 1, by Adrienne Harris, is about bending or straining, rather than rupturing, the bond between analyst and patient when the former is for a time emotionally unavailable after a tragic personal loss. Harris describes her patients’ reactions (ranging from concern to resentment) to her evident mourning and her preoccupation with her husband’s untimely and unnecessary death. We have probably all suffered personal losses during the course of our working lives, either finding solace in the work or struggling to concentrate on patients beset by personal demons, often imaginary, that have little to do with us and often begrudging the neediness of those in our care.
Unlike the papers that follow, Harris’s meditation on herself as a “dead mother” (Green 1999) has nothing to with an institutional setting. My only criticism here is that she has omitted what might have been the telling details of her story. Specifically, I could not help wondering how her husband died and why she felt so guilty about this. Nor do I think such questions are a matter of prurient interest. Even the subsequent chapters suffer to some degree from a failure to report specific data that could be used in evaluating the conclusions drawn from them—a problem in most analytic case presentations. While analytic authors are constrained by the need to protect both their patients’ privacy and their own anonymity, as well as by possible legal liabilities, many other factors may come into play in what the historian Barbara Tuchman (1962) has lamented as the tendency of certain colleagues to privilege “systems” over “facts.”
Interestingly, Harris’s account suggests that the trauma of abandonment, actual or emotional, in clinicians’ personal lives may lead them to abandon their patients—a variable that predisposes not a few boundary violators to abandon all their patients, including those with whom the transgression has occurred (Gabbard and Lester 1995). One excellent chapter, “The Trauma of Patient Suicide” by Jane Tillman and Anne Carter, deals directly with its theme within the consulting room—namely, the therapist’s sense of having been abandoned, betrayed, and injured by the patient. Included in this chapter is an uncompromisingly honest description of Carter’s anxiety, self-doubt, and self-examination in the wake of such a suicide, as well as a brief but comprehensive survey of the literature on the subject. Both Carter’s personal account and Tillman’s review of the literature, including her own contributions, highlight a clinician’s irrational omnipotence, guilt, fears of professional retribution, and moral soul searching.
No doubt many of us have experienced something like this, if not in the form of suicide, then as deaths from drug overdoses and other reckless behavior. The problem is that apart from the theme of severed attachment in the therapeutic dyad, this paper seems out of place here, distracting the reader from the volume’s overall thrust.
The papers on the death of the analyst get closer to home. Their focus is on the impact of an analyst’s death from the perspectives both of the bereaved patient and of the clinician charged with picking up the pieces. These accounts also point up the lack of communication with the patient, both by the dying doctor and by the institution in which a training analyst is embedded—a problem presaging the organizational shutdown occurring when boundary violations are discovered.
The first of these chapters, by Robin Deutsch, the book’s editor, is a poignant meditation on the sudden death of her training analyst. In this essay, replete with her dreams, she concentrates on the fragmentation of what John Donne referred to as the “dialogue of one” that takes place between the actual sessions—or, as Deutsch puts it, the “analysand voice.” In doing so, she reminds us that an analysis is not confined to the consulting room but has an internal life of its own. And as we regress in the process, the illusion of the “dual unity” of infant and mother may be revived in the transference such that a potential rupture of the dyad brings with it, as Deutsch puts it, a “fragmentation” of the self-representation.
Again certain potentially critical details are missing from this account. While we cannot predict with certainty when we will die, I wondered about this analyst’s age in the context of the obligation of individual practitioners and institutes to consider actuarial statistics in an effort to protect candidates and other patients, as far as possible, from traumas such as this. As Deutsch herself notes, analysts, like all human beings, tend to deny their mortality.
Jenny Randles and Frances Thomson-Salo’s “Abandoned without Warning,” written from the of perspective of the consultant/analyst, considers the impact on a patient when the therapist suddenly succumbs to terminal illness, aborts the treatment, and dies, vanishing as if without a word. The authors stress the shame, resonant with early loss, felt by the aggrieved patient.
While I was intrigued by this counterintuitive notion, I could not help questioning whether such an emphasis might not have been an artifact of the case itself—that of an isolated and damaged woman whose mother had been profoundly disturbed. Which brings me to another problem bedeviling analytic theorizing: that is, the tendency to gloss over individual differences. Again I wondered about this therapist’s age, when it comes to protecting patients who are not candidates and therefore not subject to institute guidelines.
In “Being the Second Analyst,” Madeleine Bachner focuses on the countertransference issues encountered in taking over a case after the first analyst has died. Presenting the complexities of her work with two such bereaved patients in some detail, she emphasizes the intersubjective triangulation that occurs in this situation: patient, former analyst, and oneself as a sort “foster care” parent. She speaks of her temptation to overcompensate by being too nurturing, as well as of her critical attitude toward one of the deceased analysts, whom she did not know, and her mourning for the other, who had been her supervisor and mentor.
Many of us have treated patients in similar circumstances, with the ghost of the former therapist hovering in the air for both parties. In one such instance, I found myself sympathizing with the anger of a woman toward her deceased therapist, who happened to have been a dear friend of mine, for practicing too long after the diagnosis of her terminal illness and for dropping dead, just as the patient’s mother had. I found myself critical of my friend for what I felt was her use of patients to deny her certain, indeed imminent, death.
The ethics in these circumstances may be ambiguous and debatable. However, this is hardly the case when it comes to the situations described in the remaining and central essays in the book, and this despite the best efforts of our organizations to muddy the waters and obscure stark realities.
Death is bad enough, but betrayal, which is an act of will, may be even harder to swallow. Anyone at any age can fall ill and die, and short of suicide we have little control when it comes to our mortality. Falling from grace is another matter. Much of the current literature on boundary violators, focusing for the most part on their psychology, has stressed their vulnerability and advocated compassion for their plight. Yet, as Robert Stoller once commented in speaking of child abuse, there is always choice. One may raise a hand, but striking out or molesting a child—or a regressed analytic patient—is quite another matter.
With the possible exception of Charles Levin’s brilliant last chapter, which considers an array of continuous abuses, the contributions in the last two sections concentrate specifically on the collateral damage caused by sexual boundary violations on the part of revered training analysts. The chapters in the third section, characterized by riveting first-person narratives, deal mostly with disruption of the treatment of other patients, while the fourth and final section provides an overview of the harm done to and by the transgressor’s institute. Several of the authors were forced to contend with such traumas at the beginning of their careers yet went on to rise within the ranks, even while remaining haunted by memories of their analyst’s immorality.
In “Losing a Training Analyst for Ethical Violations,” Elizabeth Wallace endeavors to fill what she sees as a void in the literature. She begins by describing her learning only in fits and starts about her analyst’s boundary violation with another analysand. Though Wallace did feel “held” by her fellow candidates, organizational concerns about confidentiality and legal liability made for an aura of secrecy and mystery about what had taken place. This, in turn, left her feeling very much alone in her dismay—isolated, guilty by association, potentially contaminated, and irrationally ashamed.
In retrospect, Wallace reflected on her analyst’s bending if not breaching the boundaries with her as well while simultaneously seeming to dodge her erotic transference, especially during the time “in the dark” when the ethics investigation was under way. Unsupported by her institute, she struggled with her de-idealization of her analyst, succumbing at times to the guilt encountered in the pathological mourning of an ambivalently held significant other, in this instance in an identification specifically with the transgressor. A decade later, much like adult children from dysfunctional homes, Wallace had made the best of a bad beginning of her analytic career, putting the trauma behind her as best she could.
In the next two chapters—“Collateral Damage” and “A Chorus of Difference”—Candace Young and Jane Burka, both of whom are now training analysts, deconstruct their experiences as, respectively, a candidate and a recent graduate when informed officially of their highly regarded training analysts’ ethical transgressions and subsequent expulsion from their institutes. Hope indeed springs eternal, and so like Wallace each lingered for a time in a treatment limbo with their errant doctors until it became apparent that, beset by personal distress, they were much too self-preoccupied to attend to their patients. In both instances, the idealizing transference was, as Burka puts it, “demolished” (p. 127).
Young proceeds from her individual experience to ponder the “radioactivity” and fallout of these untoward events for the institute membership in general. Already fragile because of the diminished status of psychoanalysis, analytic “families” so stressed may find themselves demoralized to the breaking point. It is, she believes, a state of disarray that threatens the very future of our field and, with it, I would add, the only medium in which individuals can find healing in telling “without prejudice” the whole of their life story.
Burka, who had to contend as well with her analyst’s violation of her right to confidentiality with his lover-patient and who filed and won a lawsuit against him, takes a somewhat different tack, emphasizing her passage from “moral outrage to complexity and pluralism” (p. 126). As I understand her, by acknowledging her own fleeting temptation to cross the line between the professional and the personal in far less dramatic ways, she was able to empathize with and thus truly separate from the analyst who had doubly betrayed her. Without forgiving his immorality or regretting having taken legal action, over time she dislodged him from his position in loco parentis and accepted the reality of his and everyone’s human frailty.
As an aside, I think it striking that the authors of all three papers in this section are women, and their unethical analysts men. This is no doubt a function of the demographics of boundary violations, which for the most part involve male perpetrators. But it is important not to overlook the impact on male analysands of a cashiered father figure and role model’s disgrace.
The three papers in the fourth section proceed from more personal accounts to an increasingly sweeping overview of the impact of boundary violations on our organizations. Assuming an historical perspective, the authors deconstruct the current dysfunction of what amounts to an intergenerational psychoanalytic “family.” More pessimistic in their outlook, the contributions here are disturbing in different ways.
The title of Kathy Sinsheimer’s opening essay on the subject says it all: “Silencing.” Concealing unwanted truths has been until now—when the waning world of candidates and patients demands that we think and act otherwise—a “way of life in a psychoanalytic institute,” to borrow from the title of Charles Levin’s concluding chapter. Sinsheimer is a personal and supervising analyst in San Francisco, the setting of a relatively recent high-profile boundary violation by an unnamed psychoanalyst and analytic legacy who is known to all of us.
The author begins with a brief foray into the history of our field, and the long suppressed shenanigans of its founding fathers and later icons. Her list begins with Carl Jung and his seduction of his teenage patient Sabina Spielrein (Freud 1909; Kerr 1993). She then mentions Sándor Ferenczi’s having sex with his stepdaughter, Elma Palos (Berman 2004), almost immediately after taking her into analysis—an act of incest not only figurative but literal. From there she proceeds to the flagrant antics of the now notorious Masud Khan in the 1970s (Godley 2001; Sandler and Godley 2004). Significantly, because of their self-interest both Freud and the seemingly saintly Winnicott (see Anderson 2014) were accessories after the fact in countenancing and then concealing the misconduct of both disciples and patients.
Which brings me to Sinsheimer’s basic argument. When Melanie Klein’s followers descended on Phyllis Grosskurth in full force for having revealed their heroine’s terrible family secrets—the possible suicide of a son and the public antipathy of a daughter, both of whom their mother had “analyzed”—the disillusioned Klein biographer, who had been embraced as an “honorary Keinian,” was stunned by the “immaturity” of her erstwhile sponsors. Because of this, she was moved to write a paper titled “Psychoanalysis: A Dysfunctional Family?” (Grosskurth, 1998). With this metaphor in mind, Sinsheimer proceeds to demonstrate how the primitive power structures of psychoanalytic organizations typically shut down open discussion of collective “family” secrets, “gaslighting” wide-eyed candidates and compromising both their perceptual acuity and their critical thinking.
The next chapter continues in this vein, very much as its title, “Trouble in the Family,” might suggest. Its author, Donna Fromberg, was trained at the Boston Psychoanalytic Institute, the seat in recent years of three scandalous boundary violations by impeccably credentialed analysts, whose names once again most analysts know but for allegedly legal reasons dare not speak. Applying Bionian principles to the group dynamics influencing the attempts by members of the institute to resolve conflicts about their commitment to psychoanalysis, Fromberg presents her own acute and subsequently lingering dismay and confusion as she tried to make sense of the hearsay and inconsistent official pronouncements that came her way at the outset of her training. Her account makes clear just how traumatizing, in the strict sense of the term, not only the boundary violations themselves but the institutional responses to them are, not only for those immediately affected but for an entire community.
Charles Levin’s concluding essay, “Trauma as a Way of Life in Psychoanalytic Institutes,” is at once the most pessimistic and thought-provoking of the book’s contributions. Levin, whose current credentials as director of the Canadian Institute of Psychoanalysis and editor-in-chief of the Canadian Journal of Psychoanalysis place him at the pinnacle of the profession, nonetheless possesses the courage and intellectual honesty to articulate what not a few of us who have been candidates and who are now training analysts have felt in our heart of hearts but have been too ashamed and fearful to acknowledge publicly. “One of the ongoing traumas of being an analyst,” Levin writes, “is that one is implicitly expected to ‘represent’ a corrupt authority” (p. 194).
Stepping back from the discrete traumas of boundary violations per se, the author reflects on his enforced surrender as a candidate to a crudely authoritarian and politically reactionary training analyst, “Dr. Fish,” and, having graduated, on his acquiescence to the ongoing subjugation of the next generation to this very same figure and others of his ilk. Secure in his position as an officially authoritative analyst, Levin has chosen instead to continue to analyze himself, as well as the organizations in which he is now a leader, and, in his words, to “dismantle my unconscious fantasy that I had inherited a private preserve of analytic authority” (p. 194).
Alas, like many of us, Levin has come to understand that what may have been redemptive for him in his self-analysis does not necessarily translate into substantial change when it comes to our colleagues and their organizations. In this regard, he cites Kernberg’s analysis of “illness” in psychoanalytic institutions (1986), a groundbreaking paper by the most eminent of analysts that nonetheless initially had little impact on training procedures. That is, until recently, when the downturn in the field made self-examination and change imperative.
In effect, Levin experienced his training analysis as a sort of “brainwashing,” as did many of us in the days when these so-called treatments were reported to education committees. And like him, embarrassed by our surrender to “Big Bother,” even the most liberal of us, falling prey to the “Stockholm Syndrome,” went on to perpetuate the system. That is, until the cognitive and moral dissonances and our identifications with the aggressor became too much to tolerate any longer and we had to speak out (see Ross 1999).
I would add here only that such “totalism” and “thought reform,” to borrow from Robert J. Lifton’s work on brainwashing in Maoist China (1961), discourage inquiry and independent mindedness of all sorts (see also Freud 1921). Interestingly, Lifton, who abjured psychoanalytic training for these very reasons, underscores the indoctrinators’ exploitation of their victims’ guilt over what they felt to be their neglect or disobedience of ancestors as a means to control their minds, much as the leaders of our institutes once dismissed candidate dissent and curiosity as presumptuous expressions of their “oedipal,” parricidal aggression.
As Kernberg has implied, a covert and perhaps unconscious objective may have been to keep the door shut when it comes to psychoanalytic family secrets and abuses of power—in the consulting room, institutional hierarchies, and psychoanalytic history. Hence the relevance of Levin’s overarching conclusions as a coda to these reflections on boundary violations. The ramifications, he implies, are legion and may imperil our future. Having seen the “worst,” Edgar in King Lear ponders the possibility that the “worst is yet to come.”
The book’s endpaper, by Dianne Elise, is a rather abstract meditation on the timelessness in the unconscious of these traumas and their repression. She implies, as I understand her, that our past haunts our future.
That having been said, like much of the current literature in the shrinking world of our discipline (no pun intended), this volume’s frame of reference is inadvertently solipsistic in that it restricts itself to that world. For a variety of reasons, this courageous undertaking omits from consideration the harm done to the families of both patient and analyst in these circumstances. In the long run, a psychoanalyst is a service provider toward whom a patient has father and mother transferences. Betrayal by an actual parent or spouse is another matter, and the ruptures that occur with the loss of moral compass, continuity of one’s identity, and even financial means are far more devastating.
And what about abused patients who are not candidates? As far as the boundary violator’s “civilian” patients are concerned, they may never learn when, how, and why their preoccupied therapists failed them.
I myself know how all this works; half a century ago, as a late adolescent, I myself happened to have been concurrently in both positions (Ross 1995). To reverse the Frank Sinatra lyric, “When I was seventeen, it was not a very good year.”
In conclusion, I would simply like to commend the series and volume editors, along with the contributors, for their courage in stepping forth in the face of a deafening silence on the part of our institutions. I can only hope that it’s not too late to follow the lead of Louis Brandeis, who reminded us that “sunlight is the best disinfectant.”