Looking Beyond: Toward a Psychoanalytic Future

First, the universal human axis of mortality and illness

The plague forces a confrontation with the stark and nonnegotiable reality of death and the brutality of chance: en masse and yet within the singular loneliness of individual existence. Stripped of the collective fortification of our denial of death, we are left existentially exposed. Along this line, each of us is vulnerable, and as so many messages of solidarity extol: we are all in this together. Power did not protect Boris Johnson from infection and the intensive care unit; wealth and fame did not protect Tom Hanks.

Second, the differential structural axis of inequity and difference

It is clear now that the pandemic does not affect us all equally, and along this line, we are not at all in this together. While power and wealth cannot guarantee you will not get infected, they go very far indeed in determining your risk of infection and the possible outcomes of illness. Black and brown communities bear disproportionate casualties, with the mortality rate for African Americans more than double what it is for whites (Tai et al. 2020). The impact on immigrants, refugees, and the undocumented has been profound and manifold, not only directly in disease burden but structurally, as processing systems have been significantly disrupted, often leaving already precarious individuals falling through the holes in the safety net (Loweree, Reichlin-Melnick, and Ewing 2020; see also immigrationimpact.com). And a new kind of generational tension, waged on the existential grounds of life itself, has emerged (Ayalon 2020; Rudolph and Zacher 2020), seeming to pit the restless and uncaring exuberance of the young against the fearful wariness of the elderly. (Isn’t the abundance of caution we see in the psychoanalytic community driven not only by education level and political affiliation, but also by the lived sense of precarity due to a disproportionately older cohort?)

To the extent that psychoanalysis engages with the reality of this pandemic—and how can it do otherwise?—it must think along these two axes of vulnerability. The first axis corresponds to the personal and individual dimension of psyche, bounded by a mortal organismal body subject to the universal laws of birth and death. This terrain has been the usual domain of psychoanalysis. We are familiar with its elaborate theoretical architecture: the drives and their vicissitudes, infantile sexuality, the inscription of individual objects and their attachments, relations, and losses on the development of the individual mind. The second axis of differential inequity corresponds to the collective dimensions of psyche, a vast and vastly undertheorized domain for psychoanalysis, whose hallmark is not universality but plurality, the relations of one-to-many, collectivization beyond the individual, the imperative of membership in groups that precede us, and that carry and inscribe within us the order of a social unconscious. It is a domain we must develop with some urgency, since it has become indispensable for the thinking and practice of contemporary psychoanalysis.

Deluge and Disruption

If the anticipatory fear of the Y2K computer bug that shadowed the turn of the millennium turned out to be more hype than substance, it stood as a kind of collective fantasy of catastrophes to come. Some twenty-one months after clocks around the globe clicked to 00 without major incident, two planes buckled and then flattened the twin towers of the World Trade Center: it was like America falling to its knees. And four short years later, Hurricane Katrina slammed through the levees of New Orleans, inundating 80 percent of the city. These inaugural events of the new century are emblematic of dire problems at the level of the collective: the escalation of tensions wrought by a shrinking world that brings radically different ideologies into combustible friction, the ineffectiveness of a global response (in all senses of the phrase) to a dangerously warming planet, the inadequacy of attention to the suffering of the poor and marginalized, the structural devastation of racial inequity. Young-Breuhl (2013) asserts that true global consciousness first arose in the aftermath of the convulsive world wars of the twentieth century, but necessarily as a highly traumatized consciousness, one as yet unable to tend to what ails us a species, a consciousness scarred by the brute, pernicious structures of defense characteristic of the severely wounded.

In Beyond the Pleasure Principle, Freud (1920) defines “as ‘traumatic’ any excitations from outside which are powerful enough to break through the protective shield . . . a breach in an otherwise efficacious barrier against stimuli” (p. 29). We must rework now the concreteness with which conventional psychoanalysis has read the phrase “from outside,” despite the many openings in Freud’s text for a consideration of something more systematic than simple reductions to the singular individual. Certainly the attacks on the twin towers and the breach of the levees emanate from an outside delimited not only by geography, but by the exteriority of a psychic collective. It was we—a word that immediately conjures a host of problems regarding what constitutes interiority, and of who is excluded precisely in order to constitute it—we who were flooded by these cataclysmic events (cataclysm, from the Greek for “deluge”). There is little doubt that the American psyche is fractured, confused, and ailing.

In Freud’s “metapsychological speculations,” as he calls his theorizing in Beyond the Pleasure Principle, the response to a breach of a protective shield is “‘anticathexis’ on a grand scale”: the less able a system is to bind the influx of external stimuli, Freud writes, “the more violent must be the consequences of such a breach” (p. 30). The catastrophic events of this young century have breached a collective stimulus barrier, shattering the imaginary coherence of supposedly united states of collectivity. In response to overwhelming events: the anticathexis of Trump’s wall, as concrete fortification of the threatened boundary of national identity. In the face of uprisings protesting the police murder of black women and men: the violence of the State, tear gas, jackboots, brute militarization of containment. And to confront the ubiquitous invisible “invader” of SARS-CoV-2: mania, denial, grandiosity. Maniacal defense, we know, is flimsy at best; at worst, it is the virulent enemy of stability, growth, and ethics.

Like the moving jolt of an earthquake following geological fault lines into the soft spots of a foundation and the weak seams of a house that stands or falls, trauma tracks backward in time along the fragilities of a structure, sounding out previous fissures, cracking open old suture lines. The cataclysm of Covid recalls the cataclysm of Katrina, deluge upon deluge, as once again we witness the deadly effects of systemic inequity.

The prudent response to an earthquake is aptly called retrofitting. The structural work required—first to heal the damage done, then to reconfigure and fortify—is retrospective; it requires looking back and taking stock of the insufficiencies of the edifice. We are familiar with the pained and painstaking processes of such reconstruction in our clinical work with individual patients, and with the failings of Reconstruction in our nation’s history.

Since just before the 2016 elections, I have been thinking about Bion’s notion of catastrophic change as a model for what is taking place on the social plane (1970). Closely aligned but not to be confused with trauma, catastrophic change is psychic perturbation at the threshold of growth. Catastrophe here can be understood as a rupturing of the container by what it contains, old skins no longer able to hold new wine. At such a juncture, we arrive at a fork in the road: the question is whether to accept the necessity of change, which will require enormous work, sacrifice, and the loss of the “old ways” (in this sense, a “catastrophic” destruction of what was known and cherished), or to hold tenaciously to the old out of fear, doggedly clinging to forms that no longer hold, resulting in seismic disruptions to the collective psyche (in this sense, the greater catastrophe of failed attempts to live through broken containers, a catastrophe of the future).

Along the second axis of vulnerability—of social inequity and the collective aspects of psyche—psychoanalysis is in an era of catastrophic change, struggling with the difficulty (and at times refusal) to confront the limitations of our existing containers in order to creatively elaborate new forms.

Caesura

Certainly the last several months have upended our world (catastrophe from the Greek meaning downturning, overturning). From the vantage of constructive catastrophic change, we might interpret this upending as necessary disruption, though it may at times feel instead like total destruction. Can there still be a psychoanalysis after the death of the “embodied co-presence” of analyst and analysand? (Isaacs Russell 2020).

Along with so many others, we analysts have lost the commons: that fabric of relation that extends beyond the individual. Glances exchanged with strangers on crowded streets, small talk at gatherings, mild flirtation with waiters. In the professional world, we have lost the matrix of connections with others that surrounds the immediate clinical work and gives it texture. I notice it acutely in my work at the community clinic: gone are the hallway consultations, the friendly chatter at the reception desk with patients and staff. But the loss also echoes in my private practice: I no longer pick up the patient from the waiting room, witnessed by someone else’s patient perhaps, a subtle and powerful public mark of our shared intimacy. Or at the institute and conferences: we no longer share communal resonances at a lecture; incidental conversations on the way to our seats have fallen silent. Most obviously, of course, we have lost the consulting room—a fundamental change that has disturbed the material bedrock of psychoanalytic practice, demonstrating how vital a factor the quality of embodied presence is for analytic work.

But at times our mourning of the setting has tended toward the melancholic. We abjure the fixation of the screen, and lament the loss of bodies together in the room to such a degree, one might think psychoanalysis had in fact ceased—or that clinicians have merely pretended to do it, not yet wanting to acknowledge its newfound impossibility. Yet have we not also now heard many stories about the poignancy of the work, the startling intimacy of seeing into a patient’s home, of hearing the voice directly in the ear? Might our threnody for the lost office not also blind us to the deeper implications of what it may mean that analysis not only continues, but perhaps at times even thrives despite such a radical breach in the material setting?

There are through-lines of continuity amid the rubble of rupture.

And this continuity of analysis across catastrophic breaches says a great deal about what analysis actually is. We are used to speaking of the couch as the lap of the analyst mother. Does the patient’s cradling of the phone not also invoke the maternal dyad? Or might the proximity of our gaze when a patient is holding a camera phone—the face sometimes so close, our gaze at times brushing up against a torso or bare arm being adjusted—not remind of us of the intimate landscape of the lover? Freud’s introduction of the couch disrupted social conversation, denaturalized it, altered the positions of the participants, reconfigured their shared perception. We have been able to think deeply about the implications of this disruption. How does this thinking continue, now that the setting of the conventional office is disturbed?

I do not mean to glorify the virtual office or to be cavalier about the loss of co-presence. I mean instead to emphasize one of the functions of mourning: namely, to help make room for a new object, for the aliveness of possible futures. Through our mourning of what we have lost as analysts, we may be able to peer more deeply into what analysis has to offer.

About a month into shelter-in-place, K. and I reminisced about how we would track together the patterns of late afternoon light on the wall in the office, marking the passing of the seasons. We were recalling the photos she sometimes took and showed me of sunsets seen on the way to the office. Now she was using the same cell phone camera as the portal to our virtual sessions. She flipped the camera around to show me a woman—just a little dark blob on my screen—sitting alone on a fire escape on the building across the way. Maybe the woman could see the sunset from her perch there, K. mused, a view she didn’t have from her own vantage point. The session was marked by absence, but was hardly remote. The inadequacy of what the camera could capture, but what it nonetheless figured, opened a vein of poignant remembrances, portals to other losses, and to a palpable longing to be together again, sharing a place, that has fueled the analytic work. (I recall a line from Robert Hass’s “Meditation at Lagunitas” [1979]: “Longing, we say, because desire is full of endless distances.”)

These “portals of mourning” demonstrate the transferability of psychoanalytic process across material settings, highlighting the relation between psyche and its material iteration as a fundamental site of analytic attention. This is fundamentally what we mean by transference, is it not? The mother remembered may take flesh and form in a session, but only in the transference, as a virtual object; in this sense, all analysis is virtual.

The pandemic-forced move to phone or video conferencing does not, of course, actually eliminate bodies or embodiment from analytic encounters. What it does do is radically change the relationship of those bodies to each other—their spacing and points of contact. It does away with co-location, and it doubles the places in which the setting of analysis simultaneously unfolds. (In one reverie: the screen is a transparent membrane or skin at which these two disparate places touch.)

The current moment provides an opportunity to investigate the deeper structures of the clinical frame. From Marion Milner (1952) to José Bleger (1967) to current contemporaries (see the collection by Tylim and Harris [2018]), we have a rich literature that takes up the complexities of framing in the conventional setting. In line with these writers, I suggest we consider the frame less as a noun, and much more as a verb, as framing. Certain material frames of reference have surely been lost for now—the consulting room and couch we inherited from Freud and his descendants—but obviously not our capacity for framing.

The relation of psyche to materiality made more evident by this jump in psychoanalytic practice to new material setups—this reiteration of psychoanalysis—helps us understand that the various setups themselves are, as Houzel (2012) calls them, “concretizations of psychoanalytic theory” (p. 186). He notes three examples of these “concretizations”: infant observation, play therapy, and “the armchair/couch analytic situation.” Indeed, the elaboration of the talking cure into the playing cure in the second psychoanalytic generation amounted to a new iteration of psychoanalysis in the rambunctious materiality of the toy room, with powerful and far-ranging theoretical implications. Infant observation, considered as another such concretization, is also consequential theoretically, for now the metabolization of psychoanalytic process moves to a place distant (the consulting group) to the observation itself (the home of the infant and family).

I want to advance the idea that, in part, framing concerns the relationship between psyche and such material configurations, making psychoanalytic process more fungible and mobile than we conventionally think. Under Covid, we have participated in sessions that take place in patient’s beds, in parks and nursery rooms and the backseats of cars. Suddenly there is a proliferation of stage sets for the dream plays that psychoanalysis can become. Following Bion’s injunction to “investigate the caesura,” Civitarese (2008) writes about deconstructing the slash in such pairs as psychotic/nonpsychotic part of the personality, night dreams / waking dreams, transference/countertransference. Perhaps we are in the process of deconstructing the slash between fort and da (fort/da), as a new kind of praxis emerges in the strange present-absence of virtuality, a thereness that is also a here, a compressed fortda. What does it mean for our discipline that analysis can take place in this new dimension?

The Covid crisis has forced our hand, giving most every practicing analyst the direct experience of how analytic process can endure across a variety of material configurations, and this continuation of practice across the breach of our so-called lockdown should embolden the innovative expansion of our clinic. If we are to attend to the second axis of vulnerability that the pandemic has laid bare, I suggest we now need to incorporate learning from other “theoretical concretizations,” material constellations that go well beyond the dyadic to include the group. Membership in groups—which is as necessary to human subjectivity as a mother is to a baby—is the primary mode of transmission of the social unconscious (Hopper 2003).

Following the analytic ethos, which compels us to take responsibility for our thoughts, associations, and feelings, even unto their unconsciousness, but considered now on a collective level, the catastrophes of the current moment call on us to look closely at ourselves as a discipline. The relative paucity of theorization of the social unconscious and of the relationship of framing to materiality has made it difficult to take up seriously the structural inheritances of our discipline. By this I mean the unconscious ways we have become something of a gated community: the cost of training, our whiteness, the absence of our presence in places of greatest need (González 2020). The pandemic injunction to shelter in place (which compelled withdrawal and a turning inward), coupled with the recent uprisings against anti-black racism in the face of police brutality (which compelled an outpouring of anger and a turning outward) have been twin forces operating at the level of the group, with profound implications for our patients, ourselves as analysts, and our discipline. The psychoanalysis that emerges from this disruption cannot be the same as the one that entered it. Theoretical innovation will need to incorporate insights from group analysis and critical race theory to help make possible the rigorous framing of collective dimensions of our current catastrophes, and facilitate the growth-promoting kind of catastrophic change psychoanalysis now faces.

In “Instincts and Their Vicissitudes” (1915), Freud famously commented on the “measure of the demand made upon the mind for work in consequence of its connection with the body” (p. 122). Today we must extend this formulation, and suggest that there is also a demand made upon the mind—both individual and collective—in consequence of its connection with the social. I am with the later Freud: that analysis is more than the clinical praxis we have institutionalized, that it is a praxis of thinking that can apply to civilizations and their discontents. With Enrique Pichon-Rivière and Juan Tubert-Oklander: that there is a continuity between individual analysis, group analysis, and social analysis. And with George Bermudez: that all analysis is applied analysis (the setting of the conventional consulting room being just one such application).

We are now called to take the high road of catastrophic change, the one that demands innovation. For some of us that will mean employing understandings we have harvested from conventional two-person analysis to develop a richer understanding of the collective dimensions of individual subjectivity and to help unpack the social unconscious forces that operate within our theory. We will need to continue to innovate forms of engagement with communities in greatest need, and to teach in our institutes how these forms of community engagement are actually central to the principles of psychoanalysis and the formation of the analyst. We must address the psychoanalytic significance of the whiteness of our institutes—that is, we must attempt to understand what the fact of our whiteness makes evident about the social unconscious structures of institutional psychoanalysis. And, as with our patients, we must struggle to grow and change.

We must do what we do as psychoanalysts, and get to work.