A Confusion of Tongues: The Analytic Community

from fort da; Journal of the Northern California Society for Psychoanalytic Psychology, 2000 (6) 95-100.

B. Apfelbaum PhD

Victoria Hamilton's The Analyst's Preconscious (1996) should be recognized as a watershed event in the literature, but it has been all too easy to overlook, perhaps because the modest title gives no clue to its scope. It is a thorough and probing investigation of analysts' operating frameworks, explicit and implicit assumptions, interpretive priorities and, indeed, their confusion of tongues. It could have been a simple attitude survey, and Hamilton did use a short questionnaire, but she also conducted interviews of up to two hours with 65 analysts (selected to represent variations in theoretical affiliation, age, and experience) in four cities: London, New York, San Francisco, and Los Angeles (where she, a British native and trained there; practiced until recently). Her study is thorough in the way that only a study can be that began as a doctoral dissertation.

Despite this ambitious effort at data collection, Hamilton was able to avoid being overwhelmed by it, finding creative ways to discover and communicate the illuminations buried therein. The result is a model of functional research that preserves the flavor of these analysts' individual struggles with patients, other analysts, and with themselves. Through sophisticated methods of data reduction she is able to bring out the deep structure of analysts' thinking.

Long interview excerpts fill much of the book. These are framed by Hamilton in essays that not only offer a perspective on the material but also expertly connects it with the literature. This opens a unique window onto what analysts really think about what they do and about each other.

Her purpose was "to systematize the beliefs and actions that are typical of practicing American and British analysts today" (between 1988 and 1990). She found that "the area between [their] avowed theoretical orientation" and actual clinical practice "reveals the muddled overlaps and uncomfortable, precarious coexistence of parts of belief systems." She could easily have deplored the muddle but, instead, she proposes that it represents the preconscious, a psychic area in which contradictory assumptions may be expected to coexist. Her purpose in choosing this designation is "to protect the analyst's imaginative capacities and efforts, as these have been curtailed and undermined through psychoanalysis' scientist leanings and aspirations to become a more cohesive, homogeneous discipline" (p. 3). In other words, she argues for what she calls "pluralism," seeing it as a healthy tolerance of differences just below the surface, as contrasted with the wholly conscious "strife [that] is rife among psychoanalysts of different persuasions, each arguing for the 'right' developmental theory and therapeutic action."

However this may be, Hamilton's use of the preconscious is an awkward fit for her findings since much of their value lies in revelations of the conscious attitudes that she contrasts with the preconscious. Given the assurance of anonymity and the presence of a responsive and tolerant interviewer, the subjects treat us to their unpublishable opinions, their often unsparing views of those they disagree with, as well as analytic gossip, malicious and otherwise. In casting her book simply as a revelation of an inevitable pluralism that lies beneath the surface, Hamilton does not do justice to the fact that her findings also illuminate the intolerance of pluralism that she decries—the confusion of tongues.

But, first, the most noteworthy finding—something we suspected but had no way previously to verify—is that "analysts think and practice much more loosely than they publicly claim." Other newsworthy discoveries:

The majority of analysts of all theoretical persuasions focused their interpretations on the here-and-now transference relationship and minimized the frequency, and importance, of references to the past.

(p. 226)

And, again, for the majority of analysts:

Free association, the interpretation of the Oedipus complex and the erotic transferences, reconstruction, and the development of a transference neurosis did not engage the attention of the analysts

(p. 310).

Her most sobering finding is that:

Analysts in one psychoanalytic culture can be intensely preoccupied with theoretical and technical matters that are of no interest to analysts in a society where esteemed figures are personally unknown and where their work has not been transmitted by students and admirers. For instance, Bion's influence lingers on in Los Angeles because of the influential people he analyzed and supervised, whereas references to his work are rare in the New York Psychoanalytic Society or in the San Francisco Institute. Similarly, the differences that are hotly debated at self psychology conferences in the United States between Kohut's colleagues and more contemporary intersubjectivists are of no interest to British analysts simply because no important colleague or analysand of Kohut has permanently settled in the British psychoanalytic community. (p. 128)

Hamilton's own readiness to fully entertain and enter into opposing views is in marked contrast to many of her respondents. She was taken aback by some of the vituperation she encountered. "In the first interviews with American analysts of a self-psychological perspective, I had no idea that questions about conflict or the therapeutic alliance would arouse the scorn that they did." She comments that analysts "tend to stereotype terms that are foreign to their preferred conceptual scheme," or they may simply be at a loss to make sense of such terms: One analyst's bemused comment was, "I don't know what a 'selfobject tie' is. I would interpret the patient's avoidance of separateness."

How are these revelations to be interpreted? Of course, it goes beyond the scope of this book to do more than briefly speculate about the condition of the field that Hamilton has uncovered. Her findings help to explain why there has not already been a "psychoanalysis of science" applied to the field itself: analysts respect for and curiosity about other analysts seems limited by the unresolved tensions in the field. If Hamilton had not done this study, it is not likely that anyone else would have, although if the field is ever going to psychoanalyse itself more such explorations are needed. Failing that, analysts are left simply pathologizing opposing schools, as in the "Americans" calling the Kleinians "crazy to interpret transference the moment the patient walks into the room," or the Kleinians "long-standing joke...about Americans' fear of interpreting the transference" (p. 119) This disqualification rather than discussion of opposing views reaches its nadir in another joke relayed by one of the respondents that Klein's theory was her way to escape blame from her children. This may less apparent in San Francisco, by Hamilton's glowing report:

As a group, the San Francisco analysts were the most responsive both to the request for interview and during the interview-discussions. They engaged with great concentration and enthusiasm on all areas discussed. This quality is especially interesting, since the San Francisco analysts were the most consistent geographic group and at the same time very widely read and open to other ideas. I felt I was being invited an ongoing study group.They were particularly gracious and respectful toward me and toward their colleagues in the San Francisco community. (p. 313f)

Hamilton's own interpretation of her findings is that "attachment—both between patient and analyst and between analyst and his close colleagues—dominates the psychoanalytic domain." Thus,

Analysts form attachments to specific theories, to key figures that provide the analyst with a measure of security [that enables him or her to manage] immersion for often eight to ten hours a day in the intense emotional field of the analytic relationship. (p. 311)

Hamilton's recourse to attachment theory is an eminently forgiving object relations view that risks going deep prematurely and may reflect some disappointment in her colleagues, the implication being that infantile attachments to theories and the intolerance it generates may be an irremediable symptom of "the impossible profession."

I think we need to make some allowance for the fact that territorial allegiances, the overriding influence of prestigious figures, and the scornful dismissal of opposing views—what Hamilton refers to as the "strife" in the field—is endemic to all disciplines, even the hard science (the Kuhn effect). This is to say that we are all more human than otherwise, not that this at all precludes the possibility of going more deeply into the phenomenon. But there is an explanation more specific to the field that can be inferred from Hamilton's findings.

Even in the soft sciences it is not the case that there is so little agreement about basic terminology, let alone basic concepts. The "muddle" may not simply be the natural content of the preconscious. The ultimate value of Hamilton's work may lie in revealing the lack of a coherent conceptual system that can particularize and rationalize divergent views. This suggests that the often heard complaint that the field suffers from a lack of empirical validation is, at best, premature. For example, the Weiss-Sampson group has neatly confirmed their principles using a variety of empirical designs. But how likely is it that their proofs have influenced otherwise unconvinced practitioners?

One reason for this conceptual disarray is the lack of an academic setting, with its well-established means of enforcing conceptual clarity, as for example, by periodic review articles that contrast alternative theories and offer theoretical constructs through which to organize them. (Illustrative exceptions are reviews by.Laurence Friedman, e.g., 1988).

But there is a more serious problem here that is best brought to light by another heroic and indispensable work, Greenberg and Mitchell's much better known Object Relations in Psychoanalytic Theory (1983). Much of their book consists of tracing the dense abstractions and tortuous linguistic evasions employed by major analytic theorists to avoid seeming innovative and therefore not to appear to have deviated from accepted principles. Any reading of the major theoretical journals demonstrates the same defensive murkiness. How much clarity is possible when major theorists are, at least in part, dedicated to obfuscation?

It is here that we can find the most immediate explanation for what Hamilton sees as our attachment issue—the unexpectedly overriding influence on analysts' thinking of the locale in which they practice and on personal contacts. The condition of the field is such that without direct personal contact it is difficult to know what other analysts are talking about. The fact, for example, as Hamilton's reports, Bion's influence lingers in Los Angeles but is limited in the New York and San Francisco Institutes, may be most directly attributed to the fact that personal-to-person communication is not only freer, it inevitably is clearer, not relying on interpretations that themselves need an interpreter.

Tolerance of differing views and freedom of debate were not virtues of early psychoanalysis since the rejection of psychoanalytic explanations was only to be expected. Interpretations were confrontations, and superego effects—the patient's defensiveness—could, as is legendary, even be taken as proof of their correctness. Id analysis required the stamina to withstand both patients' and the public's outrage. In the face of such massive resistance, whether real or imagined, an analyst's allegiance to the established model was seen as a test of loyalty.

Constructivism has taken us so far from this siege mentality that several of Hamilton's respondents feel it necessary to insist that some narratives are better than others and that the analyst's subjectivism has its edge over the patient's. However, an "elderly analyst of international standing," made it clear that the old confrontational style is still with us. When asked if he uses qualifiers (e.g., "I think...," or, "Is it possible that...?") in making an interpretation, his answer was: "In general I avoid it. Sometimes, under certain circumstances, I might say something like, 'It might be.'" Whereas a member of the British Independent (Middle) group answered: "I do use 'perhaps,' 'maybe.' I don't have any qualms about it."

Of course, there also are familiar opposing views that are relatively calmly discussed, e.g., whether the transference neurosis is iatrogenic or immanent in the patient, whether there is a real relationship, the uses of dreams, distinctions regarding containment and holding. Although discussion founders when the the same terms are used differently, as when one analyst uses "deficit" to mean an admission of hopelessness about change "confirming their [patients'] suspicion that they were defective," whereas another thinks of the deficit concept as an indispensable alternative to seeing the patient as resisting change ("It would be almost sadistic to think of deficit as resistance").

Judging from this report, the field as a whole still appears not to treat defense as the focus of interpretation. For example, the word "guilt" appears only once (shame, less surprisingly, appears not at all), and even at this one point the interviewee advises that the analyst should be on guard not to shy away from confronting a patient with material he or she feels guilty about. The Kleinians are at the farthest remove from defense analysis, as expected, treating the patient's "evasion of reality" as something to overcome rather than to analyze, just as did the early analysts. It appears that the technique of interpretation is still being left to timing and tact.

Obviously, questions of representativeness can be raised (suppose Chicago rather than Los Angeles had been in the pool, or that London had not). Some analysts did not respond to Hamilton's letter soliciting their cooperation (we are not told the percentage), and we do not know the criteria used by those who nominated subjects (other than a few broad categories), but we owe a considerable debt to Hamilton for pursuing this study at all. If this study is widely read, and my purpose in reviewing it now is toward this end, it may stimulate interest in analyzing our way of relating to one another, especially as influenced by the past, and the implications this has for the evolution of the psychoanalytic model.

References

Friedman, L. (1988) The clinical popularity of object relations concepts. Psychoanalytic Quarterly, 57, 667-691.

Greenberg J.R. & Mitchell, S.A. (1983) Object Relations in Psychoanalytic Theory.

Cambridge, MA: Harvard University Press.
Hamilton, V. (1996) The Analyst's Preconscious. Hillsdale, NJ: Analytic Press.