I had a session with my therapist yesterday, a psychoanalyst. So, I was talking — then my therapist went into one of her typical rambling discourses on what I had just said. I said to her, “How do I know you’re not making all that up? As far as I know all of that could be your confabulation.” She replied: “It doesn’t matter. I’m not looking for factual accuracy.” And I said: “When I was seeing Dr. Palombo, I had the sense that he would withhold an intervention until he was fairly certain of what he was saying.” And she said: “He probably did. But I don’t do that. I am not looking for accurate interpretations.”
Is this legitimate? What school of psychoanalysis is she following? I’m flabbergasted. I’m also thinking of terminating her.
What’s the difference between seeing my therapist and seeing a tea leaf reader? It doesn’t matter?
My last therapist (at a trauma clinic) employed a primarily time-limited, CBT approach with me. At least one research paper found that introjective patients do “particularly poorly” in CBT therapy.
The constructive response of introjective patients to long-term psychodynamic treatment stand in stark contrast to findings in our analyses (Blatt et al. 1995, 1996) of data from the study of brief treatment for depression (sixteen weeks once a week) in the NIMHsponsored Treatment of Depression Collaborative Research Program (TDCRP), which compared the differential effects of two forms of manual-directed brief psychotherapy for depression (cognitive-behavioral therapy [CBT] and interpersonal therapy [IPT]) with medication (imipramine, IMI) and a double-blind placebo. Differences in symptom reduction among the three active treatments (CBT, IPT, and IMI) in this study, both at termination and at follow-up, were minimal (see, e.g., Elkin et al. 1989). In further analyses of data from the TDCRP, however, we (see Blatt et al. 1995, 1996) found that introjective (highly self-critical or perfectionistic) patients did particularly poorly in all three treatments. Thus, introjective patients appear not to benefit extensively in brief treatment in the TDCRP or from long-term SEP in the MPRP, but appear to be particularly responsive to classic PSA [psychoanalysis] and to other long-term, psychodynamically oriented intensive treatments.
Our minds are a mosaic and certain patterns are repeated again and again.
1. The following dream expresses a twinship theme and suggests a desire for a “secret sharer” — a yearning for an alter ego with whom I might collaborate on some project. The text refers to Freud’s book Moses and Monotheism.
2. The following letter that I wrote in 1992 discusses the “secret sharer” relationship between Freud and U.S. Ambassador William Bullitt (before I knew about any such fantasy) and draws comparisons with Freud’s work on his book, Moses and Monotheism.
3. My book Significant Moments grew out of one passage from the book, Freud’s Moses: Judaism Terminable and Interminable. Prof. Yerushalmi’s book, which I purchased in the fall of 1991, was the seed from which my entire book grew.
4. My father’s father’s name was Moses. He died in 1929 from an infectious disease, bacterial meningitis. My father used to say, “If my father were alive today, they could have cured him with penicillin.” My father’s father is buried in Montefiore Cemetery in Philadelphia (Jenkintown).
5. In my book The Emerald Archive I created a character based on Dr. P–. I gave him the name Moses — Moses Haim.
I suspect that I based the name on Sir Moses Haim Montefiore, 1st Baronet, FRS (1784 – 1885), who was a British financier and banker, activist, philanthropist and Sheriff of London. Born to an Italian-Jewish family, he donated large sums of money to promote industry, business, economic development, education and health among the Jewish community in the Levant, including the founding of Mishkenot Sha’ananim in 1860, the first settlement of the New Yishuv. As President of the Board of Deputies of British Jews, his correspondence with the British consul in Damascus Charles Henry Churchill in 1841–42 is seen as pivotal to the development of Proto-Zionism.
Vienna, June 30, 1896
My dear Wilhelm,
You taught me that a kernel of truth lurks behind every absurd popular belief, and I can give you an example of this. Certain things should not be mentioned even in jest, otherwise they come true. Thus I wrote to you recently that there was no real need for a congress, and today I have to tell you of a serious obstacle which stands in the way of the next one, or at least in the way of fixing its date. My old father (age eighty-one) is in Baden in a most shaky state, with heart failure, paralysis of the bladder, and so forth. Eagerly waiting for news and traveling to see him were the only things of interest in these past two weeks. Therefore I do not dare make any plans now that would take me a day’s journey away from Vienna. To be sure, he is a tremendous fellow,2 and should he still be granted a span of well-being, as I hope he will, I shall use it for our meeting. I cannot announce my visit today; but could you arrange to take time off if I were to send you a telegram announcing that within twenty-four hours I intend to leave to see you, so that there would still be enough time for you to cable and cancel the trip? Avoiding your significant dates, of course.
I feel a pall has been cast over me, and all I can say is that I am looking forward to our congress as to the slaking of hunger and thirst. I bring nothing but two open ears and one temporal lobe lubricated for reception. I foresee important things — I am that self-seeking — also for my purposes. With regard to the repression theory, I have run into doubts that could be dispelled by a few words from you, in particular about male and female menstruation in the same individual. Anxiety, chemical factors, and so forth — perhaps with your help I shall find the solid ground on which I can cease to give psychological explanations and begin to find a physiological foundation!
I have really been quite inactive as well. The completely uninteresting work on infantile paralyses had to serve as my main focus.
. . . but all my ideas come from literature or psychoanalytic texts read as literature. You can see how I read concrete things (set forth in the quotes) and then I turn these literary ideas into psychoanalytic concepts.
Am I trying to be my own analyst, . . . or am I trying to be my own Harold Bloom, the literature professor?
DR. CEASER: He tries to be his own Harold Bloom. That is unacceptable in an analytic patient!!
(1) the self as alien intruder among external objects (Mahler); (2) the self as both alien intruder and a person who is alienated from himself because of ego fragmentation (Camus); (3) the need for mirroring selfobjects (Wagner); the need for mirroring selfobjects in individuals who had faulty parenting and who consequently struggle with ego fragmentation; (4) the father as intruder; (5) and the incorporation of the intruding father into the ego as both an ideal (a derivative of the father as an “honored” person) and an inhibiting force (a derivative of the “hated and feared” father) (Freud).
It’s uncanny that the quotes come back to slavery, antisemitism and (racism).
For the first time I thought about something that is quite fascinating concerning Freud’s Moses and Monotheism. Moses was an intruder in the Royal House of Egypt, the Hebrews were intruders in Egypt, the father is an actual intruder in relation to the mother vis-a-vis the child, and the father is symbolically an intruder (or introject) in the mind of the child who incorporates the [intruding] father. In the book Moses and Monotheism Freud moves from a discussion of the ancient Hebrews in Egypt to a discussion of the development of the superego and the incorporation of the image of the father into the child’s ego. For the first time I saw that the themes of intrusion and incorporation in Freud’s book Moses and Monotheism are overdetermined and relate to both the relations of ancient Hebrews to Egyptians but also to the relationship of father to child. Maybe that’s a novel insight about Freud’s book.
Freud writes: “In the course of individual development a part of the inhibiting forces in the outer world [the intruding father] becomes internalized; a standard is created in the Ego which opposes the other faculties by observation, criticism and prohibition. We call this new standard the superego. From now on the Ego, before undertaking to satisfy the instincts, has to consider not only the dangers of the outer world, but also the objections of the super-ego, and has therefore more occasion for refraining from satisfying the instinct.”
May I inquire: Is this a Jewish dream? Does the dream relate to cultural issues as much as to purely psychological issues?
The following dream from Freud’s book, Interpretation of Dreams discusses Jewish concerns, which is unusual in Freud’s book. The dream has an unusual content as compared with Freud’s other dreams: it relates to both cultural issues and purely psychological issues. Might we say that in this dream Freud finds himself in the role of an intruder in Rome? The Jew in the Catholic city?
On account of something or other that is happening in Rome, it is necessary for the children to flee, and this they do. The scene is then laid before a gate, a double gate in the ancient style (the Porta Romana in Siena, as I realize while I am dreaming). I am sitting on the edge of a well, and I am greatly depressed; I am almost weeping. A woman – a nurse, a nun – brings out the two boys and hands them over to their father, who is not myself. The elder is distinctly my eldest son [Martin], but I do not see the face of the other boy. The woman asks the eldest boy for a parting kiss. She is remarkable for a red nose. The boy refuses her the kiss, but says to her, extending her his hand in parting, “Auf Geseres,” and to both of us (or to one of us) “Auf Ungeseres.” I have the idea that this indicates a preference.
This dream is built upon a tangle of thoughts induced by a play I saw at the theatre, called Das neue Ghetto (The New Ghetto). The Jewish question, anxiety as to the future of my children, who cannot be given a fatherland, anxiety as to educating them so that they may enjoy the privileges of citizens – all these features may easily be recognized in the accompanying dream-thoughts. “By the waters of Babylon we sat down and wept.” Siena, like Rome, is famous for its beautiful fountains. In the dream I have to find some sort of substitute for Rome (cf. chapter V., B.) from among localities which are known to me. Near the Porta Romana of Siena we saw a large, brightly-lit building, which we learned was the Manicomio, the insane asylum. Shortly before the dream I had heard that a co-religionist [i.e., a Jew] had been forced to resign a position, which he had secured with great effort, in a State asylum.
Our interest is aroused by the speech: “Auf Geseres,” where one might expect, from the situation continued throughout the dream, “Auf Wiedersehen” (Au revoir), and by its quite meaningless antithesis: “Auf Ungeseres.” (Un is a prefix meaning “not.”) According to information received from Hebrew scholars, Geseres is a genuine Hebrew word, derived from the verb goiser, and may best be rendered by “ordained sufferings, fated disaster.” From its employment in the Jewish jargon one would take it to mean “wailing and lamentation.” Ungeseres is a coinage of my own, and is the first to attract my attention, but for the present it baffles me. The little observation at the end of the dream – that Ungeseres indicates an advantage over Geseres – opens the way to the associations, and therewith to understanding. This relation holds good in the case of caviar; the unsalted kind is more highly prized than the salted. “Caviar to the general” – “noble passions.” Herein lies concealed a jesting allusion to a member of my household, of whom I hope – for she is younger than I – that she will watch over the future of my children; this, too, agrees with the fact that another member of my household, our worthy nurse, is clearly indicated by the nurse (or nun) of the dream. But a connecting-link is wanting between the pair, salted – unsalted and Geseres – Ungeseres. This is to be found in gesauert and ungesauert (leavened and unleavened). In their flight or exodus from Egypt the children of Israel had not time to allow their dough to become leavened, and in commemoration of this event they eat unleavened bread at Passover to this day. Here, too, I can find room for the sudden association which occurred to me in this part of the analysis. I remembered how we, my friend from Berlin and myself, had strolled about the streets of Breslau, a city which was strange to us, during the last days of Easter. A little girl asked me the way to a certain street; I had to tell her that I did not know it; I then remarked to my friend, “I hope that later on in life the child will show more perspicacity in selecting the persons whom she allows to direct her.” Shortly afterwards a sign caught my eye: “Dr. Herod, consulting hours…” I said to myself: “I hope this colleague does not happen to be a children’s specialist.” Meanwhile, my friend had been developing his views on the biological significance of bilateral symmetry, and had begun a sentence with the words: “If we had only one eye in the middle of the forehead, like Cyclops…” This leads us to the speech of the professor in the preliminary dream: “My son, the myopic.” And now I have been led to the chief source for Geseres. Many years ago, when this son of Professor M’s, who is today an independent thinker, was still sitting on his school-bench, he contracted an affection of the eye which, according to the doctor, gave some cause for anxiety. He expressed the opinion that so long as it was confined to one eye it was of no great significance, but that if it should extend to the other eye it would be serious. The affection subsided in the one eye without leaving any ill effects; shortly afterwards, however, the same symptoms did actually appear in the other eye. The boy’s terrified mother immediately summoned the physician to her distant home in the country. But the doctor was now of a different opinion (took the other side). “What sort of ‘Geseres’ is this you are making?” he asked the mother, impatiently. “If one side got well, the other will, too.” And so it turned out.
I avoided a foray into a distracting discussion of theoretical psychoanalytic issues (that I don’t understand) by simply presenting a few quotations that foreshadow the various perspectives of the dream: (1) the self as alien intruder among external objects (Mahler); (2) the self as both alien intruder and a person who is alienated from himself because of ego fragmentation (Camus); (3) the need for mirroring selfobjects (Wagner); the need for mirroring selfobjects in individuals who had faulty parenting and who consequently struggle with ego fragmentation; and (4) the father as intruder. The quotes are the themes of the dream.
I had an additional insight about “The Dream of the Intruding Doctor.” I have come to see that my thoughts about the dream are too concrete — I talk about people as intruders in a literal sense. But there is a deep symbolic sense of intrusion that relates to Kohut’s theories about narcissism. The fundamental issue (which, of course, does not negate the concrete literal issues I have already written about) relates to the individual’s introjection of foreign elements from external objects into the self and the consequent fragmentation of the self. As an individual, I contain foreign “intruders” that are unintegrated or assimilated. This opens up a remarkable insight about my sense of Dr. P.: he is both an intruder and a selfobject that supports the firming of the bipolar self. It’s kind of Janusian: these are polar opposite qualities. Kohut argued that if the child’s own exhibitionistic initiatives are responded to by mother, and if his or her needs to idealize are accepted, then the lines of development of the bipolar self can progress. Thus for Kohut, an unalienated self is possible.
This became clear to me upon reading the psychoanalyst Philip Mollon’s paper about Kohut: “Releasing the Unknown Self.”
In optimum development the caregiver will be responsive to the child’s own initiatives so that his or her own potential, talents and inherent developmental agenda can be supported.
However, in less good circumstances, the child will be compelled to incorporate the mother’s desire as an internalized structure [an “intruder”] around which to organize the self – or will organize around an idealized abuser, or indeed around any available perceived source of strength.
This inner structure will then be opposed to the child’s authentic potential. The work of [Kohutian] psychoanalysis involves undoing this alien parasitic structure [the “intruder”], thereby releasing the unknown true self. However, such work brings the threat of fragmentation and may result in great anxiety.
Mollon writes: “Whereas mirroring and availability for idealization brings about the emergence and firming of the bipolar self, abuse within a caregiver relationship forces the child back into the state of the fragmented self. In response, the child organizes his or her fragmented self around the figure of the abuser – forming an aspect of the alien self [the “intruder”]. This is a variant of identification with the aggressor. Challenge to the perception of the self as bad and the abuser as good brings the threat of fragmentation. The shame is structured within the personality – resulting in a part experienced as bad and unlovable, and another part experienced as accusing and condemning.
The attorney determined that “eggs and sausages” was “a total vulgar” and “therefore inappropriate” on Twitter. The term, referring to common breakfast foods, was “highly offensive” and “vulgar,” and that it had “decidedly negative sexual connotations.” Freedman’s Twitter contained imagery depicting an “extreme preoccupation with breakfast foods” and “antisocial behavior.” The term “eggs and sausages” communicated “food obsession, depravity [and] vulgar sexual imagery.” Whether one considers the term “eggs and sausages” as a sexual term, or finds that Freedman has used the term in the context of extreme phallic imagery and food obsession, “we have no question but that [the term is] extremely offensive.”