COMMENTARY ON APCS CONFERENCE 2014
As a graduate student in a dual-oriented program (both psychodynamic and cognitive-behavioral), I enjoyed the opportunity to have discussions from a purely psychodynamic perspective. Philosophizing and debating issues of social justice, culture, and society through this theoretical lens led to stimulating dialogue that continued outside of the room. In addition, the conference was an opportunity to network and meet like-minded professionals.
COMMENTARY ON APCS CONFERENCE 2014
STUDENT VOLUNTEER DEREK PYLE
This was my second year attending APSC’s annual conference and again I was struck by the overall group of individuals in attendance, characterized by people committed to important social causes in an environment that feels uniquely inviting and collaborative. From panel presentations to lunchtime discussions, it was a stimulating and thought-provoking weekend. As a volunteer helping sort out audio and visual difficulties in each of the presentation rooms, I often moved between simultaneously-held sessions. At times this disrupted my ability to experience the discussions held within any particular panel session, but on the other hand, I got a rather comprehensive patchwork from the overall range of discussions held across the conference. What follows are some of my thoughts inspired from the weekend.
At various points in the conference, I contemplated the goals of psychoanalytic work, as seen from the perspective of clinicians and from the perspective of people seeking treatment. Megan Kolano, Amy Taylor and Kristen Hennessy gave a lovely presentation on their work within a psychoanalytically-informed long-term residential program, Cornerstone Behavioral Health, serving individuals with developmental and intellectual disability. Discussing psychoanalytic work with an individual who has largely been abandoned by her family—and as the individual acknowledges, she will die while still a resident in her state-run program—the panelists discussed how a main goal of the treatment might be improvement in quality of life amidst institutionalization (rather than seeking re-integration into the larger community). While speaking out against the dehumanization and infantilization of individuals with intellectual disability, the panelists affirmed their belief that such individuals should not be precluded access to psychoanalytic-treatment.
In another panel, Esther Rashkin critiqued the notion that a friendly bartender might be able to provide therapeutic support for individuals, advocating instead for the importance of clinicians who have developed their abilities for empathy and practice skilled forms of human relatedness. Esther also discussed her experiences of insurance-company review processes, criticizing the insurance-companies for pressuring clinicians to work toward ending treatment and instead having individuals rely on family, friends, and community as natural supports. Esther maintained that non-skilled community members should not be asked or expected to provide significant emotional support for individuals.
While I was heartened to think of what certainly sounded like a more humane state-run institution (in the first panel) in the midst of an increasingly dispiriting cultural ethos de-emphasizing the depth of human subjectivity (the insurance companies in the second panel), I was also left considering larger implications about the goals of psychoanalytic treatment. Isn’t one fundamental goal of psychoanalytic treatment that the clinician eventually become obsolete? In my view, at the end of treatment and in the best of circumstances, a person has adequately fulfilling emotional intimacy with family, friends, and community; in the worst case, a person would be able to live their life with meaning even amidst a less than fulfilling social world.
To be able to live with one’s aloneness—to arrive at satisfactory compromises between internal drives and external circumstance, to feel internally freed from the familial and social forces of psychic coercion—isn’t this embedded within the ethos of psychoanalysis? In the case of someone who has been unwillingly institutionalized, what does it mean for a clinician to read that individual psychoanalytically—are there times when unwanted psychoanalytic treatment is a kind of psychic coercion, an invasion of one’s psychic space? I do not think these are simple questions; certainly Gail Hornstein’s biography of Frieda Fromm-Reichmann and the Chestnut Lodge shows how psychoanalytic treatment can at times awaken the internal fire of an individual who has otherwise been abandoned to die in the backwards of marginalization.
In another panel presentation called “The Social Dimensions of Psychiatric Diagnoses,” Jeremy Ridenour, Marilyn Charles, Megan Kolano, Jason Moehringer, and Louis Scuderi discussed the complicated task of utilizing diagnoses in psychoanalytic-treatment. While a good portion of the panel’s focus deferred to standard conversation about how one arrives at psychoanalytically informed diagnoses, it was quite interesting to hear Marilyn Charles discuss her work with young adults in inpatient settings, at times viewing their struggles as related to developmental and formative identity-based crises rather than utilizing hard and fast psychiatric labels. Megan Kolano also discussed a case wherein she treated a woman who was very concerned with receiving psychiatric diagnosis. Rather than providing some generic answer, the treatment involved an ongoing dialogue centered around the question “Am I psychotic?” Dr. Kolano offered a great deal of rich clinical detail to illustrate what sounds like a rather successful treatment.
Given that APSC is concerned with the relationship between social justice, psychoanalysis, and the broader field of mental health, it was surprising that there was little conversation about the larger discourse currently occurring across the field, as related to diagnoses and the questioning of psychiatric authority. This again raises questions about the nature of therapeutic work—who has the ability to speak authoritatively about a person’s psyche? Is it possible for a psychoanalyst to “read” the unconscious experience of an individual who does not want—or is not seeking—psychoanalytic treatment? This is a conversation in part related to structural perspectives about the nature of the psyche. If there are universalized structures that distinguish “healthy” and “unhealthy” minds, perhaps it is relatively simple to diagnose where someone sits on this continuum—as normal or borderline; as neurotic, psychotic, or perverse. The conversation underrepresented at APCS, however, involves the growing number of individuals and groups emerging from the peer movement, mad culture, and the psychiatric survivor movement, calling for the end of diagnosis while demanding the freedom to self-identify the parameters of one’s own lived experience.
Even within the ISPS organization, where psychoanalytic panels take place alongside panels run by members of the Hearing Voice Network, there doesn’t seem to be much conversation back-and-forth, between the two camps. As psychoanalysis is increasing relegated away, the fear is that we will lose an important dimension of humanistic depth—and yet it is also humans who are refuting the depth of psychoanalysis as artificially imposed. Is it possible to look beyond the systematic influence of capitalism—which has a vested interest in doing away with psychological treatments that are expensive and difficult to manualize—and create models of mind that are flexible enough to contain the depth of unconscious subjectivity, without hegemonically forcing unconscious meaning into the supposed psyches of unwilling subjects?
On another note, it was also interesting to think about the socio-political critiques offered this weekend, in panels like “Privilege, Pathology and Confrontation in the Neoliberal Era” and “Activist Interventions in Education Settings.” Throughout these discussions, people spoke about the challenge of supporting and developing humanistic values amidst oppressive, hostile or just plain indifferent institutions and environments. Yet at the same time, the conference’s array of panelists showed something of a different story, at least at some localized levels. Throughout APSC there are numerous teachers, and numerous students, revealing the various possibilities of those who depart from typical paths. It was enlivening to see such an array of graduate students and early career clinicians present this weekend, displaying great depth of engagement with psychoanalytic thought, and with related humanistic endeavors, including feminism and social justice work. I was particularly impressed by Jennifer Marion, Cassie Kaufman, and Sophia Frydman’s discussion sadomasochism, BDSM and non-normative sexuality (ome of the authors was not present for the presentation of the paper, but I retain all three names nonetheless). They were able to discuss their interviews with an individual engaged in the New York BDSM community, presenting her range of experiences as both liberatory and riddled with struggle; the result was a complex yet very rich portrayal of human sexuality.
The roundtable on “Psychoanalysis and Feminism: Recollection, Working Through, and Transformation” created a lively discussion between second- and third- wave feminists and today’s generation. This was not a simple conversation celebrating progress, however. Margeaux Feldmen spoke about her hopefulness that social media will make the realities of social oppression, and the hope of feministic endeavors, more accessible in an unprecedented way; Karen Lombardi shared her skeptical perspective from an older generation, stating that she too felt this way about new forms of protest, outrage and activism in her generation, but in retrospect saw that these events were not enough to create transformation, only enacting more “repetition” instead.
In the weekend’s final roundtable discussion, “Is Femininity a Categorical No?”, much of the conversation centered around the expectations of female-bodied clinicians, as related to modes of dress and therapeutic style. Various individuals discussed their concerns that female-bodied clinicians are too often scrutinized for their modes of dress, or of therapeutic relatedness, for being “too provocative” or “too flirtatious.” Questions also related to determining how does one assess whether these things are in fact affecting therapeutic relationships, positively or adversely.
During this conversation, someone briefly brought up Jody Messler Davies’s conception of post-oedipal sexuality, wherein flirtation in the clinical setting may at times be an indicator of health—the experience of two autonomous beings relating amidst the reality of their full selves (and including sexual identity as part of adult selfhood). I mentioned briefly a comment made by Andrea Celenza at last year’s APsaA conference, wherein she suggested that an analysis is not complete unless there has been some experience of actively working through erotic transference and countertransference. During the roundtable, Marilyn Charles asked whether discussion about how bodies was too discursive, sidestepping a much larger possibility; she suggested that advocates of femininity might best be suited developing personal values as completely independent of the patriarchical gaze, and no longer seeking affirmation from those systems. I am also reminded of a dinner table conversation I had during APSC with Kevin Foster, who is currently working on a doctoral thesis examining the inverse relationship between the subjective distress experienced as a result of microaggressions and the development of healthy autonomy and self-regulation. This raises questions about how we as individuals are and are not held to the mercy of oppressive systems—and whether the psychoanalytic enterprise might offer an individual a new kind of agency, freed from systemic and even interpersonal oppressions. This is not a yes or no matter.
I think to the various criticisms of neoliberalism expressed at the conference, and how this affects the therapeutic enterprise. Is there a time when abstracting theorizing about the need for massive systemic change becomes a diversionary pitfall, because we then take less responsibility for affecting change within our own localized human networks? I recently heard Carina Håkansson speak at the Mad in America film festival in Arlington, Massachusetts. Carina is a part of an incredible organization in Sweden called the Family Care Foundation, providing powerful home environments to promote the recovery of individuals who have experienced extensive psychiatric hospitalization. Carina said she often receives emails and phone calls from people in the United States, with people asking if they can come—or send a family member—to Sweden, to live in one of the homes. The answer is “No.” Create your own communities here in the States, she said—don’t wait for the outside savior.
Then I remember the APsaA conference again, the men on the panel criticizing Andrea Celenza’s remarks, implicating them as outlandish and perverse. I remember another panel at APsaA, where Jody Messler Davies was criticized as being self-centered for her relational approach. The panel became very heated, with Jody Davies expressing that she felt villainized by the many of the men in the room, and then those men denied that they were attacking her, insisting instead that she was just being overly reactionary. Are these the human and institutional tides that prevent change? I think of how the “388 clinic” in Quebec has done remarkable psychoanalytic work with young psychotic adults, despite the lengthy lawsuit they faced from Canadian pharmaceutical companies insisting that it was unethical to offer psychological treatment for individuals suffering from what the companies held to be biologic illness. After eventually winning the lawsuit, however, the 388 analysts were asked by the Canadian government to set up a second clinic in another province, because the first one has been so effective. The analysts, however, do not feel that their clinic can be simply replicated somewhere else, insisting that what they do not cannot simply be manualized and then replicated.
All of these vignettes raise for me messy questions: at what level will these individualized modes of human relatedness—psychoanalytic relationships and communities—be able to effect change on the national, or global scales? At what level does an individual’s resiliency fortify one against systemic tides? If individual and localized community change is all we can achieve, will this be enough?