tag:theconversation.com,2011:/au/topics/psychoanalysis-22018/articles
Psychoanalysis – The Conversation
2024-01-26T17:58:00Z
tag:theconversation.com,2011:article/220544
2024-01-26T17:58:00Z
2024-01-26T17:58:00Z
What would Carl Jung tell you to do with your spreadsheet of life goals? Throw it away and embrace the feminine
<figure><img src="https://images.theconversation.com/files/571591/original/file-20240126-22431-ca00qi.jpg?ixlib=rb-1.1.0&rect=44%2C33%2C2436%2C1912&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Carl_Jung#/media/File:ETH-BIB-Jung,_Carl_Gustav_(1875-1961)-Portrait-Portr_14163_(cropped).tif">Wikipedia/ETH-Bibliothek</a></span></figcaption></figure><p>Current debates about gender have become <a href="https://www.theatlantic.com/newsletters/archive/2023/04/how-the-gender-debate-veered-off-track/673819/">polarised</a>. These divisive arguments tend to focus on narrowly defining “man” or “woman”, rather than considering archetypal underpinnings of the feminine and masculine. For psychiatrist and psychoanalyst Carl Jung and post-Jungian thinkers, these concepts are crucial to understanding gender and wider cultural dynamics.</p>
<p>A Jungian perspective considers the feminine and masculine as concepts that are not specific to man or woman but germane to people of all genders. They are embedded in thousands of years of history, folklore and myth and their characteristics are <a href="https://books.google.co.uk/books?hl=en&lr=&id=2bXgBQAAQBAJ&oi=fnd&pg=PP1&dq=archetypes+across+cultures+carl+jung&ots=ERwaxWqeWO&sig=jz9trW7Qr3aTL8PQlMX1l52adVw">remarkably similar across time and cultures</a>. </p>
<figure class="align-left ">
<img alt="The Venus von Willendorf sculpture" src="https://images.theconversation.com/files/571621/original/file-20240126-21-d13e8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/571621/original/file-20240126-21-d13e8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=888&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571621/original/file-20240126-21-d13e8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=888&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571621/original/file-20240126-21-d13e8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=888&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571621/original/file-20240126-21-d13e8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1115&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571621/original/file-20240126-21-d13e8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1115&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571621/original/file-20240126-21-d13e8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1115&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Venus von Willendorf: keep her on your desk?</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Venus_figurine#/media/File:Wien_NHM_Venus_von_Willendorf.jpg">Wikipedia/Naturhistorisches Museum Wien</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Jung’s understanding, expanded on by <a href="https://www.routledge.com/Feminist-Views-from-Somewhere-Post-Jungian-themes-in-feminist-theory/Gardner-Gray/p/book/9781138897823">others</a> relates the feminine to mythical and spiritual dimensions such as the moon, soul, creativity, inwardness, darkness, chaos, intuition and (active) receptivity. A masculine energy is often associated with the sun, spirit, light, (immediate) action, aspiration and outwardness. </p>
<p>The feminine is <a href="https://books.google.co.uk/books/about/The_Ravaged_Bridegroom.html?id=mgk-AAAAMAAJ&redir_esc=y">neglected</a> in patriarchal, neoliberal cultures that value rationality, action and ambition. We found this to be very much the case in a study of <a href="https://journals.sagepub.com/doi/full/10.1177/00187267231199650">15 young women starting out in their professional careers</a>. These women set out their professional ideals in terms of upward momentum and ascension, speaking negatively of periods of stagnation and inaction. They appeared to apply linear, progressive reasoning to their work, for instance describing career goals as sequential “boxes to tick”.</p>
<p>The women in our study also appeared to shun cyclical, <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiS6LfXqfaDAxVMWEEAHbEsAU0QFnoECBoQAQ&url=https%3A%2F%2Fwww.bbc.com%2Fworklife%2Farticle%2F20201109-why-the-paradox-mindset-is-the-key-to-success&usg=AOvVaw0llMkgbZkKm2cVRTtPpk9o&opi=89978449">paradoxical thinking</a>, which might entail, for example, embracing periods of slowness during which we experience boredom and ennui. These periods can open us up to spontaneous and unexpected possibilities. </p>
<h2>The value of ‘nothingness’</h2>
<p>Adopting a feminine way of being encourages us to experience and embrace periods of inaction and depression, rather than continuously pursue upward momentum and productivity. This might seem to be the last thing we’d want in professional life, but that is not necessarily the case.</p>
<p>Renowned Jungian analyst Mary Louis von Franz <a href="https://books.google.co.uk/books/about/The_Cat.html?id=Jsu0AAAAIAAJ">observes</a> how in many fairy tales there is “a long period of barrenness before the hero child is born”. She reflects that in periods of depression and when nothing is happening, “an enormous amount of energy accumulates in the unconscious”. But “nothingness” or being “unproductive” is not honoured in a society that values action and (quick) results.</p>
<p>The women we spoke with reflected on the difficulty of embracing periods of slowness in discussions of motherhood, for example. When discussing their careers and lives in the longer term, they often spontaneously discussed motherhood as something they desired. One woman described her uterus as making her “baby crazy,” explaining the sensation of a ticking clock: “I feel like the alligator in Peter Pan, the clock is in my belly.”</p>
<p>But for these women, maternal desire was complicated by career ambitions. Rather than embracing the paradox and value of motherhood as a <a href="https://www.google.co.uk/books/edition/Maternal_Desire/mr2SDwAAQBAJ?hl=en&gbpv=0">meaningful journey with much to offer</a>, most participants anxiously anticipated what they would have to “give up” in terms of their career. </p>
<p>The two were seen as in conflict, with early motherhood – an inward period of deep reflection – understood as undermining professional goals and work productivity. Many felt their employers were implicitly unsupportive of working mothers, not valuing the slow, deep process of intuitive learning that motherhood fosters, and offering little in the way of alternative frameworks to include or support their participation in the workplace.</p>
<h2>Life in a spreadsheet</h2>
<p>A feminine way of being also encourages “<a href="https://www.bbc.com/worklife/article/20201109-why-the-paradox-mindset-is-the-key-to-success">both/and thinking</a>” – paradox and circularity that spark intuitive creativity. Such feminine energy embraces darkness, chaos, and spontaneous possibility. It seeks, as Jungian analyst Sylvia Perera <a href="https://junginla.org/product/descent-to-the-goddess/">explains</a>: “the potential of cleansing immersion in the darkness of the unknown”. But embracing such darkness may seem out of the question in a society that lauds rationality. We are not, in short, encouraged to let life happen.</p>
<p>Most of us instead adopt linear, rational thinking that hinders feminine creativity. In our study, women used bureaucratic metaphors to describe their existential plans and future life events. They spoke of marriage, careers and having children in terms of “ticking boxes” and “to-do lists”. For example, one woman described creating an Excel spreadsheet to organise her career goals, such as promotions and management aspirations, and life goals (detailing by when she needed to get married and buy a house).</p>
<figure class="align-center ">
<img alt="A woman pointing her pen at a spreadsheet displayed on her computer monitor." src="https://images.theconversation.com/files/571448/original/file-20240125-25-ydzrof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571448/original/file-20240125-25-ydzrof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571448/original/file-20240125-25-ydzrof.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571448/original/file-20240125-25-ydzrof.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571448/original/file-20240125-25-ydzrof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571448/original/file-20240125-25-ydzrof.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571448/original/file-20240125-25-ydzrof.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Hmm, it says here I’m an abject failure, yet I seem to be fabulous.’</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Planning life events as though they are “goals” turns them into markers of success or failure on a linear course, rather than <a href="https://www.google.co.uk/books/edition/The_Pregnant_Virgin/MyAFAQAAIAAJ?hl=en&gbpv=0&bsq=the%20pregnant%20virgin">rites of passage</a> in a potentially far more cyclical life. We might, as a result, pursue such “events” at all costs. And if we don’t meet these markers, we might perceive that as “failure”, missing out on an opportunity to undergo a process of reflection that could provide wisdom and insight into the human condition.</p>
<p>When rejected for a promotion, for example, we could take time to reflect on why the rejection happened and how we can deal with rejection more generally. Which emotions does it provoke in us and where do they originate? The loss of the promotion can, if we allow it, open a different path – and one that is perhaps better aligned with our genuine sense of self.</p>
<p>People of all genders should consider turning toward the feminine by embracing periods of stagnancy and depression as vital to their development. And we could all benefit from valuing cyclical, paradoxical thinking as part of our personal growth. This involves understanding which aspects of ourselves are foregrounded, and which are the <a href="https://books.google.co.uk/books?hl=en&lr=&id=-vH8DQAAQBAJ&oi=fnd&pg=PT9&dq=shadow+jung+zweig&ots=yKO2NVbOul&sig=_GC3y8c2tsgAMqGYNNgvKqEjT6M&redir_esc=y#v=onepage&q=shadow%20jung%20zweig&f=false">“shadowed”</a>, unconscious parts of ourselves that we strongly deny as existing or reject, but that can significantly affect us nonetheless.</p>
<p>Truly asking whether we are rejecting the inner archetypal feminine (or masculine) is a good place to start. Friends are usually better at spotting our shadow characteristics than we are, and often even more effective is a skilled psychoanalyst.</p><img src="https://counter.theconversation.com/content/220544/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The legendary psychoanalyst would encourage us to embrace the feminine at work and at home by resisting the urge to see life as a linear, organised path.
Aliette Lambert, Senior Lecturer in Marketing, University of Bath
George Ferns, Senior Lecturer in Business and Society, University of Bath
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/219281
2023-12-07T17:28:07Z
2023-12-07T17:28:07Z
OCD is so much more than handwashing or tidying. As a historian with the disorder, here’s what I’ve learned
<figure><img src="https://images.theconversation.com/files/563995/original/file-20231206-25-yjbxqt.jpg?ixlib=rb-1.1.0&rect=15%2C22%2C5077%2C3328&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/woman-touching-her-temples-hands-suffering-2196452389">Elena Abrazhevich/Shutterstock</a></span></figcaption></figure><p><em>Readers are advised that this article contains explicit discussion of suicide and suicidal and obsessional thoughts. If you are in need of support, contact details are included at the end of the article.</em> </p>
<hr>
<p>At the age of 12, “out of nowhere”, Matt says he started having repetitive thoughts concerning whether he wanted to end his life. Every time he saw a knife, he would ask himself: “Am I going to stab myself?” Or, when he was near a ledge: “Am I going to jump?”</p>
<p>Matt had heard a lot about teenage depression, and thought this must be what was going on. But it was confusing, he says: “I didn’t feel suicidal, I really enjoyed my life. I just had an intense fear of doing something to hurt myself.”</p>
<p>Shortly afterwards, pre-empted by hearing about a notorious banned film, Matt began questioning whether he, like the central character, might be a serial killer. These thoughts “kept coming and coming” and he would lie in bed running over scenarios, trying to work out whether he was “going crazy”:</p>
<blockquote>
<p>I really needed help. I didn’t know who to talk to. But it wasn’t on my radar to think about this as OCD.</p>
</blockquote>
<p>Obsessive-compulsive disorder (OCD) is a significant mental health diagnosis in the 21st century. The World Health Organization (WHO) lists it as <a href="https://www.bmj.com/content/348/bmj.g2183.long">one of the ten most disabling illnesses</a> in terms of loss of earning and reduced quality of life, and OCD is frequently cited as the fourth most common mental disorder globally after depression, substance abuse and <a href="https://www.nhs.uk/mental-health/conditions/social-anxiety/#:%7E:text=Social%20anxiety%20disorder%2C%20also%20called,better%20as%20they%20get%20older.">social phobia</a> (anxiety about social interactions).</p>
<p>Yet everything Matt knew about OCD, he tells me, came from daytime talkshows where “people were washing their hands 1,000 times a day – it was all about external and really extreme behaviours”. And that didn’t feel like what he was going through.</p>
<hr>
<p><em>Across the world, we’re seeing unprecedented levels of mental illness at all ages, from children to the very old – with huge costs to families, communities and economies. <a href="https://theconversation.com/uk/topics/tackling-the-mental-health-crisis-147216?utm_source=TCUK&utm_medium=ArticleTop&utm_campaign=MentalHealthSeries">In this series</a>, we investigate what’s causing this crisis, and report on the latest research to improve people’s mental health at all stages of life.</em></p>
<hr>
<p>A similar experience is recounted in the 2011 book <a href="https://overcoming.co.uk/582/Taking-Control-Of-OCD---VealeWillson">Taking Control of OCD</a> by John (not his real name) who, after a colleague had taken their own life, became “inundated with thoughts” about what he might do to himself. Every time he crossed the road, John thought: “What would happen if I stopped moving and was run over by a bus?” He also had thoughts of murdering those he loved. John recalled:</p>
<blockquote>
<p>Try as I might, I just couldn’t chase the thoughts out of my head … When I tried to explain what was going on to my girlfriend, I couldn’t find a way of articulating what was happening to me … At the time, I thought OCD was all about triple-checking you had locked the front door and that your drawers were tidy.</p>
</blockquote>
<p>Despite the prevalence of OCD in contemporary society, the experiences of Matt and John reflect two important features of this disorder. First, that the stereotype of OCD is one of washing and checking behaviours – the <a href="https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/">compulsions</a> aspect, defined clinically as “repetitive behaviours that a person feels driven to perform”. And that obsessions – defined as “<a href="https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/">unwanted, unpleasant thoughts</a>” often of a harmful, sexual or blasphemous nature – are viewed as obscure, confusing and unrecognisable as OCD.</p>
<p>People who experience obsessional thoughts are therefore frequently unable to identify their symptoms as OCD – and <a href="https://pubmed.ncbi.nlm.nih.gov/26132683/">neither</a>, very often, are the experts they see in clinical settings. Due to mischaracterisations of the disorder, OCD sufferers with non-typical, less visible presentations usually <a href="https://www.sciencedirect.com/science/article/pii/S2666915321001578?via%3Dihub">go undiagnosed for ten or more years</a>.</p>
<p>When John visited his GP, he was diagnosed with depression. He recalled that the GP concentrated more on the visible effects of his distress - a lack of appetite and disrupted sleeping patterns. The thoughts remained invisible. As he put it:</p>
<blockquote>
<p>I don’t know how you’re supposed to tell someone you don’t know that you have thoughts about killing people you love.</p>
</blockquote>
<p>Even for those with “textbook” OCD such as my friend Abby, “the compulsion is just the tip of the iceberg”. Abby was able to self-diagnose at the age of 12, when she experienced handwashing and locking door compulsions. She says people still think of her as “Abby [who] likes to wash her hands a lot”.</p>
<p>Now, she tells me, “I realise that I have no interest in washing my hands – I’m a pretty messy person, and I don’t mind other people being messy.” Rather than a love of cleaning, her acts were related to the altogether scarier obsessional thought: “What if I am going to hurt other people?”</p>
<p>Clinical guidelines, such as those provided in the UK by the <a href="https://www.nice.org.uk/guidance/cg31/resources/obsessivecompulsive-disorder-and-body-dysmorphic-disorder-treatment-pdf-975381519301">National Institute for Health and Care Excellence</a>, define OCD as being characterised by both compulsions <em>and</em> obsessions. So, why do the difficulties encountered by Matt, John and Abby – of recognising the internal thoughts that dominate their lives – appear to be <a href="https://letsqueerthingsup.com/2018/05/12/i-didnt-know-i-had-ocd-heres-why-the-stereotypes-are-so-harmful/">so common</a>?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Wordcloud for obsessive-compulsive disorder (OCD)" src="https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">OCD is a multifaceted disorder, yet understanding tends to focus on the visual, compulsive aspect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/obsessive-compulsive-disorder-ocd-word-cloud-1786299122">Colored Lights/Shutterstock</a></span>
</figcaption>
</figure>
<h2>My experience of OCD</h2>
<p>From the age of 16, I have also suffered with thoughts that I later came to associate with OCD, but which began as invisible and tormenting. An article I wrote in 2014, entitled <a href="https://www.ocduk.org/the-unseen-obsession/">The Unseen Obsession</a>, described my experience of having left university midway through my studies due to a single thought that gathered “such power that I even ended up attacking my body in an attempt to eliminate its force”. I wrote:</p>
<blockquote>
<p>I have suffered with obsessional thoughts for the last four years, and can safely say that [OCD] is far from being about clean hands.</p>
</blockquote>
<p>My obsessions have taken many forms since my teenage years. They began with me wondering whether things really existed, whether my parents were really who they said they were, and whether I wanted to harm – and was a risk to – my family, friends, even my dog.</p>
<p>Many of us know what it is like to ruminate about a person, a conflict, or something else we feel anxious about. But for those with obsessional thoughts (diagnosed or otherwise), this is quite different to simply “overthinking”. As I attempted to explain in my article:</p>
<blockquote>
<p>Conversations falter as the thought leaps through your mind. Other topics seem less important, and time to yourself provides space to assess, analyse, and look for evidence of the thought being ‘true’ … [Obsessing] is like fighting: you push and shove your thoughts away and they come back with twice as much force. You spend time trying to avoid them and they pop up everywhere, taunting and mocking your failed attempt at running away.</p>
</blockquote>
<p>It took me six months of weekly therapy sessions before I felt able to voice my obsessional thought to my therapist – someone I had known for a number of years. My unwillingness to be open about it was not only tied up with feelings of shame about its taboo content, but also my inability to see such thinking as part of a recognised disorder.</p>
<p>The question of what constitutes OCD, why we understand – and misunderstand – it as we do, as well as my own experience of living with it, led me to study <a href="https://www.cambridge.org/core/journals/british-journal-for-the-history-of-science/article/visible-compulsions-ocd-and-the-politics-of-science-in-british-clinical-psychology-19481975/D431B7D6003860F9E6ABE50476BA46A4">how OCD became recognised and categorised as a mental health disorder</a>.</p>
<p>In particular, my research shows that there are important insights to be gained from the research decisions made by a group of influential clinical psychologists in south London in the early 1970s – shedding light on why so many people, myself included, still struggle to recognise and make sense of our obsessional thoughts.</p>
<h2>The origin of the concepts</h2>
<p>Categories of mental illness are not stable across time. As medical, scientific, and public knowledge about an illness changes, so does how it is experienced and diagnosed.</p>
<p>Prior to the 1970s, “obsessions” and “compulsions” did not exist in a unified category – rather, they appeared in an array of psychiatric classifications. At the start of the 20th century, for example, British doctor James Shaw <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/8D219344EF697D92E69BF9ED60F8508B/S000712500016204Xa.pdf/verbal-obsessions.pdf">defined</a> verbal obsessions as “a mode of cerebral activity in which a thought – mostly obscene or blasphemous – forces itself into consciousness”.</p>
<p>Such cerebral activity could, according to Shaw, arise in hysteria, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/neurasthenia">neurasthenia</a>, or as a precursor to delusions. One of his patients – a woman who experienced “irresistible, obscene, blasphemous and unutterable thoughts” – was diagnosed with obsessional melancholia, a “form of insanity”.</p>
<p>The symptom arose from what Shaw defined as “nervous weakness”, an explanation that reflected the <a href="https://academic.oup.com/book/25373/chapter-abstract/192459930?redirectedFrom=fulltext">broader 19th-century view</a> that obsessional thoughts were indicative of a fragile nervous system – either inherited, or weakened through overwork, alcohol or promiscuous behaviour (described as “<a href="https://pubmed.ncbi.nlm.nih.gov/3514404/">degeneration theory</a>”). Notably, Shaw did not mention any form of repetitive behaviour in relation to these verbal obsessions.</p>
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<a href="https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bearded man holding a cigar" src="https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=844&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=844&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=844&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1061&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1061&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1061&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sigmund Freud, founder of psychoanalysis.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Sigmund_Freud_LIFE.jpg">Max Halberstadt via Wikimedia Commons</a></span>
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<p>At a similar time to Shaw’s writings, Sigmund Freud, the Austrian founder of psychoanalysis, developed his psychoanalytic category of “<a href="https://journals.sagepub.com/doi/10.1177/0957154X9800903504">Zwangsneurose</a> – translated in Britain as "obsessional neurosis” and in the US as “compulsion neurosis”. In Freud’s <a href="https://www.mhweb.org/freud/ratman1.pdf">writings</a>, the “Zwang” referred to persistent ideas that emerged from a repressed conflict between unresolved childhood impulses (those of love and hate) and the critical self (ego).</p>
<p>Freud’s <a href="https://ia802907.us.archive.org/17/items/SigmundFreud/Sigmund%20Freud%20%5B1909%5D%20Notes%20Upon%20A%20Case%20Of%20Obsessional%20Neurosis%20%28The%20Rat%20Man%20Case%20History%29%28James%20Strachey%20Translation%201955%29.pdf">most famous case study</a>, published in 1909, featured the “Rat Man”, a former Austrian army officer who possessed a variety of elaborate symptoms. In the first instance, he had become obsessed that he would fall victim to a horrific rat-based punishment that had been recounted to him by a colleague. The patient also expressed that if he had certain desires such as a wish to see a woman naked, his already-deceased father “will be bound to die”.</p>
<p>The Rat Man was described by Freud as engaging in a “system of ceremonial defences” and “elaborate manoeuvres full of contradictions” that have been read by some as the behavioural aspects of what would become OCD. However, there are crucial differences between the “defences” of Freud’s client and the compulsions of OCD, including that the former largely involved thinking rather than acting, and were by no means consistent or stereotyped.</p>
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<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em></p>
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<p>The psychoanalytic category of “obsessional neurosis” was adopted and modified in Britain during the first world war, and became a staple – but inconsistently defined – diagnosis in British psychiatric textbooks of the inter-war period. Up to the 1950s, the terms “obsession” and “compulsion” were being used interchangeably in psychiatric writing. The complexity surrounding their meaning is demonstrated in the <a href="https://www.google.co.uk/books/edition/Inquiries_in_Psychiatry_Clinical_and_Soc/JsZrAAAAMAAJ?hl=en">writings of Aubrey Lewis</a>, a leading figure in post-war British psychiatry, who referred to “obsessional illnesses” as being made up of “compulsive thoughts” and “compulsive inner speech”.</p>
<p>Like Freud, Lewis mentioned the “complex rituals” of the obsessional – such as the patient “who is perpetually putting himself in the greatest trouble to ensure that he never steps on a worm inadvertently”. But he cautioned against “the dangers of associating any kind of repetitious activity with obsessionality”, writing that “it certainly cannot be judged on behaviourist grounds”.</p>
<h2>Defining OCD by visible behaviour</h2>
<p>OCD began to emerge in the form we recognise it today from the early 1970s – and was established as a formal psychiatric disorder through its inclusion in the third and fourth editions of the American Psychiatric Association’s <a href="https://aditpsiquiatriaypsicologia.es/images/CLASIFICACION%20DE%20ENFERMEDADES/DSM-III.pdf">Diagnostic and Statistical Manual</a> (commonly known as DSM-III and DSM-IV) in 1980 and 1994.</p>
<p>The centrality of visible and measurable behaviours in the categorisation of OCD – particularly washing and checking – can be traced back to a series of experiments conducted by clinical psychologists in the early 1970s at the Institute of Psychiatry and the Maudsley Hospital in south London.</p>
<p>Under the direction of South African psychologist Stanley Rachman, the complex array of symptoms contained in the categories of obsessional illness and obsessional neurosis were divided into two: “visible” compulsive rituals, and “invisible” obsessional ruminations. While Rachman and his colleagues conducted a large research programme on compulsive behaviours, obsessions were relegated to the backburner.</p>
<p>For example, in <a href="https://www.sciencedirect.com/science/article/pii/000579677190009X">their investigation</a> of ten psychiatric inpatients diagnosed with obsessional neurosis, “compulsions had to be present for entry into the trial and patients complaining of ruminations were excluded” – a statement reiterated throughout subsequent experiments.</p>
<p>Indeed, this study did not merely require patients to exhibit some form of visible compulsion. The ten patients included were exclusively those with “visible handwashing” behaviour, which was viewed as the “easiest” symptom to experiment on. Likewise, the second round of studies only included patients who engaged in visible “checking” behaviour, such as whether a door was unlocked.</p>
<p>In a <a href="https://www.sciencedirect.com/science/article/pii/0005796771900088">1971 paper</a>, Rachman offered his rationale for taking this approach, explaining how “obsessional ruminators raise special problems for the clinical psychologist because of their subjective, private nature”. This, he argued, was in contrast with “the other main feature of obsessional neurosis, compulsive behaviour, which can be approached with greater ease. It is visible, has a predictable quality, and many reproducible analogies in animal research”.</p>
<p>Rachman viewed compulsions as “visible” and “predictable” in large part due to the way clinical psychology had developed as a new profession in Britain, at the Maudsley Hospital in particular, in the decades following the second world war. To differentiate their practice from the existing mental health professions of psychiatry (medically trained doctors specialising in mental health) and psychoanalysis (talking therapy derived from Freud), these early clinical psychologists presented themselves as “<a href="https://www.bps.org.uk/psychologist/eysenck-and-development-cbt">applied scientists</a>” who brought scientific methods from the laboratory to a clinical setting. Their conception of science was rooted in empiricism – with an emphasis on visibility, measurability and experimentation.</p>
<p>As part of this commitment to empirical science, these clinical psychologists adopted a <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fh0054288">model of anxiety</a> derived from 20th-century behaviourism. This focus on observable behaviour was <a href="https://www.cambridge.org/core/journals/journal-of-mental-science/article/abs/learning-theory-and-behaviour-therapy/38CA4A9BC0CA773F6BEE93EDDC71584F">viewed as</a> having much greater scientific value than psychoanalysis, which dealt with the “<a href="https://www.taylorfrancis.com/books/mono/10.4324/9780203766767/causes-cures-neurosis-psychology-revivals-eysenck-rachman">unverifiable</a>” and “unscientific” realm of thoughts and thinking.</p>
<p>So, when obsessional ruminations gained a renewed focus in the mid-1970s, it was through this lens of visible compulsive behaviours. Rachman and his colleagues started talking about “mental compulsions” (such as saying a good thought after a bad thought) as “equivalent to handwashing”- rather than focusing on the importance and content of these thoughts in their own right.</p>
<p>In the early 1980s, clinical psychology came under pressure from cognitive psychologists (those concerned with thinking and language) for its reductive focus on behaviour. But despite this move to <a href="https://www.sciencedirect.com/science/article/abs/pii/0005796785901056">include cognitive approaches</a>, the centrality of visible behavioural compulsions has continued to characterise perceptions of OCD in cultural and clinical domains. </p>
<p>This is perhaps most evident in media portrayals of the disorder – a critique taken up by cultural scholars such as <a href="https://www.tandfonline.com/doi/abs/10.1080/01639625.2013.872526">Dana Fennell</a>, who look at representations of OCD in TV and film.</p>
<p>The archetypal portrayal of OCD has <a href="https://www.ocduk.org/david-beckham-documentary-our-statement/">not been helped</a> by the recent publicity given to David Beckham and his <a href="https://www.mirror.co.uk/news/health/david-beckham-ocd-update-football-31102545">extensive tidying</a>. When I ask Abby what she thought about the <a href="https://www.theguardian.com/football/2023/apr/28/david-beckham-ocd-obsessive-compulsive-disorder-netflix-documentary">attention</a> that Beckham’s OCD was receiving in the media, she replies: “It’s so boring. It’s the same presentation that always gets thought of as OCD.”</p>
<h2>Limitations to the ‘gold standard’ treatment</h2>
<p>This archetypal portrayal of OCD also relates to how it is treated. The <a href="https://www.dovepress.com/getfile.php?fileID=54942">“gold standard” treatment</a> in the UK today is the behavioural technique of <a href="https://www.ocduk.org/overcoming-ocd/accessing-ocd-treatment/exposure-response-prevention/">exposure and ritual prevention</a> (ERP), either on its own or combined with cognitive therapy. ERP gained acceptance from the experiments of Rachman and colleagues in the early 1970s, when they were exclusively working with patients with observable behaviours.</p>
<p>One of their <a href="https://www.sciencedirect.com/science/article/abs/pii/S0005796772800032">key studies</a> involved patients from the Maudsley Hospital who repeatedly washed their hands. They were told to touch smears of dog excrement and put hamsters in their bags and in their hair, while being prevented from washing for increased lengths of time.</p>
<p>Such experiments were again governed by observability and measurability. The “success” of ERP treatment – and its perceived superiority over psychiatric and psychoanalytic methods – was demonstrated by a reduction in the patients’ visible handwashing behaviour.</p>
<p>Today, if you are diagnosed with OCD by a psychiatrist and given OCD-specialist treatment via the NHS, you will most likely be told to undergo the same kind of ERP procedure that hospital inpatients were experimentally given in the 1970s: touching a set of items that you fear (exposure) while being prevented from engaging in your usual compulsive behaviour.</p>
<p>An identical method is also used when it comes to obsessional thoughts. Patients are asked to identify their worrying obsession, then either expose themselves to provoking situations or repeat the thought in their mind without engaging in “mental compulsions” – such as counting, replacing a bad thought with a good thought, or trying to “solve” the content of the obsessional thought.</p>
<p>It’s certainly true that this form of behavioural therapy can be <a href="https://www.dovepress.com/getfile.php?fileID=54942">hugely helpful</a> in the treatment of OCD symptoms. Abby, after undergoing ERP for 14 years, said she had “developed a lot of practices around not giving into my [washing and checking] compulsions”.</p>
<p>I also found the approach beneficial in reducing the threatening quality of my obsessional thoughts. Repeating “I want to hurt my family” or “I don’t really exist” to myself over and over again, without actually trying to solve these issues, reduced the time I spent ruminating.</p>
<p>However, while being a huge advocate of ERP, Abby also observed that “sometimes when I get rid of a compulsion, it doesn’t mean I just get rid of the obsession.” While the “outward compulsions” disappear, “it doesn’t mean my mind stops cycling and mental questioning”.</p>
<p>Some contemporary clinicians have referred to ERP, designed around visible symptom reduction, as a “<a href="https://www.justinkhughes.com/wp-content/uploads/2021/03/ocd_texas_talk_with_molly_and_justin_2019__22common_pitfalls_of_erp_for_ocd_22.pdf">whack-a-mole technique</a>” – you get rid one symptom (obsession or compulsion) and another pops up.</p>
<p>ERP is frequently accompanied with cognitive therapy techniques, such as <a href="https://www.apa.org/pubs/books/supplemental/Treatment-for-Postdisaster-Distress/Handout-27.pdf">cognitive restructuring</a> (identifying beliefs and providing evidence for and against them), or being told that obsessions are “just thoughts”, that they are meaningless, and that you do not want to enact them.</p>
<p>Despite the success of cognitive-behaviour therapy (CBT) and ERP in scientific trials, a <a href="https://www.sciencedirect.com/science/article/pii/S0010440X21000018?via%3Dihub">major review of evidence</a> in 2021 questioned whether the effects of the approach in treating OCD had been overstated – reflecting the high proportion of OCD cases that are designated as “<a href="https://www.ncbi.nlm.nih.gov/books/NBK551808/">treatment resistant</a>”. </p>
<p>I also believe there are some crucial limitations to contemporary treatments for OCD. Exposure (ERP) techniques stem from a period in which thoughts were not being considered at all by clinical psychologists, while CBT designates the content of obsessional thoughts as unimportant. Matt, like me, has found that CBT “can only take you so far”, explaining:</p>
<blockquote>
<p>Part of this was that [CBT therapists] are so committed to the idea that thoughts don’t have meaning … [They] treat your symptom and once those are gone, you should get on with your life. I didn’t find that there was a way of thinking about [my] ruminations in the context of my whole life.</p>
</blockquote>
<h2>Experiences of alternative treatments</h2>
<p>So much of my understanding about OCD has changed since I first wrote about it for <a href="https://www.rethink.org/aboutus/">Rethink Mental Illness</a> almost a decade ago. Thinking about the historical development and categorisation of OCD has, it turns out, given me a greater sense of ease regarding this widely misunderstood condition. I feel less bound by our current conceptual frameworks, and more able to reflect on what I think is helpful in terms of how to successfully manage my obsessional thoughts.</p>
<p>For example, despite being warned away from psychoanalysis from a young age (my mum is a clinical psychologist, and psychologists are often fervently anti-psychoanalytic!), I have found psychoanalysis incredibly helpful in becoming comfortable with my thoughts. </p>
<p>This is because CBT typically focuses on present symptoms without looking into their meaning or how they relate to your personal history, and this comes into tension with my desire, as a historian, to think about the past. In contrast, psychoanalysis locates obsessional thoughts in history – pointing to childhood as a crucial point of psychic development. I have been able to understand my obsessions as the result of a deep childhood fear concerning the death of my loved ones, from which I developed a rigid desire for control.</p>
<p>As a young teenager trying to determine what was going on with him, Matt went to the public library and took out a <a href="https://ia903102.us.archive.org/15/items/petergay1989freudreader/Adam%20Phillips%20%5B2006%5D%20Penguin%20Freud%20Reader.pdf">Freud reader</a>. He describes this as “the worst possible thing for a 14-year-old to read”, as it made him believe “that I did really have all these [murderous suicidal] impulses and all my fears are true”.</p>
<p>Despite this experience, while training to become a social worker, he “got into psychoanalysis as an alternate way to think about therapy and think about my own experience”. For him, psychoanalysis revealed the opposite to the image of “OCD as handwashing”.</p>
<p>Instead, he says, it focused on the aspects of “obsessionality that are internal”, showing him that the “mind is so powerful that it can produce a lot of imaginary fears”. It also allowed him to see “OCD symptoms as wrapped up with my whole life”.</p>
<p>Particularly profound in psychoanalytic thought is the acceptance of the complexity and unknowability at the heart of human experience. As Jaqueline Rose, professor of humanities at Birkbeck, University of London, <a href="https://fitzcarraldoeditions.com/books/the-plague">wrote:</a>: </p>
<blockquote>
<p>Psychoanalysis begins with a mind in flight, a mind that cannot take the measure of its own pain. It begins, that is, with the recognition that the world – or what Freud sometimes refers to as ‘civilisation’ – makes demands on human subjects that are too much to bear.</p>
</blockquote>
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<a href="https://images.theconversation.com/files/563998/original/file-20231206-17-435y0w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of a woman with eyes closed holding her temples." src="https://images.theconversation.com/files/563998/original/file-20231206-17-435y0w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563998/original/file-20231206-17-435y0w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563998/original/file-20231206-17-435y0w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563998/original/file-20231206-17-435y0w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563998/original/file-20231206-17-435y0w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563998/original/file-20231206-17-435y0w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563998/original/file-20231206-17-435y0w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/woman-touching-her-temples-hands-suffering-2156846349">Elena Abrazhevich/Shutterstock</a></span>
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<p>This idea of “a mind in flight” has helped me think about my obsessions – whether my parents are really who they say they are; am I going to hurt those I love? – as part of a battle for certainty and control that is both unattainable and understandable, considering the world we live in.</p>
<p>The aim of psychoanalytic treatment is not to eradicate symptoms but to bring to light the difficult knots that humans have to deal with. Matt refers to psychoanalysis as acknowledging “a sort of messiness of the mind … I’ve found the psychoanalytic view of accepting your own messiness extremely helpful”. Rose similarly describes psychoanalysis as “the opposite of housework in how it deals with the mess we make”.</p>
<p>In the UK, psychoanalysis has been rejected within NHS service provision. And I believe this is, at least in part, a result of historical critiques levelled at it by clinical psychologists as they developed behaviour therapies to treat OCD in the late 20th century.</p>
<h2>‘A lot of emotion and sadness’</h2>
<p>While compulsive behaviour such as handwashing and checking is widely perceived as “representative” of OCD, the tormenting experience of having obsessional thoughts is still rarely acknowledged and discussed. The <a href="https://www.theguardian.com/commentisfree/2019/feb/21/ocd-sex-disorder-pure-rose-cartwright">shame and confusion</a> attached to such thoughts, coupled with the feeling of being misunderstood, make this an important issue to address, particularly when <a href="https://www.madeofmillions.com/articles/pure-o-an-exploration-into-a-lesser-known-form-of-ocd">misdiagnosis of OCD</a> is so high.</p>
<p>My <a href="https://www.cambridge.org/core/journals/british-journal-for-the-history-of-science/article/visible-compulsions-ocd-and-the-politics-of-science-in-british-clinical-psychology-19481975/D431B7D6003860F9E6ABE50476BA46A4">PhD on the history of OCD</a> has also showed me the ways in which psychological research shapes how we conceive of diagnostic categories – and consequently, ourselves. While psychology’s commitment to objectivity, empiricism and visibility has provided tools that are tremendously useful in the clinic, my research sheds lights on how the often-exclusive focus on visible symptoms has at times trumped the appreciation of the complex experience of having obsessional thoughts.</p>
<p>I first met Matt in 2019 at the first <a href="https://ocdinsociety.wixsite.com/home/2019">OCD in Society</a> conference, held at Queen Mary University of London, where he was giving a presentation on the “multiple meanings of OCD”. We discussed our own experiences of the disorder, and what we thought that history, psychoanalysis and anthropology could contribute to understandings of OCD.</p>
<p>Matt was 34, and he told me this was the first time he “had ever voiced the internal stuff out loud, and heard other people talk about it”. Recalling how this made him feel, he continued:</p>
<blockquote>
<p>I felt a lot of emotion and sadness. The isolation had been such a big part of my life that I had stopped noticing it. Then being out of the isolation was such a relief, it made me realise how bad it had been.</p>
</blockquote>
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<p><em>If you are experiencing suicidal thoughts and need support, you can call your GP, <a href="https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-use-111/">NHS 111</a>, or free helplines including <a href="https://www.samaritans.org/">Samaritans</a> (116 123), <a href="https://www.thecalmzone.net/">Calm</a> (0800 585858) or <a href="https://papyrus-uk.org/">Papyrus</a> (0800 068 4141).</em></p>
<p><em>In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found <a href="http://www.suicide.org/international-suicide-hotlines.html">here</a>.</em></p>
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<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
<ul>
<li><p><em><a href="https://theconversation.com/how-to-solve-our-mental-health-crisis-214776?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">How to solve our mental health crisis</a></em></p></li>
<li><p><em><a href="https://theconversation.com/how-music-heals-us-even-when-its-sad-by-a-neuroscientist-leading-a-new-study-of-musical-therapy-214924?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">How music heals us, even when it’s sad – by a neuroscientist leading a new study of musical therapy
</a></em></p></li>
<li><p><em><a href="https://theconversation.com/unlocking-new-clues-to-how-dementia-and-alzheimers-work-in-the-brain-uncharted-brain-podcast-series-194773?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Unlocking new clues to how dementia and Alzheimer’s work in the brain – Uncharted Brain podcast series
</a></em></p></li>
</ul>
<p><em>To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. <a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK"><strong>Subscribe to our newsletter</strong></a>.</em></p><img src="https://counter.theconversation.com/content/219281/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eva Surawy Stepney receives funding from the Arts and Humanities Research Council (AHRC) via the White Rose College of the Arts and Humanities (WRoCAH). </span></em></p>
Research decisions made by clinical psychologists in the 1970s can help explain why so many people, myself included, struggle to make sense of our obsessional thoughts.
Eva Surawy Stepney, PhD Candidate in History, University of Sheffield
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/206580
2023-08-24T20:20:46Z
2023-08-24T20:20:46Z
Friday essay: ‘black bile’, malaria therapy and insulin comas – a brief history of mental illness
<p>Possibly the earliest account of a disturbed mind is recorded in a 3,500-year-old <a href="https://en.wikipedia.org/wiki/Vedas">Hindu text</a> that describes a man who is “gluttonous, filthy, walks naked, has lost his memory and moves about in an uneasy manner”.</p>
<p>In the Bible’s Old Testament, in the first <a href="https://www.britannica.com/topic/Books-of-Samuel">Book of Samuel</a>, we read that King David simulated madness to gain safety: </p>
<blockquote>
<p>And he changed his behaviour … and feigned himself mad in their hands, and scrabbled on the doors of the gate, and let his spittle fall down upon his beard.</p>
</blockquote>
<p>In the <a href="https://www.britannica.com/topic/The-Book-of-Daniel-Old-Testament">Book of Daniel</a>, we find a vivid description of King Nebuchadnezzar’s mental state: </p>
<blockquote>
<p>And he was driven from men, and did eat grass as oxen, and his body was wet with the dew of heaven, till his hairs were grown like eagles’ feathers, and his nails like birds’ claws.</p>
</blockquote>
<p>The ancient Greeks made early attempts to explain madness. In the 5th century BC, <a href="https://fherehab.com/learning/humors-ancient-mental-health">Hippocrates</a> viewed it as seated in the brain and influenced by four bodily fluids: blood, phlegm, black bile and yellow bile. </p>
<p>The Greek physician Galen, who practised in Rome 600 years later, argued that depression was caused by an excess of black bile (hence the term “melancholia”, from <em>melan</em>, black, and <em>khole</em>, bile). </p>
<p>His contemporary, <a href="https://www.britannica.com/biography/Aretaeus-of-Cappadocia">Aretaeus of Cappadocia</a>, colourfully described how, if black bile moves upwards in the body, “it forms melancholy; for it produces flatulence and eructations [or, belches] of a fetid and fishy nature, and it sends rumbling wind downwards, and disturbs the understanding”. </p>
<h2>A troubled mind, possessed</h2>
<p>During the Middle Ages, monasteries preserved the view of madness as an illness, and of those afflicted as sick rather than sinful. At the same time, the more sinister belief that the <a href="https://pubmed.ncbi.nlm.nih.gov/25208453/">principal cause</a> of the troubled mind was possession by spirits or the devil prevailed.</p>
<p>Sufferers were taken to sanctioned healers for <a href="https://theconversation.com/exorcisms-have-been-part-of-christianity-for-centuries-107932">exorcisms</a>, a practice still carried out today in some cultures. People who failed to respond to such treatment might then seek out a celebrated expert. </p>
<p>Consider Hwaetred, a young man living in what is now England in the 7th century, who became tormented by an “evil spirit”. So terrible was his madness that he attacked others with his teeth and killed three men with an axe when they tried to restrain him. Taken to several sacred shrines, he obtained no relief. His despairing parents then heard of Guthlac, a monk who lived a hermit life north of Cambridge. After three days of prayer and fasting, Hwaetred was purportedly cured.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/543694/original/file-20230821-29-c0gqfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543694/original/file-20230821-29-c0gqfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543694/original/file-20230821-29-c0gqfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543694/original/file-20230821-29-c0gqfs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543694/original/file-20230821-29-c0gqfs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543694/original/file-20230821-29-c0gqfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543694/original/file-20230821-29-c0gqfs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543694/original/file-20230821-29-c0gqfs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">St Francis Borgia Helping a Dying Impenitent – Goya (1788)</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>Over time, the role of religious authorities in mental illness dwindled, and the medical profession claimed the exclusive practice of the healing arts. Insanity once more came to be seen more as a physical malady than a spiritual taint. Even so, life for the mentally ill could be appalling. </p>
<p>During the 17th century, religiously inspired persecution of the mentally ill was justified by the clerical hierarchy, and treatment was often some combination of neglect and bestial restraint. </p>
<p>Psychiatrists Martin Roth and Jerome Kroll <a href="https://books.google.com.au/books/about/The_Reality_of_Mental_Illness.html?id=pCQ4AAAAIAAJ&redir_esc=y">describe</a> the insane in this period as “miserable individuals, wandering around in village and in forest, taken from shrine to shrine, sometimes tied up when they became too violent”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-invention-of-satanic-witchcraft-by-medieval-authorities-was-initially-met-with-skepticism-140809">The invention of satanic witchcraft by medieval authorities was initially met with skepticism</a>
</strong>
</em>
</p>
<hr>
<h2>A watershed: asylums</h2>
<p>The late 18th century was a watershed in the history of psychiatry. The insanity of England’s <a href="https://www.bbc.com/news/magazine-22122407">King George III</a> revealed society’s ambivalence to the mentally ill (vividly captured in the 1994 film <a href="https://www.imdb.com/title/tt0110428/">The Madness of King George</a>). </p>
<p>In France, <a href="https://www.britannica.com/biography/Philippe-Pinel">Philippe Pinel</a> released the chains that had fettered the “lunatic” for centuries, ushering in an unprecedented phase of benevolent institutional care. </p>
<p><a href="https://dictionary.apa.org/moral-therapy">Moral therapy</a>, a form of individualised care in small hospital settings, was promoted by English Quakers at the <a href="https://en.wikipedia.org/wiki/The_Retreat">York Retreat</a> and gradually supplanted inhumane physical treatments such as purging, bleeding and dunking in cold water.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/BHNSAK8d3qc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">English society’s ambivalence to the mentally ill in the 18th century is depicted in the 1994 film, The Madness of King George.</span></figcaption>
</figure>
<p>As populations grew and urbanised, the sheer numbers of mentally ill people in burgeoning city slums demanded action. An institutional solution emerged. </p>
<p>Asylums (from the Greek word meaning “refuge”) were built in rural settings with the best of intentions, planned to be havens in which patients would receive humane care. In the serenity of the countryside, and through carrying out undemanding tasks, they could be distracted from their internal torment and find dignity far from the bustling crowd. </p>
<p><a href="https://www.britannica.com/biography/Daniel-Defoe">Daniel Defoe</a>, the English writer, remained unconvinced: “This is the height of barbarity and injustice in a Christian country; it is a clandestine Inquisition, nay worse.”</p>
<p>Although conceived in a spirit of optimism, asylums tended to deteriorate into centres of hopelessness and demoralisation. They soon became overcrowded dumps. Institutions built for a few hundred people were soon holding thousands. Very few residents were discharged; many stayed for decades. Brutal oppression replaced anything that might have resembled treatment; malnutrition and infectious disease became rife.</p>
<p>In the grim environment, people were shut away and forgotten. With them out of sight and out of mind, a loss of public interest and political neglect became the norm.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/543690/original/file-20230821-15-v420lw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543690/original/file-20230821-15-v420lw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543690/original/file-20230821-15-v420lw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=483&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543690/original/file-20230821-15-v420lw.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=483&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543690/original/file-20230821-15-v420lw.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=483&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543690/original/file-20230821-15-v420lw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=607&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543690/original/file-20230821-15-v420lw.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=607&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543690/original/file-20230821-15-v420lw.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=607&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Asylums were conceived optimistically, but more often housed oppression than treatment. Picture: The Hospital of Bethlehem.</span>
<span class="attribution"><span class="source">Wellcome Collection</span></span>
</figcaption>
</figure>
<p>The brooding building on the hill came to symbolise the stigma and fear attached to mental illness. By the mid-19th century, critics were voicing concerns that asylums had become human warehouses that entrenched mental illness rather than curing it. </p>
<p>The combination of powerless patients, hospitals run more for the convenience of staff than for the benefit of the sick, inadequate inspection by state bodies, and lack of resources led at times to quite disgraceful conditions. Unwittingly, the spread of asylums also triggered the movement of psychiatry away from the mainstream of medicine.</p>
<p>The conditions of the asylums are evocatively described in Henry Handel Richardson’s Australian novel <a href="https://www.textpublishing.com.au/books/the-fortunes-of-richard-mahony">The Fortunes of Richard Mahony</a>. We read of Richard’s decline, probably from syphilis affecting the brain, which at that time afflicted a large proportion of mental patients.</p>
<p>Towards the end of the novel, his wife comes to visit him in the asylum:</p>
<blockquote>
<p>She hung her head … while the warder told the tale of Richard’s misdeeds. 97B was, he declared, not only disobedient and disorderly, he was extremely abusive, dirty in his habits … he refused to wash himself, or to eat his food … she had to keep a grip on her mind to hinder it from following the picture up: Richard, forced by this burly brute to grope on the floor for his spilt food, to scrape it together, and either eat it or have it thrust down his throat … There was not only feeding by force, the straitjacket, the padded cell. There were drugs and injections, given to keep a patient quiet and ensure his warders their freedom.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-case-for-the-fortunes-of-richard-mahony-by-henry-handel-richardson-24474">The case for The Fortunes of Richard Mahony by Henry Handel Richardson</a>
</strong>
</em>
</p>
<hr>
<h2>Great and desperate cures</h2>
<p>In the asylum, psychiatry turned into a modern medical discipline. The
accumulation of thousands of patients provided the first opportunity
to study mental illness systematically and to develop theories about its
causes. </p>
<p>The idea that these conditions were due to brain alterations, and especially degenerative processes, became dominant, encouraged by the discovery of the cerebral pathology associated with <a href="https://www.healthline.com/health/neurosyphilis">neurosyphilis</a> and <a href="https://theconversation.com/what-causes-alzheimers-disease-what-we-know-dont-know-and-suspect-75847">Alzheimer’s disease</a>. A similar degenerative process was proposed by the great German psychiatrist <a href="https://www.britannica.com/biography/Emil-Kraepelin">Emil Kraepelin</a> to cause <a href="https://www.sciencedirect.com/topics/computer-science/dementia-praecox">dementia praecox</a> – later renamed “schizophrenia” – leading to pessimism about the possibility of recovery.</p>
<p>But the priority for asylums was to relieve the suffering of overwhelming numbers of disturbed patients. Psychiatrists grasped for “great and desperate cures”. <a href="https://en.wikipedia.org/wiki/Henry_R._Rollin">Henry Rollin</a>, an English psychiatrist and medical historian, captures the intense zeal:</p>
<blockquote>
<p>The physical treatment of the frankly psychotic during these centuries makes spine-chilling reading. Evacuation by vomiting, purgatives, sweating, blisters, and bleeding were considered essential […] There was indeed no insult to the human body, no trauma, no indignity which was not at one time or other piously prescribed for the unfortunate victim.</p>
</blockquote>
<p>Treatments were sometimes based on rational grounds. Malaria therapy, for instance, was launched as a treatment for neurosyphilis by the Viennese psychiatrist <a href="https://www.britannica.com/biography/Julius-Wagner-Jauregg">Julius Wagner-Jauregg</a> in 1917, earning him a Nobel Prize ten years later. </p>
<p>The high fever caused by the malarial parasite disabled the <a href="https://www.britannica.com/science/spirochete">spirochete</a> that caused neurosyphilis, but the hope that it would be equally effective for other forms of psychosis was soon dashed. The wished-for panacea was not to be.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/543703/original/file-20230821-10846-x44evz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543703/original/file-20230821-10846-x44evz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543703/original/file-20230821-10846-x44evz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543703/original/file-20230821-10846-x44evz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543703/original/file-20230821-10846-x44evz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543703/original/file-20230821-10846-x44evz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543703/original/file-20230821-10846-x44evz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543703/original/file-20230821-10846-x44evz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Malaria therapy, a treatment for neurosyphilis, earned its inventor a Nobel Prize.</span>
<span class="attribution"><span class="source">Jimmy Chan/Pexels</span></span>
</figcaption>
</figure>
<p><a href="https://www.britannica.com/science/insulin-shock-therapy">Insulin-coma therapy</a> was introduced by Manfred Sakel in the 1930s in Vienna and was soon being used in many countries to treat schizophrenia. An insulin injection was administered six days a week for several weeks, producing a state of light coma lasting about an hour, because of reduced glucose reaching the brain. </p>
<p>Many years later, an investigation carried out in the Institute of Psychiatry in London, a leading research centre at the time, showed conclusively that the coma itself was of no therapeutic value. Any positive change was probably due to the staff’s painstaking care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/girl-interrupted-interrogates-how-women-are-mad-when-they-refuse-to-conform-30-years-on-this-memoir-is-still-important-199211">Girl, Interrupted interrogates how women are 'mad' when they refuse to conform – 30 years on, this memoir is still important</a>
</strong>
</em>
</p>
<hr>
<h2>ECT and lithium</h2>
<p>The first widely available and effective biological treatments for mental illness were developed in the asylum. The discovery in 1938 of <a href="https://theconversation.com/electroconvulsive-therapy-a-history-of-controversy-but-also-of-help-70938">electroconvulsive therapy</a> (ECT) by <a href="https://www.psychiatrictimes.com/view/ugo-cerletti">Ugo Cerletti</a> and Lucio Bini, two Italian psychiatrists, led to a dramatically effective treatment for people with severe depression. </p>
<p>ECT was eagerly adopted in practice, but its history illustrates a typical pattern of treatment in psychiatry: unbridled early enthusiasm is later tempered by a protracted process of scientific evaluation. </p>
<p>The same can be said of the use of brain surgery to modify psychiatric symptoms. This was pioneered in 1936 by Portuguese neurologist <a href="https://www.britannica.com/biography/Antonio-Egas-Moniz">António Egas Moniz</a> (another Nobel Prize winner in the field of psychiatry) and surgeon Almeida Lima, and remains controversial in psychiatry to this day.</p>
<p>A momentous breakthrough was the discovery in 1949 by <a href="https://www.nature.com/articles/d41586-019-02480-0">John Cade</a>, an Australian psychiatrist, of lithium as a treatment for manic excitement. The lithium story reveals how the incorporation of a new medication into psychiatric practice is not always smooth. </p>
<p>Several US and Danish psychiatrists had experimented with lithium in the 1870s and 1890s, only to have their work ignored until Cade’s rediscovery. It was another 18 years before lithium was shown to prevent the recurrence of severe changes of mood, its primary clinical use now.</p>
<p>Major tranquillisers were added to the growing range of psychiatric medications after being discovered fortuitously in 1953. An antihistamine used to calm patients undergoing surgery was shown to reduce the torment of psychotic patients, but without making them sleepy. </p>
<p>Shortly after this, the US psychiatrist <a href="https://www.nytimes.com/1983/02/14/obituaries/nathan-kline-developer-of-antidepressants-dies.html">Nathan Kline</a> discovered that a drug being tested for its effect in patients with tuberculosis had antidepressant properties — the forerunner of medications for depression. All these drugs radically transformed the practice of psychiatry. </p>
<h2>Freud, ‘talking cures’ and shell shock</h2>
<p>A very different aspect of mental health care arose in the 1890s, outside
the asylum. Concerned with neurotic conditions, the new treatment grew chiefly out of neurology but was also influenced by a scientific interest in hypnosis and the unconscious. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543695/original/file-20230821-25-qtirft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543695/original/file-20230821-25-qtirft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543695/original/file-20230821-25-qtirft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=816&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543695/original/file-20230821-25-qtirft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=816&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543695/original/file-20230821-25-qtirft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=816&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543695/original/file-20230821-25-qtirft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1025&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543695/original/file-20230821-25-qtirft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1025&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543695/original/file-20230821-25-qtirft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1025&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sigmund Freud.</span>
<span class="attribution"><span class="source">Max Halberstadt/Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>Sigmund Freud conceived a dynamic model of the mind in which, through the mechanism of repression, painful or threatening emotions, memories and impulses are prevented from escaping into conscious awareness. </p>
<p><a href="https://theconversation.com/a-dangerous-method-in-defence-of-freuds-psychoanalysis-5989">Psychoanalysis</a> grew to become an integrated set of concepts about normal and abnormal mental functioning and personality development, and spawned a new method of psychologically based treatment. Psychoanalysis emerged as a major theoretical underpinning of contemporary “talking cures” (psychotherapies), and its influence spread far beyond treating mental ill-health.</p>
<p>Both world wars profoundly influenced the field. The high incidence of “<a href="https://theconversation.com/shell-shock-treatments-reveal-the-conflict-in-psychiatrys-heart-29822">shell shock</a>” in World War I drove home the lesson that mental illness could affect not only those genetically predisposed, but even the supposedly robust. It soon emerged that anyone exposed to traumatic experiences was vulnerable. </p>
<p>A positive outcome from World War II was the development of techniques for screening large numbers of recruits, which revealed the substantial prevalence of emotional problems among young adults. </p>
<p>The need to treat numerous psychiatric casualties led to the development of group therapies. These paved the way for the so-called <a href="https://en.wikipedia.org/wiki/Therapeutic_community">therapeutic community</a>, based on the idea that an entire ward of patients could be an integral part of treatment.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ehPcYibzUKc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Group therapy, as depicted in One Flew Over the Cuckoo’s Nest.</span></figcaption>
</figure>
<p>The idea of deinstitutionalisation began to gather pace in the 1960s, driven by a burgeoning civil-rights movement. <a href="https://www.penguin.com.au/books/asylums-9780241548004">Asylums</a>, an influential book at the time by sociologist Erving Goffman, containing his minute observations of the sense of oppression experienced by patients in these “total institutions”, was one catalyst for their closure. </p>
<p>Hundreds of thousands of long-stay patients began to be transferred to alternative accommodation and specialist care in the community, a process that is still in progress.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-body-keeps-the-score-how-a-bestselling-book-helps-us-understand-trauma-but-inflates-the-definition-of-it-184735">The Body Keeps the Score: how a bestselling book helps us understand trauma – but inflates the definition of it</a>
</strong>
</em>
</p>
<hr>
<h2>What is mental illness?</h2>
<p>It is challenging to define what makes a pattern of behaviour and experience a mental disorder. Generally, such a pattern – or “syndrome” – is considered to be a disorder if it is associated with psychological distress, such as intense and prolonged anxiety or sadness, or significant dysfunction, such as a serious impairment in functioning in one or more key areas of daily life. </p>
<p>If the pattern is short-lived, relatively mild, or entirely understandable in light of the trials and tribulations of the person’s life, it should be seen as a problem in living rather than a mental disorder. Such problems may still benefit from consultation with a mental health professional despite not being diagnosable disorders.</p>
<p>This definition of what counts as a mental disorder also clarifies what is not a mental disorder. Merely being unusual or violating social norms does not mean a person has a disorder. </p>
<p>It is difficult sometimes to decide whether a new kind of behaviour is a mental disorder. For instance, should <a href="https://theconversation.com/no-youre-probably-not-addicted-to-your-smartphone-but-you-might-use-it-too-much-89853">excessive smartphone use</a> or <a href="https://theconversation.com/gambling-on-pokies-is-like-tobacco-no-amount-of-it-is-safe-51037">compulsive gambling</a> be counted as diagnosable addictions?</p>
<h2>Troubling cases</h2>
<p>These decisions about what to include under the umbrella of mental illness are fraught, and there have been some troubling historical cases when disturbing decisions were made or proposed. </p>
<p>In the 1850s, for example, Samuel Cartwright, a physician from Alabama, proposed a new diagnosis called “<a href="https://www.nytimes.com/2000/01/15/arts/bigotry-as-mental-illness-or-just-another-norm.html">drapetomania</a>” to explain why African-American slaves would wish to escape their servitude. </p>
<p>He recommended slaves should be treated kindly and humanely to prevent the disorder, but whipped if this treatment failed. A more patent abuse of the concept of mental illness would be hard to imagine, and it should be noted that other physicians ridiculed Cartwright’s proposal at the time.</p>
<p>Two other controversial cases date to the last century. In the early 1970s, one of us (Sidney) stumbled across disturbing media reports that many political and religious dissenters and human-rights activists in the Soviet Union were being labelled as mentally ill and detained in mental hospitals indefinitely or until they renounced their “disturbed ideas”. </p>
<p>For instance, <a href="https://en.wikipedia.org/wiki/Petro_Grigorenko">General Pyotr Grigorenko</a> criticised the privileges of the Soviet elite and publicly espoused the rights of the <a href="https://en.wikipedia.org/wiki/Crimean_Tatars">Crimean Tatar</a> ethnic minority group. He was diagnosed with paranoid tendencies, one symptom being his “reformist ideas”, and forcibly committed to a psychiatric facility. </p>
<p>In effect, Soviet psychiatry’s definition of mental illness, and psychosis in particular, was so broad that political beliefs about the desirability of social change were recast as delusions.</p>
<p>The second case comes from the US. <a href="https://daily.jstor.org/how-lgbtq-activists-got-homosexuality-out-of-the-dsm/">Until 1973</a>, homosexuality was defined as a sexual deviation and included in the set of recognised mental disorders. Under pressure from civil, women’s and gay rights activists, it was removed from the diagnostic manual.</p>
<p>Noting such cases, whenever the boundary of a mental illness is expanded to include new diagnoses or loosen old ones, some critics will worry we are treating normal behaviour as a pathology and that we will harm people by labelling them. And whenever the boundary contracts, others will worry that people with psychological troubles are being excluded from clinical care. </p>
<p>Deciding what is and isn’t a mental illness is difficult, but has marked consequences.</p>
<hr>
<p><em>This is an edited extract from <a href="https://scribepublications.com.au/books-authors/books/troubled-mindSees-9781922585875">Troubled Minds: Understanding and treating mental illness</a> by Sidney Bloch and Nick Haslam (Scribe Publications), published 29 August 2023.</em></p><img src="https://counter.theconversation.com/content/206580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Haslam receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Sidney Bloch does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Humans have attempted to understand and treat mental illness for centuries – from ancient Greek medicine, Middle Ages exorcisms and the rise of asylums, to modern medical breakthroughs.
Sidney Bloch, Emeritus Professor in Psychiatry, The University of Melbourne
Nick Haslam, Professor of Psychology, The University of Melbourne
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/210135
2023-07-21T09:21:20Z
2023-07-21T09:21:20Z
Virginia Woolf’s copy of her first novel was found in a University of Sydney library. What do her newly digitised notes reveal?
<figure><img src="https://images.theconversation.com/files/538690/original/file-20230721-19-grm0uz.jpg?ixlib=rb-1.1.0&rect=32%2C8%2C5431%2C3628&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Virginia Woolf's own, marked up, copy of her first novel: newly digitised.</span> <span class="attribution"><span class="source">The University of Sydney/Stefanie Zingsheim</span>, <span class="license">Author provided</span></span></figcaption></figure><p>One of just two copies of Virginia Woolf’s first novel, <a href="https://www.penguin.com.au/books/the-voyage-out-9780141919850">The Voyage Out</a> (1915), annotated with her handwriting and preparations to revise it for a US edition, was recently rediscovered in the <a href="https://www.library.sydney.edu.au/collections/rare-books/">Fisher Library Rare Books Collection</a> at the University of Sydney. </p>
<p>Purchased in the late 1970s, it had been misfiled with the science books in the Rare Books collection. Simon Cooper, a metadata services officer, found it in 2021 and immediately understood the value of his discovery.</p>
<p>The Sydney copy, which is the only one available for the public to view, has now been digitised. It’s <a href="https://digital.library.sydney.edu.au/nodes/view/13658">available online</a> – allowing scholars and readers to study and consider Woolf’s editorial interventions. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/538694/original/file-20230721-29-biub4l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/538694/original/file-20230721-29-biub4l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538694/original/file-20230721-29-biub4l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538694/original/file-20230721-29-biub4l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538694/original/file-20230721-29-biub4l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538694/original/file-20230721-29-biub4l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538694/original/file-20230721-29-biub4l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538694/original/file-20230721-29-biub4l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Virginia Woolf’s annotated copy of The Voyage Out is one of two in the world, and the only one publicly available.</span>
<span class="attribution"><span class="source">The University of Sydney/Stefanie Zingsheim</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The Voyage Out follows Rachel Vinrace and a mismatched collection of characters embarking on her father’s ship to South America. Woolf’s story grapples with self-discovery and satirises Edwardian life.</p>
<p>It almost finished her writing career. She struggled through years of drafts, eventually abandoning the first version in 1912: it was titled Melymbrosia, named after the food of the Greek gods. Woolf’s ideas on colonialism, women’s suffrage and gender relations were considered too dangerous for a first-time novelist.</p>
<p>Over the next three years, she composed the (retitled) novel we have today, published by her half-brother <a href="https://en.wikipedia.org/wiki/Gerald_Duckworth">Gerald Duckworth</a> in London in 1915. At this pivotal moment, she began her diary and suffered a significant mental breakdown, losing the rest of the year to illness.</p>
<p>In preparation for the novel’s first US edition, published by George H. Doran in New York in 1920, Woolf carried out a series of revisions to her text. Two copies of the first UK edition of the novel contain the evidence of this process, with Woolf’s handwritten annotations and typed page fragments pasted into each book.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/guide-to-the-classics-a-room-of-ones-own-virginia-woolfs-feminist-call-to-arms-145398">Guide to the classics: A Room of One's Own, Virginia Woolf's feminist call to arms</a>
</strong>
</em>
</p>
<hr>
<h2>Why revise?</h2>
<p>What motivated Woolf to revise her text? She made revisions in the aftermath of her breakdown, and after her literary career was revived with her second novel, <a href="https://www.penguin.com.au/books/night-and-day-9780140185683">Night and Day</a>, published in 1919.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/538695/original/file-20230721-19-ga2m4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/538695/original/file-20230721-19-ga2m4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/538695/original/file-20230721-19-ga2m4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=820&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538695/original/file-20230721-19-ga2m4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=820&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538695/original/file-20230721-19-ga2m4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=820&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538695/original/file-20230721-19-ga2m4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1030&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538695/original/file-20230721-19-ga2m4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1030&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538695/original/file-20230721-19-ga2m4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1030&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Virginia Woolf(Picture: George Charles Beresford)/Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>Scholars have suggested she wished to place some distance between her own psychological stresses and the anguish of her primary character, Rachel Vinrace. Both Woolf and her chief protagonist had domineering father figures, had lost their mothers at a relatively young age, and were denied a formal education – instead being schooled at home. Laying out her character’s mental life so starkly caused Woolf some discomfort. A new edition may have provided an opportunity to reconsider.</p>
<p>This is a plausible theory. But does the evidence in Woolf’s corrections bear it out? There are two main places in the text where the majority of changes are indicated: both are pivotal moments in the narrative.</p>
<p>The first set of changes occurs in Chapter XVI, where the conversation between Vinrace and Terence Hewet – the pair occupying the romantic plotline of the novel – is altered to reduce access to Rachel’s inner thoughts. Entire paragraphs are replaced by typed text pasted directly onto the page, where the narrator studies Rachel without the guarantee of understanding her.</p>
<p>This has the effect of diluting some uncomfortable autobiographical elements in the text, but also marks a significant shift in the way narration accesses the minds of characters. </p>
<p>The narrator is bounded by the limits of character itself: the depths of Rachel’s subjectivity are unknown even to her. This bears the mark of modern psychology and <a href="https://theconversation.com/a-dangerous-method-in-defence-of-freuds-psychoanalysis-5989">Freud’s theory</a> of the unconscious, in the years before and during the composition of the novel.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sophie-cunninghams-pandemic-novel-admits-literature-cant-save-us-but-treasures-it-for-trying-187724">Sophie Cunningham's pandemic novel admits literature can't save us – but treasures it for trying</a>
</strong>
</em>
</p>
<hr>
<h2>A modernist revolution</h2>
<p>This innovation signals a profound shift in modernist fiction, which began in the late 19th and early 20th centuries and is characterised by a self-conscious break with traditional ways of writing. </p>
<p>The unknowability of Woolf’s characters begins with the dark regions of the mind. No longer in the realm of realism, where thoughts and actions are knowable (and often transmitted by an omniscient narrator), instead the narrator provides a portrait of the complex modern person, who responds to the world in ways not fully accountable by reason.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/538696/original/file-20230721-29-jsbx42.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/538696/original/file-20230721-29-jsbx42.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/538696/original/file-20230721-29-jsbx42.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=928&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538696/original/file-20230721-29-jsbx42.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=928&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538696/original/file-20230721-29-jsbx42.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=928&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538696/original/file-20230721-29-jsbx42.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1167&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538696/original/file-20230721-29-jsbx42.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1167&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538696/original/file-20230721-29-jsbx42.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1167&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>The other significant set of revisions in the Sydney text arise in Chapter XXV, in which Rachel and Terence attempt to navigate the future of their nascent relationship – which also marks Rachel’s descent into fever and her decline, ending in death. </p>
<p>Long passages are marked for deletion (although none were actually deleted in the first US edition). They are largely concerned with Rachel’s fevered consciousness and Terence’s attitudes towards romantic love and its effects on an artistic life.</p>
<p>Woolf again may have wished to put distance between the narrator and the intimate thoughts of her characters, invoking instead a space of ambiguity, where words and gestures are to be interpreted by readers rather than analysed in full light by a knowing narrative consciousness.</p>
<p>Woolf’s first novel straddles the conventions of realism inherited from the 19th century and the new, experimental fiction of the 20th. The Sydney text tells an important part of this story. </p>
<p>It shines a light on Woolf’s developing technique and its evolution into the free indirect style for which she became famous in later novels such as <a href="https://www.penguin.com.au/books/mrs-dalloway-9780143136132">Mrs Dalloway</a>, <a href="https://www.penguin.com.au/books/to-the-lighthouse-vintage-classics-woolf-series-9781784870836">To the Lighthouse</a> and <a href="https://www.penguin.com.au/books/the-waves-vintage-classics-woolf-series-9781784870843">The Waves</a>.</p>
<p>Woolf was at the centre of the revolution in the novel form during the time of modernism. The evidence is there in her annotated copy of The Voyage Out.</p><img src="https://counter.theconversation.com/content/210135/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Byron has been the recipient of one Discovery Grant and two fellowships from the Australian Research Council, most recently a Future Fellowship from 2017 to 2020.</span></em></p>
A Sydney librarian recently discovered a misfiled lost gem in the stacks: Virginia Woolf’s own copy of her first novel, with handwritten notes for revision. An expert explores what they tell us.
Mark Byron, Professor, University of Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/206979
2023-06-13T16:15:57Z
2023-06-13T16:15:57Z
A science of sexuality is still possible — but not in the traditional sense
<figure><img src="https://images.theconversation.com/files/531198/original/file-20230609-29-7wkphc.JPG?ixlib=rb-1.1.0&rect=11%2C16%2C3760%2C2499&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A rainbow flag is being waved during Pride Parade in Saskatoon, Sask., in June 2022. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Heywood Yu</span></span></figcaption></figure><p>Human sexuality has long been a subject of fascination and curiosity in the scientific community. Researchers from different fields have sought to understand why we are attracted to certain people and how our sexual orientation develops.</p>
<p>From Sigmund Freud to Judith Butler, the road to a science of sexuality is a fascinating history of ambition and culture wars, error and scientific breakthrough.</p>
<p>My recent research continues the quest to make a science out of sexuality. Two <a href="https://www.jstor.org/stable/j.ctv19cwdnt">opposing schools of thought currently divide</a> the field: psychoanalysis and queer theory. </p>
<p>Psychoanalysts believe desire follows specific laws and follows predictable patterns, while queer theorists argue that laws have exceptions and advocate for a more creative view of sexuality.</p>
<p>My research proposes <a href="https://doi.org/10.1057/s41282-022-00366-1">an information theory of desire</a> that
straddles the line these two groups by arguing we should consider the object of our desire as information.</p>
<p>Psychoanalysis can help us understand how this particular kind of information is stored, while queer theory can help us understand how this information is organized and re-organized internally. </p>
<h2>Birth of psychoanalysis</h2>
<p>Sigmund Freud, originally trained as a physician, believed in the scientific basis of sexuality. He was the first to regard sex as the subject of a serious discussion. Starting in 1902, <a href="https://www.freud.org.uk/2020/05/14/freud-at-home-the-wednesday-psychological-society/">colleagues gathered every Wednesday</a> in his apartment to discuss the psychoanalytic practice he established. </p>
<p>Debates about how to study sexuality soon divided Freud’s circle of colleagues. In 1911, Alfred Adler broke away and <a href="https://www.apa.org/pubs/books/Alderian-Psychotherapy-Intro-Sample.pdf">turned psychoanalysis into social and cultural studies</a>. Two years later, Carl Jung broke away and turned <a href="https://www.jstor.org/stable/27505718">toward philosophical and existential questions</a>.</p>
<figure class="align-center ">
<img alt="A black-and-white photo of a man with a white beard, round black glasses and a hat." src="https://images.theconversation.com/files/531192/original/file-20230609-28-mm18zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531192/original/file-20230609-28-mm18zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=455&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531192/original/file-20230609-28-mm18zi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=455&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531192/original/file-20230609-28-mm18zi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=455&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531192/original/file-20230609-28-mm18zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=571&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531192/original/file-20230609-28-mm18zi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=571&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531192/original/file-20230609-28-mm18zi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=571&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Psychoanalyst Sigmund Freud at his home in London in June 1938.</span>
<span class="attribution"><span class="source">(AP Photo)</span></span>
</figcaption>
</figure>
<p>At the time, Lou Andreas-Salomé, the first female psychoanalyst, did not believe <a href="https://archive.org/details/freudjournaloflo0000unse/page/130/mode/2up?q=honesty">either separation threatened the scientific status of psychoanalysis</a>:</p>
<blockquote>
<p>“The source of its vitality does not lie in any hazy mixture of science and sectarianism, but in having adopted as a fundamental principle that which is the highest principle of all scientific activity. I mean honesty.”</p>
</blockquote>
<p>Though Freud retained Andreas-Salomé’s loyalty until the end, he didn’t share her optimism about the uniting power of honesty and <a href="https://archive.org/details/sigmundfreudloua00freu/page/18/mode/2up?view=theater&q=loathsome">thought divisions at the heart of his movement</a> would delegitimize it. </p>
<h2>North American psychology</h2>
<p>The quest to turn sexuality into a credible science survived Freud, especially in North America. Clinically trained psychologists in the post-Second World War era <a href="https://doi.org/10.1007/978-94-017-8688-1_41">borrowed Freudian theories and employed traditional scientific methods</a> to empirically test them. </p>
<p>Dismissing Freud’s exclusive interest in individual case studies, <a href="https://doi.org/10.1177/000306515300100203">American</a> and <a href="https://journals.sagepub.com/doi/pdf/10.1177/070674376400900610">Canadian</a> psychologists aimed to understand populations more widely. However, this shift led to <a href="https://heinonline.org/HOL/Page?handle=hein.journals/socprob3&div=42&g_sent=1&casa_token=PyF5exLVo0cAAAAA:AJB84TRzpeslt3--Ri334K5VpX3FZCtPLrDboLHYfQmWGlPIjYamTZQ_0mrUKgx3VsAzm2fCIw&collection=journals">seeing homosexuals as a separate social group</a>, which ultimately gave rise to <a href="https://heinonline.org/HOL/Page?handle=hein.journals/medlgjr15&div=8&g_sent=1&casa_token=aOsBLK2-uLMAAAAA:q2Z3RRyS3GYeLaWsXniM5Fo86CI-07Qij9Av2NmCvqgE51HKGNG3TRMrk1RtPuz45VTNdI2wIg&collection=journals">homophobia</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642357/?page=1">conversion therapy</a>.</p>
<p>In the United Kingdom, Freud’s daughter Anna <a href="https://lambdaliterary.org/2014/08/rebecca-coffey-on-sigmund-freuds-relationship-with-his-lesbian-daughter-anna-and-using-fiction-to-explore-the-truth/">promoted curing homosexuality</a> even though her father had <a href="https://pep-web.org/browse/document/ijp.032.0331a">denounced similar practices</a>. </p>
<p>In France, psychoanalyst Jacques Lacan urged his colleagues to <a href="https://doi.org/10.18574/nyu/9780814743232.001.0001">return to Freud’s methods</a>. Consumer culture silenced similar voices in North America. </p>
<p>Psychotherapy lost its scientific motto — the pursuit of truth — and became a <a href="https://global.oup.com/academic/product/happier-9780190655648?cc=us&lang=en&">matter of pursuing happiness</a>. Keenly aware how the big screen dumbed down Freud’s psychology, Marilyn Monroe — a serious <a href="https://www.yahoo.com/lifestyle/tagged/health/healthy-living/marilyn-monroe--bookworm%E2%80%94highlights-from-her-library-184157109.html">reader of psychoanalysis</a> — turned down starring in a movie about him out of respect.</p>
<h2>Sexuality nowadays</h2>
<p>By the time Canada <a href="https://www.thecanadianencyclopedia.ca/en/article/the-1969-amendment-and-the-de-criminalization-of-homosexuality">decriminalized homosexuality in 1969</a> — and the American Psychological Association <a href="https://www.nytimes.com/1973/12/23/archives/the-issue-is-subtle-the-debate-still-on-the-apa-ruling-on.html">unclassified it as a mental disorder</a> four years later — sexuality studies had shied away from its psychological origins. </p>
<p>But biological explanations prevailed. Scientists wondered <a href="https://doi.org/10.1007/BF01541437">whether homosexuality ran in the family</a> and hypothesized the existence of a <a href="https://doi.org/10.1300/J082v06n04_02">gay gene and its relationship to natural selection</a>. </p>
<p>Despite the politically correct turn away from <a href="https://theipi.org/all-events/#!event/2022/1/28/ebook-lecture-january-28th">“why gay?” to “how gay?”</a> in post–1970s clinical research, and the anti-psychological turn in feminism known as <a href="https://www.washingtonpost.com/wp-srv/style/longterm/books/chap1/dispatchesfromthefreudwars.htm">the Freud Wars of the 1980s</a>, the prospect of a science of sexuality almost vanished until queer theorists made its case again in the 1990s.</p>
<p>Queer theory rejected <a href="https://www.cambridge.org/ca/universitypress/subjects/sociology/social-theory/social-postmodernism-beyond-identity-politics">fixed collective identities</a> and re-emphasized <a href="https://doi.org/10.1177/0959354397073003">individual case studies</a> the same way Freud had. Instead, queer theorists viewed sexuality as <a href="https://www.routledge.com/Gender-Trouble-Feminism-and-the-Subversion-of-Identity/Butler/p/book/9780415389556">something more dynamic</a>.</p>
<figure class="align-center ">
<img alt="A middle-aged individual in a black blazer and dress shirt smiles while holding a large hardcover book." src="https://images.theconversation.com/files/531193/original/file-20230609-25-hgi9vw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531193/original/file-20230609-25-hgi9vw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531193/original/file-20230609-25-hgi9vw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531193/original/file-20230609-25-hgi9vw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531193/original/file-20230609-25-hgi9vw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531193/original/file-20230609-25-hgi9vw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531193/original/file-20230609-25-hgi9vw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Philosopher and gender studies theorist Judith Butler smiles after receiving the Theodor W. Adorno award in Frankfurt, Germany, in September 2012.</span>
<span class="attribution"><span class="source">(AP Photo/Thomas Lohnes)</span></span>
</figcaption>
</figure>
<p>Queer theorists like Judith Butler emphasized the <a href="https://archive.org/details/gendertrouble00judi/page/16/mode/2up?q=internal+external&view=theater">relationship between internal and external life</a>. They highlighted how drag artists <a href="https://archive.org/details/gendertrouble00judi/page/136/mode/2up?view=theater&q=drag">disrupt the way we assign gender</a> on a daily basis.</p>
<p>This disconnect between what we see and the meaning we give it is a chance for sexuality to break with habit and become unpredictable.</p>
<h2>The challenge of our current moment</h2>
<p>Nowadays, many regard sexuality as <a href="https://www.refinery29.com/en-us/2019/08/8324299/2019-study-genetics-sexuality">too complicated</a> or <a href="https://www.themontrealreview.com/2009/Sex-and-Gender-Reconsidered.php">too subjective</a> to become a science. Freud’s theories are often dismissed as pseudoscience.</p>
<p>But this outlook is dangerous to the pursuit of science. According to Elizabeth Young–Bruehl, a queer psychoanalyst who practised in Toronto until her death in 2009, we have <a href="https://www.jstor.org/stable/25670368">abandoned Freud’s depth psychology and his theory of the unconscious</a> and promoted instead superficial psychological theories.</p>
<p>Homophobia and caricatures of psychoanalysis originated with our relationship to science, not Freud’s. Though he was keen on establishing a science of sexuality, <a href="https://doi.org/10.1080/07351690.2018.1480225">he regarded that science as historical</a> rather than experimental. </p>
<p><a href="https://biologos.org/common-questions/is-historical-science-reliable">Historical sciences</a> aim to reconstruct past events and favour the uniqueness of detail and individual cases. <a href="https://www.jstor.org/stable/23332257">Experimental sciences</a>, on the other hand, are concerned with the future and whether an event will repeat itself. </p>
<h2>Information theory of desire</h2>
<p>Why do individuals come out as gay or bisexual at a particular point in their lives, but not earlier? Why do some first same-sex experiences shape a queer identity while others do not?</p>
<p>An information theory of desire might offer insights into these questions. When queer people talk about the <a href="https://owlcation.com/social-sciences/Coming-Out-to-Yourself-A-Guide-for-Self-Acceptance">defining moment when they came out to themselves</a>, it can be useful to think of self-acceptance as a kind of computing command — an input that demands a radical re-organization of someone’s information network or identity.</p>
<p>Life events become inputs, and sexual orientations and gender identities become information networks. Certain same-sex experiences may only result in partial changes to the information network, while others may lead to the complete re-configuring of someone’s identity.</p>
<p>What can we discover with a science of sexuality? Freud’s loyal friend Andreas-Salomé was right to regard honesty as the highest principle of any scientific activity. Without it, we would be dealing with incorrect inputs or information networks viewed upside down. </p>
<p>Pride Month is not just a celebration of sexuality — it’s also a celebration of science.</p><img src="https://counter.theconversation.com/content/206979/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rayyan Dabbous does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
A new theory of desire bridges the gap between psychoanalysis and queer theory on a quest to make a science out of sexuality.
Rayyan Dabbous, PhD student, Centre for Comparative Literature, University of Toronto
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/206824
2023-06-01T11:06:40Z
2023-06-01T11:06:40Z
Psychoanalysing Succession’s tense finale – a Freudian suspension of pleasure
<p><em>Warning: the following article contains spoilers.</em></p>
<p><a href="https://www.britannica.com/biography/Sigmund-Freud">Sigmund Freud</a>, the 20th century titan of psychoanalysis, would doubtless have plenty to say about the Roy family, had the characters ever plopped down on his treatment couch.</p>
<p>The cunning ruses of the Roys are ticking timebombs of self-sabotage. Their vaulting and faltering desires mask the fundamental human requirements they are missing: love, attention, esteem and purpose. But there is another component of the Succession experience that has a complicated relationship with pleasure and desire – the viewer.</p>
<p>Kendall (Jeremy Strong) and co have shown how audiences sometimes enjoy watching the desires of society’s villains unfold. In Succession, this enjoyment stems from the clever ways show runner Jesse Armstrong and his team have balanced the characters’ psyche to reveal the human inside each monster.</p>
<p>Each character threatens dominance at the expense of another equally unlikable character. This instability divides our sympathies. Though we desire the Succession ending we want, knowing that getting it might be bad means that we long for something that violently prevents it at the exact same time.</p>
<h2>Narrative and pleasure</h2>
<p>In his 1920 essay, <a href="https://www.libraryofsocialscience.com/assets/pdf/freud_beyond_the_pleasure_principle.pdf">Beyond the Pleasure Principle</a>, Freud recalls observing a toddler throwing his toys away and then later using a string and reel to haul them back toward him, much to his pleasure. </p>
<p>This could also describe Logan Roy’s (Brian Cox) relationship to his children. It calls to mind their mother, Caroline’s (Harriet Walter) <a href="https://www.youtube.com/watch?v=bp0gvV_8C84">reflection on her ex husband</a> in season three: “He never saw anything he loved that he didn’t want to kick it just to see if it would still come back.”</p>
<p>Throughout its run, Succession has offered an intensified version of this idea. In oscillating between alliance and discord, Succession has conditioned viewers to expect the worst outcome possible for the Roy siblings at any given moment. And yet Shiv’s (Sarah Snook) boardroom betrayal of her apparently CEO-elect brother Kendall in his moment of triumph was chilling to watch.</p>
<p>This betrayal has been seeded, foreshadowed and returned to throughout the fourth series and yet its eventuality still had the power to paralyse. Viewers are increasingly <a href="https://doi.org/10.1177/1367549410363202">media literate and savvy</a>. If we expected it, then why did it still affect us? And if the Roys are all so horrible, why are we so conflicted?</p>
<h2>Moments between moments</h2>
<p>Part of the success of the fourth and final series of Succession has been the way in which it explores paroxysm (sudden flurries of activity and emotion) while the narrative is paused at uncertain moments. For example, the <a href="https://theconversation.com/how-to-write-a-eulogy-lessons-from-successions-roy-family-206553">episode of Logan’s death</a> or that of the <a href="https://www.youtube.com/watch?v=4cj2cbrvl-4">Wisconsin call on election night</a>. </p>
<p>Exploring these moments between moments and stretching them out to transmit their texture and feeling, has <a href="https://research-information.bris.ac.uk/en/publications/tension-and-release-and-tension-and-the-ethics-of-narrative-and-a">increasingly become part</a> of complex television like Succession.</p>
<p>In the final episode, there is extended pleasure before the pain. The reconciliation of the Roy siblings in Barbados – leading to Shiv and Roman (Kieran Culkin) anointing Kendall with “<a href="https://www.youtube.com/watch?v=MtL4LnnZ0ys">a meal fit for a king</a>” and the shared observation of their father on video in <a href="https://www.youtube.com/watch?v=tWCzdHG9-eE">a rare moment of lightness</a> – realigns the trio and suggests the beginning of recognition of their own traumatic past.</p>
<p>Greater weight, particularly heading toward the show’s conclusion, had been placed on restoring unity between the Roy siblings. A final moment of ecstasy was neatly ordained. Kendall would return to the site of his frequent humiliation to conquer.</p>
<p>Even the final boardroom sequence replicated this as the first three votes were in Kendall’s favour. The tide quickly turned, however, and viewers squirmed, but by now we’re used to the discomfort.</p>
<p>Complex TV shows with large ensembles often favour a general “team” which adjoins the shared fantasy between viewer and protagonist. Game of Thrones wanted justice for “the North”, The Wire wanted good police. The expert crafting toward Kendall’s success in these final minutes, despite his complicity and weakness, fed such a fantasy. But Shiv’s decision exploded it.</p>
<p>Overly neat endings risk revealing the world within television shows as utopias. Succession neatly avoided this by not showing the moment of Shiv’s betrayal in order to make it into a replacement fantasy. Instead, we swoop in during the aftermath and observe vultures pecking the carrion. Shiv is already gone, her deciding vote already placed and our pleasures are cut off mid-flight.</p>
<p>But this suspension, as <a href="https://www.libraryofsocialscience.com/assets/pdf/freud_beyond_the_pleasure_principle.pdf">Freud might observe</a>, is what we secretly enjoy the most. Desire is stimulated by what we cannot quite possess. We are left to delight in the ambiguities of Succession’s ending.</p>
<p>Jesse Armstrong has form for leaving viewers to observe his characters squirming on the head of a pin. Unlike his <a href="https://www.youtube.com/watch?v=xzsy-haNy1E">Peep Show creations</a>, the Roy family has a clear cut chance to break the cycle that returns them to their issues.</p>
<p>Their ultimate destinies are ambiguous. Kendall remains trapped within a narrative of his own creation, psychologically devastated in sight of his personal Everest. But Shiv’s apparent reconciliation with husband Tom (Matthew Macfadyen) and Roman’s bitter and bruised acceptance over a drink appear to be the beginnings of difficult new roads.</p><img src="https://counter.theconversation.com/content/206824/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Brookes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Though we desire the Succession ending we want, we long for something that violently prevents us from getting it at the exact same time.
Daniel Brookes, Lecturer in Film and Television, University of Bristol
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/182308
2022-06-22T10:04:15Z
2022-06-22T10:04:15Z
Psychologists have traditionally focused on the past – what if that’s all wrong?
<figure><img src="https://images.theconversation.com/files/462464/original/file-20220511-21-3x8q70.jpg?ixlib=rb-1.1.0&rect=17%2C25%2C5734%2C3794&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Tell me about your mother.'</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/geriatric-psychology-mental-therapy-old-age-1433830370">Syda Productions/Shutterstock</a></span></figcaption></figure><p>For over a century, psychologists such as <a href="https://www.britannica.com/biography/Sigmund-Freud">Sigmund Freud</a> and <a href="https://www.britannica.com/biography/Carl-Rogers">Carl Rogers</a> focused people’s attention on the past. And so when Mary struggles to maintain romantic relationships, she blames her past boyfriends for it. When Chris battles with addiction, he digs into his memories from childhood when he first felt humiliated. And when Saoirse doesn’t want to settle down, she attributes her free-spirited nature to being the youngest child in her family. </p>
<p>But what if these psychologists got it wrong? What if it is not the past but how we view the future that holds us back, preventing us from becoming the best versions of ourselves?</p>
<p>Psychological research has become obsessed with searching for the causes of mental ill health. However, an increasing body of research suggests that focusing on the future may protect us from depression and help us cope with stress <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/pchj.283?casa_token=HLc8soPJPeAAAAAA:56xmM1-ge8Hqb1saEgFZQUQeJCHDukEPtbeDJ72GDl5UmLedPlUMX3zuGqBZMevYMad247Yq75r86ZqU">more effectively</a>. Sometimes, instead of dissecting the negative memories, we need to focus on a better understanding of <a href="https://psycnet.apa.org/record/2012-29989-000">how we view our future</a>. </p>
<p>Many <a href="https://link.springer.com/chapter/10.1007/978-3-319-07368-2_31">veterans</a>, <a href="https://www.tandfonline.com/doi/full/10.1080/15325024.2020.1793552?casa_token=CtlvKTZGr_wAAAAA%3ALsW0y14obc6uYL-XgmlVFY9m0zbEFSMBevEdqtk4t5t2k6EtlC93Z3fmSNvvpPSwlwydf-ryatFP8w">refugees</a> and other people <a href="https://www.sciencedirect.com/science/article/pii/S0191886916308054?casa_token=lT9qDDwCTE4AAAAA:ud_lIXWxBHQpzKVC-zJ6X7vElkaMiMrTmiiLwOwLR1UPbX9eGX9Wp-Ncazwx3ZHrNZnB1cNfTQ">who have experienced trauma</a> and have mental health issues spend little time thinking about the future. Instead, they are narrowly focused on the negative past. </p>
<figure class="align-center ">
<img alt="Two soldiers in a sandy haze." src="https://images.theconversation.com/files/469805/original/file-20220620-26-swhvhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469805/original/file-20220620-26-swhvhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469805/original/file-20220620-26-swhvhl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469805/original/file-20220620-26-swhvhl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469805/original/file-20220620-26-swhvhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469805/original/file-20220620-26-swhvhl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469805/original/file-20220620-26-swhvhl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Veterans who have experienced trauma spend a lot of time focused on the past.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/united-states-marines-action-military-equipment-1069835897">Superstar/Shutterstock</a></span>
</figcaption>
</figure>
<p>However, people who have experienced trauma and developed a healthy future perspective <a href="https://dc.etsu.edu/asrf/2019/schedule/107/">report</a> being better at coping with life, having fewer negative thoughts about the past, and getting better sleep compared with those who have a negative future perspective. So, instead of dwelling on the past, people who have suffered trauma should be encouraged to think about the future and set goals that help them develop hope for a <a href="https://www.tandfonline.com/doi/full/10.1080/15325024.2013.763632?casa_token=JdM-La6F788AAAAA%3AsrYNtzodu7_aZpffwK_cbZ1ZHKXL-h_ILszjhZbVXLokLdjS0M5GMPZxBcRqqmdnaTQNAkmQ0Drv_g">good life</a>. </p>
<p>Reflecting on a positive future can help us develop healthy relationships with the days to come and be more open to life and its opportunities. With this in mind, Julie Round (a qualitative researcher) and I <a href="https://psycnet.apa.org/record/2018-44207-002">have experimented with a small group of newly retired women</a>, some of whom felt anxious when thinking about their future. They wondered what to do with the rest of their lives. Some even questioned their usefulness in this world, making them feel worse about themselves. When we asked them how they felt about setting goals, they had mixed emotions. </p>
<p>We began gently by helping them create a more positive future. Every day for four days, they wrote for 20 minutes about their “best retired self”. They imagined their dreams coming to fruition. Then, they explored the building blocks (such as home, family and leisure) to reaching their best future selves. They imagined that everything went according to plan, and were encouraged to think about what life would look like five years from now. </p>
<p>On the last day of the study, they imagined their 80th birthday using senses (for example, what did it smell like and who was there with them? – including people they had not yet met). Then we asked them to set goals for their lives ahead. </p>
<p>A week after the activity, they continued to experience mixed emotions. They needed time to process their future – all the things they looked forward to and the things they feared. However, a positive change was noted three months later, when they reported increased calmness and enthusiasm for the future. The image of them on their 80th birthday stayed with them, and they wanted to ensure they contributed to their friends, family and society just as they planned. </p>
<h2>Four techniques to create a better future</h2>
<p>Your “best retired self”, or a more generic “best possible self”, is just one of many activities you can engage in to help you create a more positive future to look forward to. Other activities include:</p>
<ul>
<li><p><a href="https://journals.sagepub.com/doi/full/10.1177/0733464817693375"><strong>Anticipate savouring</strong></a>. Consider small and more significant things happening in the near or distant future. Imagine what it would be like if everything went well for you. Enjoy the positive feelings that follow.</p></li>
<li><p><a href="https://psywb.springeropen.com/articles/10.1186/2211-1522-1-5"><strong>Develop hope</strong></a>.
Hope is about finding the will and the way towards accomplishing something we want in our lives. Try to identify what you would like your future to be and reflect on how to get there. Without a pathway, you may feel helpless about your situation.</p></li>
<li><p><a href="https://psycnet.apa.org/record/1955-05753-001"><strong>Imagine all your problems solved</strong></a>. Project yourself into a time when all the issues you are struggling with today will be resolved. Now describe in detail how you achieved this.</p></li>
<li><p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cpp.1795"><strong>Develop goals</strong></a>. Come up with a list of goals you would like to achieve. Now complete the <a href="https://viacharacter.org/">Values in Action (VIA) survey of character strengths</a> and identify how your strengths can help you achieve your meaningful goals.</p></li>
</ul>
<p>Focusing on the future offers us choices and acknowledges that we have free will, and are not just a product of our childhood or other adverse life events. We have no say in our past, but we can create a better future if we choose to face it and enter it with confidence.</p>
<p>This does not mean we should live in denial. In fact, the opposite is true. We acknowledge that bad things have happened, but we also acknowledge that we want a promising future for ourselves and choose to focus our attention on creating it. Seeing it is a starting point to making it happen.</p><img src="https://counter.theconversation.com/content/182308/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jolanta Burke does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Four ways to help you focus on the future for a better life.
Jolanta Burke, Senior Lecturer, Centre for Positive Psychology and Health, RCSI University of Medicine and Health Sciences
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/176464
2022-03-08T03:38:42Z
2022-03-08T03:38:42Z
Feminist stories and dangerous bodies: Siri Hustvedt in conversation with Julienne van Loon
<figure><img src="https://images.theconversation.com/files/444989/original/file-20220208-21-6erpo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>I first discovered Siri Hustvedt through her best known novel, What I Loved (2003), which caught my attention through <a href="https://www.nytimes.com/2003/03/09/books/let-s-have-a-fivesome.html">Janet Burroway’s review in the New York Times</a>: “that rare thing: a page turner at full intellectual stretch”. </p>
<p>Narrated via Leo, an ageing art historian who reflects on family and relationships across several decades, the novel begins as a contemplative look at art, gender and representation, and finishes in the genre of the thriller.</p>
<figure class="align-left ">
<img alt="woman" src="https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=933&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=933&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=933&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1172&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1172&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445030/original/file-20220208-25-uz6ktv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1172&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Siri Hustvedt’s 2003 breakout hit, What I Loved.</span>
</figcaption>
</figure>
<p>Hustvedt’s body of work spans novels, including <a href="https://www.hachette.com.au/siri-hustvedt/what-i-loved">What I Loved</a> and the Man Booker longlisted <a href="https://www.hachette.com.au/siri-hustvedt/the-blazing-world">The Blazing World</a> (2014), memoir, essays and poetry. Her work ranges across feminism, psychoanalysis, art criticism, psychology, philosophy and neuroscience. </p>
<p>We first met seven years ago, when she agreed to be interviewed for <a href="https://www.newsouthbooks.com.au/books/thinking-woman/">my essay collection, The Thinking Woman</a> (2019). I spent two mornings in Hustvedt’s home in Brooklyn that northern winter of 2014, as we talked at length about the nature of play. </p>
<p>In early 2022, when Hustvedt and I zoomed into one another’s living spaces to talk about her new essay collection, <a href="https://www.hachette.com.au/siri-hustvedt/mothers-fathers-and-others-new-essays">Mothers, Fathers and Others</a>, positive cases of the Omicron strain of COVID-19 were rising sharply in both New York and Melbourne. </p>
<figure class="align-right ">
<img alt="Child inside two-faced head that is both man and woman, inside a light bulb." src="https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=925&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=925&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=925&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1162&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1162&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444997/original/file-20220208-18-1k9244b.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1162&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Book cover, Mothers, Fathers and Others: New Essays, cover artwork by Louise Bourgeois (subject of one of the essays).</span>
</figcaption>
</figure>
<p>The 20 new essays were written between 2019 and 2020, against the backdrop of the latter part of Trump’s presidential rule and the arrival of the COVID pandemic in New York. </p>
<p>We talked about art, gender, misogyny, racism and cultural authority, and her long fascination with the work of US visual artist <a href="https://www.moma.org/artists/710">Louise Bourgeois</a>.</p>
<p>Our conversation began and ended by recognising that, as thinkers, writers, and mothers, our lives don’t fit into strict categories – nor are they contained by borders.</p>
<h2>Disordered cultures, policing borders and post-Trump America</h2>
<p>The essay “Open Borders: Tales from the Life of an Intellectual Vagabond” began as a lecture Hustvedt delivered in Guadalajara, Mexico during 2019, while work was underway on Donald Trump’s infamous wall.</p>
<p>She foregrounds a serious discussion of policing borders with a playful childhood memory of visiting the <a href="https://navajonationparks.org/tribal-parks/four-corners-monument/">Four Corners Monument</a> at the border of four US states, placing a hand in each of two states and a leg in each of the others: “promiscuous habitation”.</p>
<figure class="align-center ">
<img alt="Man in suit walks along tall wall." src="https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445020/original/file-20220208-19-1f7c2o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Former US President Donald Trump walks along the completed 200th mile of border wall, Tuesday, June 23, 2020.</span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Hustvedt writes: “We take for granted that our own human boundaries end with the organ that is our skin, but every person was once a cluster of dividing cells inside the body of another person.” Yet why are borders of all kinds so passionately policed? And why are porous borders so often represented as a site of horror in our culture?</p>
<p>Hustvedt turns to Mary Douglas’s <a href="https://www.routledge.com/Purity-and-Danger-An-Analysis-of-Concepts-of-Pollution-and-Taboo/Douglas/p/book/9780415289955">Purity and Danger: an analysis of the concepts of pollution and taboo</a>, first published in 1966, to help answer those questions. I ask why this particular book keeps drawing her back.</p>
<hr>
<p><strong>SIRI HUSTVEDT:</strong> I first read Douglas’s Purity and Danger not long after I arrived in New York City, in graduate school. It’s one of those books that has sustained me over the years. The central idea is that all cultures have a need for order, all cultures fear disorder, and that our cleaning habits are culturally determined. </p>
<p>In some cultures, faeces are just a joke and in other cultures they’re considered really dangerous. So, Douglas is not saying that we all share the same kinds of pollution concerns, but she’s saying that pollution concerns exist in all cultures. And the blur, the mush – especially the bodily mush we all experience, the fluids or substances that cross over the thresholds of the body – are particularly liable to being considered dangerous.</p>
<p>This was really for me a profound opening into how one thinks about borders of all kinds. Douglas makes it very clear that you cannot separate bodily borders from societal borders.</p>
<p>We mentioned, of course, Trump and the border. The border became more of a metaphor than a reality… I mean, there are people at the border, yes. But in the right-wing drama that was being acted out, what was important was the idea of sealing border from dark intruders. And this relates to purity concerns, but also to intense anxieties about sexual encounters, about fear of an encroaching Other, and the threat to borders created by gender rights that erode the male/female binary by bleeding and leaking across that border – and then, as I’m sure we’ll discuss later, a terror of human origin inside another person.</p>
<p>And it’s funny because Mary Douglas does not focus on birth in Purity and Danger. Birth is the most profound and dramatic border crossing imaginable, right?</p>
<p><strong>JULIENNE VAN LOON:</strong> Yes.</p>
<p><strong>SIRI HUSTVEDT:</strong> We all do it! [Laughter] We don’t remember [being born], but we all do it! And yet Douglas doesn’t treat birth separately as maybe the most fundamental cultural event to be codified. The beginning of life outside. Scholarship and Western philosophy and Western science have suppressed the realities of gestation and birth in ways that just flabbergast me.</p>
<p><strong>JULIENNE VAN LOON:</strong> Your concern with that suppression comes through as a key theme in Mothers, Fathers and Others. It’s a profound absence from the serious scientific and philosophical literature, isn’t it?</p>
<p><strong>SIRI HUSTVEDT:</strong> Yes, it’s what’s forgotten. And what’s forgotten turns out, for me anyway, to play a huge role in how to think about Western culture. </p>
<p>I’m really obsessed with omission as a key to understanding what has gone wrong. I’m working on a novel, but I’m hoping to write a book about the placenta after it’s finished, a non-fiction book.</p>
<hr>
<figure class="align-center ">
<img alt="An embryo with umbilical cord" src="https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445018/original/file-20220208-19-hdr0yw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">I’m hoping to write a book about the placenta, says Siri Hustvedt.</span>
</figcaption>
</figure>
<h2>‘Umbilical phantoms’: why Freud and other thinkers missed obvious birth metaphors</h2>
<p>Hustvedt goes on to describe the way the suppression of gestation and birth has prevented key players in psychoanalysis – Freud, Winnicott, Bion – from seeing (and therefore naming) images and metaphors that are placental or gestational in nature.</p>
<p>She begins by talking about <a href="https://www.oxfordreference.com/view/10.1093/oi/authority.20110803095829728">Freud’s famous observation of the “fort/da”</a> or “here/gone” game played by his 18-month-old grandson. He observed the child playing with a piece of string attached to a cotton reel, throwing it from his cot and calling “oh” when he could no longer see it, and then “ah” when it re-appeared. In in his essay <a href="https://www.freud.org.uk/2020/05/12/beyond-the-pleasure-principle-a-virtual-reading-experience/">“Beyond the Pleasure Principle”</a> (1920), Freud interpreted the game as a fantasy about control.</p>
<p>If you visualise the game for even a moment, Hustvedt points out, the placental connection becomes obvious. The string!</p>
<hr>
<p><strong>JULIENNE VAN LOON:</strong> … the umbilical cord!</p>
<p><strong>SIRI HUSTVEDT:</strong> Exactly.</p>
<p><strong>JULIENNE VAN LOON:</strong> That’s beautiful.</p>
<figure class="align-center ">
<img alt="Images of the placenta and umbilical cord." src="https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445006/original/file-20220208-18-1xi7etm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Louise Bourgeois: an unfolding portrait (MOMA exhibition)</span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<h2>Interdependence, natural cycles and human connection</h2>
<p>Hustvedt’s growing interest in gestation and the placenta got me thinking about the notion of nourishment – and the work of political philosopher Corine Pelluchon, whose book <a href="https://www.bloomsbury.com/uk/nourishment-9781350073876/">Nourishment</a> I have <a href="https://www.griffithreview.com/articles/asking-the-relevant-questions/">written about</a>.</p>
<p>For Pelluchon, hunger is central, because the decisions we make about how to maintain our own life and support the lives of others come back to it. Pelluchon sees hunger as “the originary site of ethics”. If we follow this line of thinking, we can see that the ecology we depend on – from basic material needs like water and shelter to people - depends on us in turn to maintain it. </p>
<p>Pelluchon argues that our political order needs to be reorganised to better recognise both vulnerability and interdependence.</p>
<hr>
<p><strong>SIRI HUSTVEDT:</strong> Many people who are looking at ecological models now are theorising the fact that we’re all porous and interdependent beings. [That is, we are not self-contained individuals with firm boundaries between ourselves and other forms of life.] Finding food is vital, so is our reproductive drive, our sexual drive, but we also need to breathe, a passive need dependent on the outside.</p>
<p>Another thing I’m deeply interested in is the rhythmic reality of human existence in relation to the rhythmical “out there”. We have circadian rhythms; we have a heartbeat. There’s the menstrual cycle during fertility for women. There’s breathing, but there’s also the rhythm of night and day and the pull of the tides. All of these must be recognised as part of the processes of our temporal existence, which gets covered over, too. We have an essentialist, static way of looking at the world as a bunch of fixed things. I prefer cyclical time to biographic time. We die, but others are born from us and the world moves on.</p>
<p>Speaking of nourishment again, what does the placental cord deliver? It delivers maternal nourishment, and essential hormones to the foetus, removes waste, keeps the maternal and foetal blood systems separate and orchestrates cell exchange during pregnancy. The more scientists find out about this organ, the weirder it gets. The cellular exchange creates chimeras of both mother and foetus during pregnancy. </p>
<hr>
<p>A <a href="https://www.britannica.com/science/chimera-genetics">chimera</a> is a single organism or tissue made up from cells containing more than one set of DNA.</p>
<p>“<a href="https://www.britannica.com/topic/Chimera-Greek-mythology">In Greek mythology</a>, a chimera is a fire-breathing she-monster … a mix, a blend … a terrifying animal,” Hustvedt writes, “because it involves mixing.” </p>
<hr>
<figure class="align-center ">
<img alt="Older woman dressed in black, smiling mischievously." src="https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445039/original/file-20220208-25-174839b.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Louise Bourgeois, Robert Mapplethorpe, 1982. (Tate London)</span>
</figcaption>
</figure>
<p><strong>SIRI HUSTVEDT:</strong> This is every pregnancy, and it’s typical of scientists that the old way of thinking about [cell traffic] was that they were leaks and accidents because the ideal is a sealed border.</p>
<p>After a normal birth, the placenta is delivered after the infant, and the placenta dies. The role that the placenta played as mediator inside the body of the mother is over. Its job is done. And what takes its place? Social space.</p>
<figure class="align-center ">
<img alt="Newborn baby on its mother's body." src="https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444999/original/file-20220208-19-vuebeh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Western philosophy and Western science have really supressed the realities of gestation and birth in ways that just flabbergast me, says Siri Hustvedt.</span>
</figcaption>
</figure>
<p>And that social space is one of feeding, holding, rocking, comforting, but also, crucially, of playing. Infants who can’t play are infants who will not thrive. They can die.</p>
<p><strong>JULIENNE VAN LOON:</strong> Absolutely. And adults too, right? Because play in that social space – the space between – is a lifelong essential. These ideas really come through in your essay “Both-And”. </p>
<hr>
<h2>Louise Bourgeois: wit, neuroses and ‘the yuck factor’</h2>
<p>“Both-And” explores the work of French-American visual artist, <a href="https://www.theguardian.com/books/2007/oct/06/art">Louise Bourgeois</a>, whose etching, titled Self-portrait, is reproduced on the cover of Mothers, Fathers and Others.</p>
<hr>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-i-could-go-anywhere-id-revisit-maman-louise-bourgeois-9-metre-spider-at-londons-tate-modern-157859">If I could go anywhere: I'd revisit Maman, Louise Bourgeois' 9-metre spider at London's Tate Modern</a>
</strong>
</em>
</p>
<hr>
<p><strong>SIRI HUSTVEDT:</strong> What has annoyed me with the way Bourgeois has been written about by critics is that many of them turn her into someone who is less playful, less satirical, someone who has less fun and is less smart than she is.</p>
<p>A woman artist is never considered as ironic or as intelligent as a male artist. Bourgeois’s work [is so often understood as] autobiographical – and it is, of course, but if it were only that, it would be very different. She directly takes on what I call the yuck factor – bodily mess and blur. (This goes back to Mary Douglas.) But Bourgeois is so witty that she uses this theme as a form of armour. And she’s funny. She’s dead serious too, but everyone [in the critical commentary] emphasises the depths of her neuroses, depression and agony. That’s not all there is.</p>
<p><strong>JULIENNE VAN LOON:</strong> It’s fascinating to see the way her ideas circulate and are received. And this is what I found interesting when I was writing The Thinking Woman, in terms of the women whose work I was looking at. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=944&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=944&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=944&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1186&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1186&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447680/original/file-20220221-20-n8f8ch.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1186&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">goodreads</span></span>
</figcaption>
</figure>
<p>I was reading their work [including yours] and at the same time reading its critical reception over time. And you get this really clear sense of the gendered nature of the way [women’s] work is received. I think so often we vaguely notice aspects of gendered critique in passing. We sort of see little bits and pieces, but we don’t often have the opportunity to put the whole narrative together.</p>
<p><strong>SIRI HUSTVEDT:</strong> A lot of the gendered response is unconscious, implicit forms of prejudice that appear in the criticism. There are overtly hostile responses too, but I’m not sure even those critics know why they’re so angry. </p>
<p><strong>JULIENNE VAN LOON:</strong> This reminds me of another line from “Both-And”. You write: “Perception is conservative.” What do you mean? </p>
<h2>Perception, prejudice and the story of feminism</h2>
<p><strong>SIRI HUSTVEDT:</strong> It’s an idea currently popular in the neuroscience community. </p>
<p>The brain is a predictive organ. The idea is that through past experience, experiences codified in us through repetition become “priors” that shape our present perception. Most of this is below our awareness. Only when we discover errors in those expectations because they are not borne out are we forced to change our predictions.</p>
<p>We live in a townhouse. We’ve lived here for 25 or 26 years. One of the light switches is on the wrong side in our living room. It’s an old house. It used to be lit by gas. I cannot tell you how many thousands of times I have reached with the wrong hand to turn on that damn light switch. Because the architectural convention is coded in my body. I reach for what isn’t there. In order to do it right, we have to become conscious of it. This simple example suggests scientists are on the right track to think about prediction as important to perceptual habits.</p>
<p>This relates to prejudice too. If all perception is biased by what’s happened in the past then it helps to explain why it’s so damned hard for people to undo their prejudices. Whether it’s about gender, so-called race, religion or disability. Take your pick. </p>
<p>You have to become conscious of the light switch – or your own tendencies to typecast, say, in racist or sexist ways to combat automatic gestures or feelings. And that’s why bias is not dependent on the social identity of a person. People who identify as women harbour biases against a woman who runs for political office, for example. The social code that ambition is repugnant in women has become an embodied reality.</p>
<p><strong>JULIENNE VAN LOON:</strong> Contemplating this notion that perception is inherently conservative, how do we make change possible on a grand scale? The story of feminism in the West over the last 50 years is in some ways hard to feel positive about. I sometimes think I’m so disappointed that we’ve made so little progress or we’ve gone backwards at times. I think we have to be so patient and so constant in this project of consciousness raising, with a relentless putting back on the table of the topic of prejudice – including race, including sexuality.</p>
<p><strong>SIRI HUSTVEDT:</strong> Yes, the biases are omnipresent. We also need to combat the idea that we’re always making progress. It’s complete nonsense.</p>
<p><strong>JULIENNE VAN LOON:</strong> Absolutely.</p>
<p><strong>SIRI HUSTVEDT:</strong> The notion is a legacy of 19th-century positivism. The world has never worked like that.</p>
<figure class="align-center ">
<img alt="body organs like a bunch of flowers" src="https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=994&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=994&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=994&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1249&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1249&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445009/original/file-20220208-16-sye84f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1249&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">From Louise Bourgeois: An Unfolding Portrait (MOMA exhibition)</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dwhartwig/38687842894">Daniel Hartwig/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<h2>Political turmoil, writing as activism and the sinister science of eugenics</h2>
<p>I asked Siri if she was conscious of a more overtly political turn in her recent writing.</p>
<hr>
<figure class="align-center ">
<img alt="Bettmann/CORBIS" src="https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445002/original/file-20220208-19-1qzr3r0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">07 May 1970, Kent, Ohio, USA — Anti-war demonstrators at Kent State University run as National Guardsmen fire tear gas and bullets into the crowd. — Image by © Bettmann/CORBIS.</span>
<span class="attribution"><span class="source">https://www.flickr.com/photos/97930879@N02/10501033583</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p><strong>SIRI HUSTVEDT:</strong> My writing has become more urgently political. I was politically active as a teenager, during another period of political crisis. I was born in 1955, and I was 15 when Kent State happened. </p>
<hr>
<p>In 1970 a group of Kent State University students peacefully protesting the expansion of the Vietnam War into Cambodia were fired upon by the Ohio National Guard. Four students were killed.</p>
<hr>
<p>I already opposed the Vietnam War. I marched against it. I became a feminist young. That’s when I first read Kate Millett’s <a href="http://cup.columbia.edu/book/sexual-politics/9780231174251">Sexual Politics</a>and Simone de Beauvoir’s <a href="https://www.penguin.com.au/books/the-second-sex-9780099595731">The Second Sex</a>.</p>
<p>Yes, looking authoritarianism in the face, listening to racist, misogynistic, anti-immigrant rhetoric was like hearing Goebbels again, and it has lit a fire under my butt. When Trump was still president and running for re-election, my husband and I and several others started an organisation, Writers Against Trump, now called <a href="https://www.writersfordemocraticaction.org/">Writers for Democratic Action</a>. And in whatever way we can, we’re trying to mobilise writers to write political pieces and get out the vote.</p>
<p><strong>JULIENNE VAN LOON:</strong> Has living through this period changed your thinking about what fiction can do?</p>
<p><strong>SIRI HUSTVEDT:</strong> I’m trying to write a novel now. It’s a political novel. It’s a weird political novel. But yes, I think I’ve been galvanised. </p>
<p>For several years, I’ve been researching the history of race science, eugenics, and behavioural genetics that constitute what I regard as a single history. I think that history is ongoing. It is linked to statistics, big data, and the popular notion of the gene as the determinant factor in our lives. This is bad biology but potent ideology.</p>
<p>The new version of scientific racism and sexism looks a little different, but it is something we should be really worried about.</p>
<p><em>This is the first in an occasional series of conversations between writers and thinkers.</em></p><img src="https://counter.theconversation.com/content/176464/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julienne van Loon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
On International Women’s Day, two women writers discuss feminism, writing in the age of Trump and Covid – and being ‘flabbergasted’ by the absence of birth from Western art and philosophy.
Julienne van Loon, Associate Professor, Writing and Publishing, School of Media & Communication, RMIT University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/163195
2021-07-07T15:04:07Z
2021-07-07T15:04:07Z
Nigeria’s #ENDSARS protests: a window into how creative art can be an act of therapy
<figure><img src="https://images.theconversation.com/files/409862/original/file-20210706-19-1i1m42l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protesters march at Alausa Secretariat in Ikeja, Lagos State, in October 2020.</span> <span class="attribution"><span class="source">Photo by Olukayode Jaiyeola/NurPhoto via Getty Images</span></span></figcaption></figure><p>Recent disturbing events in different regions of the world poignantly reveal how the creative arts can contribute to making sense of difficult situations and stressful times. This is particularly true of performance art. </p>
<p>Performance art provides ways of seeing, thinking, expressing and mindfulness. It highlights the idea that human beings, regardless of race, class or gender, have creative forces within them.</p>
<p>In African societies, including Nigeria, the use of the creative arts as political tools of assertion in crises is not new. This includes dance, music, art and drama.</p>
<p>For example, in colonial Nigeria, the famous <a href="https://www.blackpast.org/global-african-history/aba-womens-riots-november-december-1929/#:%7E:text=Thousands%20of%20Igbo%20women%20organized,the%20history%20of%20the%20colony.">Aba Women’s riot of 1929</a> is still a reference point. Tens of thousands of <a href="https://www.historians.org/teaching-and-learning/teaching-resources-for-historians/teaching-and-learning-in-the-digital-age/through-the-lens-of-history-biafra-nigeria-the-west-and-the-world/the-colonial-and-pre-colonial-eras-in-nigeria/the-womens-market-rebellion-of-1929">militant</a>, resilient, scantily clad or nude women engaged with a highly charged protest dance. They forced the colonial government to change its system of governance in southeastern Nigeria.</p>
<p>Prominent Nigerian historian <a href="https://www.jstor.org/stable/41971233">Adiele Afigbo</a> described the women’s protest as “one of the most telling poems of resistance against colonial hegemony”. Nigerian women became politically visible to an extent that has never been repeated.</p>
<p>More recently <a href="https://theconversation.com/young-nigerians-rise-up-to-demand-a-different-kind-of-freedom-148105">Nigeria’s #ENDSARS</a> in October 2020 represented a similar example of public protest as art.</p>
<p>Many Nigerians see their country as a failing state. This is due to the steady downhill slide of the economy and vanishing resources, dilapidated social amenities, massive unemployment, violence, insurgencies, <a href="https://theconversation.com/nigerias-poverty-profile-is-grim-its-time-to-move-beyond-handouts-163302">mounting poverty</a> and police brutality. It also includes the highhandedness of those in power. </p>
<p>Young Nigerian youths dared bullets and machine guns and took over public spaces to assert their right to a better life. For weeks, in a unified social body, they peacefully contained the “danced” protests. </p>
<p>One can view #ENDSARS as exquisitely organised politically motivated protests, fuelled and sustained by creative art making. Not many have investigated it as an event which has made a unique contribution to the understanding and study of non-verbal psychotherapy as an emerging field of study in Nigeria.</p>
<h2>Creative art therapies</h2>
<p>In 2015, at the Institute of African Studies, University of Ibadan I successfully defended the first clinical trial experimental research in <a href="https://punchng.com/why-im-advocating-dance-as-treatment-for-mental-illness-nigerian-scholar-gladys-akunna/">dance and movement therapy</a> as an aspect of creative arts therapy in Nigeria. My research tested and validated the effectiveness of dance and movement therapy treatment in adult inpatients suffering from schizophrenia and depression. </p>
<p>The subjects in the research learnt to trust and use art as a tool to connect to themselves. They were able to get quantifiable levels of improvement in health. </p>
<p>Similarly, Nigerians in the #ENDSARS protests intuitively embraced improvised art making for the release of pain and anguish, and for mustering strength for survival. </p>
<p>The popular adopted slogan for the protests was <em>sorosoke</em>, a Yoruba word which translates as “speak up”. Apart from its political connotation, it was also a group therapy engagement.</p>
<p>The therapeutic space of this event lasted a few weeks. During this time millions of Nigerians in large groups performed for their mental health.</p>
<p>Nigeria’s heavily burdened and impoverished population has been <a href="https://www.youtube.com/watch?v=uJoyjIWxNeU">publicly branded</a> as “lazy” and good-for-nothing citizens with no goals or aspirations. </p>
<p>But through their many united voices and bodies they became powerful and they found voice. Hence the importance of the slogan <em>sorosoke</em>.</p>
<p>Experts in the field of mental health agree that to have a voice is as much a part of daily living as it is of therapy. It signifies self-awareness and active agency and participation in staying healthy and productive.</p>
<h2>Artmaking and the search of mental health in #ENDSARS</h2>
<p>At the turn of the 20th century, and building on earlier research, the neurologist Sigmund Freud founded <a href="https://books.google.com/books/about/Introductory_Lectures_on_Psychoanalysis.html?id=Sfz0l6WSqFgC">psychoanalysis</a> – or the talking therapy – as a medical breakthrough in traditional psychotherapy. His approach has since become a vital aspect of the fields of psychiatry and mental health. </p>
<p>Freud also founded other significant theories including the theory of sublimation.</p>
<p>As a theory, sublimation is central to <a href="http://research.gold.ac.uk/id/eprint/15030">psychoanalytic theory</a> about the arts. </p>
<p><a href="https://literariness.org/2016/04/16/freudian-psychoanalysis/">Freud’s analysis</a> of literal and visual narratives of great artists was based on psychological nuances and influences of consciousness and beingness. To him, the subjective domains were symbolic communication of libidinal drive or fulfilment of these desires. </p>
<p>Beyond this, it was his critical evaluations of the experience of unconscious conflicts and their expression through the process of sublimation that laid the foundation on which the <a href="https://psycnet.apa.org/record/2009-12112-000">psychoanalytical study of art and the artist</a> evolved.</p>
<p>For Freud, and countless other examples, including those in Nigeria, the channelling and communication of stored painful memories can be released through a work of art – a socially acceptable form of creativity. </p>
<p>Equally significant is the symbolic form – or aesthetic appearance – of the work of art which meaningfully camouflages the hideous elements of consciousness, yielding some measure of beauty, enjoyment and appreciation. </p>
<p>For instance, as an art, dance is a specific, precise, intricately organised creative activity. It is pervaded by ideals of universality and inclusive sociality that evoke emotional and aesthetic appeal and response.</p>
<p>The #ENDSARS protests are a good example of this. They incorporated and presented potent, meaningful visual, verbal, non-verbal art displays and an overall visual quality. These yielded some measure of pleasure to both the performers and spectators. These powerfully interactive and meaningful performances were densely psychotherapeutic in form and content. </p>
<p>The protests rejected the irrational continual denial of the tragic realities in Nigeria’s socio-political landscape. Rather it was a creative way for the battered bodies and minds of Nigerians to confront their harsh, unfriendly environment. </p>
<p>And it paved the way for healing, vitality and a new vista of productive life.</p>
<p>This therapeutic goal was monstrously cut short by the Lekki Toll Gate <a href="https://www.cfr.org/blog/nigerias-lekki-toll-gate-massacre-will-not-go-away">massacre</a>. This inflated the frightful circles of mental illness and exposed hurting Nigerians in need of psychotherapy to brutal violence.</p><img src="https://counter.theconversation.com/content/163195/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gladys Ijeoma Akunna does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The protests paved the way for healing, vitality and a new vista of productive life.
Gladys Ijeoma Akunna, Visiting Scholar, Department of Creative Arts Therapies, Drexel University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/138152
2020-06-03T16:15:31Z
2020-06-03T16:15:31Z
Social psychiatry could stem the rising tide of mental illness
<p>Nearly 400 million people are affected by mental illness, according to the <a href="https://www.who.int/en/news-room/fact-sheets/detail/mental-disorders">World Health Organization</a>. Depression, alone, afflicts nearly 300 million people. It is no surprise that <a href="https://publichealthmatters.blog.gov.uk/2019/10/10/prioritising-mental-health/">concern about mental health</a> is sky high. But what should we do about it? </p>
<p><a href="https://www.time-to-change.org.uk/blog/talking-about-mental-health-will-lessen-stigma">Talking helps</a>, but it isn’t enough. We need to focus on prevention. This means identifying the factors that contribute to mental illness and tackling them. A good place to start is <a href="https://www.nature.com/articles/palcomms201624">social psychiatry</a>.</p>
<p>Social psychiatry was a preventive approach to mental health that was highly influential in the US after the second world war. It focused on identifying the social factors believed to cause mental illness. These included poverty, inequality and social exclusion. It was also an interdisciplinary approach. Psychiatrists worked closely with social scientists, especially sociologists and anthropologists, to determine the relationship between society and mental illness. </p>
<p>The roots of social psychiatry can be traced back to the <a href="https://books.google.co.uk/books/about/Mental_Hygiene_and_Psychiatry_in_Modern.html?id=UPX5t1C3GDsC&redir_esc=y">mental hygiene</a> and <a href="https://books.google.co.uk/books?hl=en&lr=&id=lH5ECgAAQBAJ&oi=fnd&pg=PP1&dq=%22child+guidance%22+history&ots=1PFHseS4Mt&sig=2t5AE7sjcE6MMKxqBWvHNSW8qXc&redir_esc=y#v=onepage&q=%22child%20guidance%22%20history&f=false">child guidance</a> movements of the early 20th century. Both mental hygiene and child guidance emphasised prevention and the role of the social environment. They also introduced new mental health professionals, including <a href="https://www.cambridge.org/core/journals/medical-history/article/often-there-is-a-good-deal-to-be-done-but-socially-rather-than-medically-the-psychiatric-social-worker-as-social-therapist-194570/94FED5E893EF4005E54027ACCF702905">psychiatric social worker</a>, in order to tackle mental illness.</p>
<p>Social psychiatry became even more influential because it was supported by a strong research base. It benefited enormously from the blossoming of social science during the 1920s and 1930s. But it also relied on the willingness of psychiatrists to listen to social scientists.</p>
<p>Indeed, the first significant social psychiatric research was done by sociologists. These were Robert Faris and H. Warren Dunham of the <a href="https://books.google.co.uk/books?hl=en&lr=&id=qD63DwAAQBAJ&oi=fnd&pg=PT9&dq=%22chicago+school%22+sociology&ots=KVN957WrZT&sig=GG2aLhNsVnnNwI8GCAHDET29ojs&redir_esc=y#v=onepage&q=%22chicago%20school%22%20sociology&f=false">Chicago School</a>. Their book, <a href="https://psycnet.apa.org/record/1939-01453-000">Mental Disorders in Urban Areas</a> (1939) established a link between poverty and mental illness.</p>
<p>Faris and Dunham analysed 30,000 hospital admissions in Chicago and used <a href="http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?printer=Y&conceptID=1170">maps</a> to demonstrate how different disorders were associated with different parts of the city. For example, paranoid schizophrenia was associated with people living in “Hobohemia”, which fringed the central business district. </p>
<p>Hobohemia residents were often homeless, resorting to stealing, begging and charity. As well as being extremely poor, Hobohemians lived “unstable” lives. Their transient and anonymous existence isolated them socially. It could also render their personality “confused, frustrated, and chaotic”.</p>
<p>Faris and Dunham summed it up neatly: “Although spending their time in the most crowded parts of the city, these homeless men are actually extremely isolated.” Other studies would show similar paradoxes.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/335710/original/file-20200518-83363-1r26iqo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/335710/original/file-20200518-83363-1r26iqo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=966&fit=crop&dpr=1 600w, https://images.theconversation.com/files/335710/original/file-20200518-83363-1r26iqo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=966&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/335710/original/file-20200518-83363-1r26iqo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=966&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/335710/original/file-20200518-83363-1r26iqo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1214&fit=crop&dpr=1 754w, https://images.theconversation.com/files/335710/original/file-20200518-83363-1r26iqo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1214&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/335710/original/file-20200518-83363-1r26iqo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1214&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rates of schizophrenia in Chicago.</span>
<span class="attribution"><span class="source">University of Manitoba</span></span>
</figcaption>
</figure>
<p>While paranoid schizophrenia was most common in Hobohemia, catatonic schizophrenia was found in poor areas with higher numbers of foreign immigrants and African Americans. Manic depression, in contrast, was found in somewhat wealthier areas.</p>
<p>The pair’s findings were <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.46.8.978">replicated</a> in other American cities. But some argued that the “<a href="https://link.springer.com/article/10.1007/BF02262736">downward drift</a>” of the mentally ill to poor neighbourhoods explained their results.</p>
<p>Faris and Dunham disagreed. They argued that the parents of patients in poor districts rarely came from more wealthy backgrounds. They also claimed that younger patients had not had time to “drift” downwards.</p>
<p>Troubled people with mental health problems do “drift” to poorer areas. And poor neighbourhoods are <a href="https://www.cambridge.org/core/journals/urban-history/article/remembering-the-west-end-social-science-mental-health-and-the-american-urban-environment-19391968/905174667AA7108B4E76D5F253C6FD3A">not always bad for mental health</a>. But Faris and Dunham’s study showed that poverty, combined with stress, chaos and isolation, was likely to lead to poor mental health.</p>
<p>Chicago during the 1930s was a fairly new city. It had experienced rapid growth, buoyed by Eastern European immigrants and African American migrants. The next city researched by social psychiatrists was very different.</p>
<p>New Haven, Connecticut traced its roots to 1638 when it was founded by English Puritans. It was also much smaller than Chicago. Its entrenched class structure was the focus of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994199/">Social Class and Mental Illness</a>, by August Hollingshead and Fritz Redlich. </p>
<p>Hollingshead, a sociologist, and Redlich, a psychiatrist, were a truly interdisciplinary team. Their book began memorably: “Americans prefer to avoid the two facts of life studied in this book: social class and mental illness.”</p>
<p>The pair divided New Haven into five class divisions. Class one consisted of “Proper New Haveners”, the wealthy elite. These people’s ancestors had lived in New Haven since the 1600s.</p>
<p>People in class five were “lower class slum dwellers”, and had low-skilled, often transient, occupations. While some of them were immigrants from Europe and Quebec, others were so-called <a href="https://newengland.com/today/living/humor/swamp-yankee/">swamp Yankees</a>. Swamp Yankees had existed on the fringes of New Haven society for centuries.</p>
<p>Hollingshead and Redlich’s analysis of class and mental health revealed stark inequities. People from class five were three times as likely to be treated for mental illness than classes one and two combined. This was despite the fact that many people in class five lacked access to psychiatric treatment and were not included in the figures.</p>
<p>Also, patients in the lower classes were more likely to receive invasive, somatic therapies. These included drugs, <a href="https://journals.sagepub.com/doi/abs/10.1177/0957154X9700802908?casa_token=kLPZfhKbpnoAAAAA:-pjf8icMQAuuby36ts_QxZkYUBjxKIt8gwy2k-g5mCYjpwkrV7QovDE_tOc8GNKAaZ2IjwTM4Oxz">electroshock therapy</a> and <a href="https://www.bcmj.org/mds-be/brief-reflection-not-so-brief-history-lobotomy">lobotomy</a>. Patients from higher classes were more likely to receive psychoanalysis.</p>
<p>Along with poverty and inequality, social psychiatrists implicated social isolation in mental illness. One study that addressed social isolation examined rural Nova Scotia in Canada. Led by psychiatrist and anthropologist Alexander Leighton, <a href="https://www.ncbi.nlm.nih.gov/pubmed/10883707">the Stirling County Study</a> found that social isolation led to depression and anxiety.</p>
<p>But social isolation was also a problem in cities. <a href="https://books.google.co.uk/books/about/Mental_health_in_the_metropolis_the_Midt.html?id=BBHbAAAAMAAJ&redir_esc=y">Mental Health in the Metropolis</a> (1962) first gained notoriety for reporting that only 19% of New Yorkers had good mental health. But its main finding was that social isolation mattered as much in cities as in rural areas.</p>
<p>The Midtown Manhattan Study conducted two-hour interviews with 1,660 white residents of the Upper East Side, aged 20-59. It found that better mental health was correlated with higher socioeconomic status. But “the loneliness, the isolation, the lostness … of urban life” was also problematic.</p>
<p>Identifying the social factors involved in mental illness was one thing. Prescribing a solution was another.</p>
<h2>An ounce of prevention</h2>
<p>Social psychiatry showed how poverty, inequality and social isolation impaired mental health. But was there any political will in the US to do anything?</p>
<p>For a short time following the second world war, there was. That’s because – as with today – there was intense concern about mental health during these years. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2089086/">The US military</a> was among the first to raise the alarm.</p>
<p>When it entered the second world war, the US military was determined to reduce the number of psychiatric casualties. They were particularly eager to prevent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176276/">shell shock</a>, which had emerged as a major problem during the first world war. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/IWHbF5jGJY0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The effects of shell shock.</span></figcaption>
</figure>
<p>Their initial approach was to screen out recruits who were thought to be mentally vulnerable. Using methods devised by psychiatrist Henry Stack Sullivan, the US military rejected <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2089086/">12% of recruits</a> – two million men – on psychiatric grounds. It’s worth noting, however, that some of these recruits were <a href="https://academic.oup.com/jhmas/article-abstract/62/4/461/734198?redirectedFrom=fulltext">probably homosexual</a> – then regarded as a mental disorder.</p>
<p>The two million rejections hinted that mental illness was more prevalent than previously thought. And, despite screening, there were <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2089086/">one million psychiatric hospital admissions</a> of US military personnel. </p>
<p>Mental illness, therefore, was in the spotlight after the second world war. And prevention quickly became central to how it was to be tackled. </p>
<p>Prominent psychiatrist William Menninger said in 1947 that prevention promised “unlimited opportunity” and could provide psychiatrists with the equivalent of a “vaccination”. The focus on prevention gave the impetus to social psychiatry.</p>
<p>Social psychiatry was buoyed by the creation of the National Institute for Mental Health (NIMH) in 1949. NIMH’s early focus was on prevention, and it funded many social psychiatry studies. It also funded the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1551089/">Joint Commission on Mental Illness and Health</a>, which stressed the role of prevention.</p>
<p>But the biggest boost for social psychiatry came from the very top. Inspired by <a href="https://www.jfklibrary.org/learn/about-jfk/the-kennedy-family/rosemary-kennedy">personal tragedy</a>, a <a href="https://millercenter.org/president/kennedy/domestic-affairs">progressive agenda</a> and the 600,000 Americans in asylums, President John F Kennedy became a proponent of prevention. </p>
<p>In February 1963, Kennedy stressed the role of prevention in a <a href="https://www.presidency.ucsb.edu/documents/special-message-the-congress-mental-illness-and-mental-retardation">speech to Congress</a>. Americans “must seek out the causes of mental illness and of mental retardation and eradicate them”. In psychiatry, “an ounce of prevention was worth more than a pound of cure”.</p>
<p>By “causes” Kennedy meant “harsh environmental conditions”. But the primary solution he recommended did not address these conditions. Instead, he proposed creating a national network of <a href="https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.51.5.616">community mental health centres</a> (CMHCs) to replace the asylum system.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/337598/original/file-20200526-106848-1o64dg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/337598/original/file-20200526-106848-1o64dg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=605&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337598/original/file-20200526-106848-1o64dg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=605&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337598/original/file-20200526-106848-1o64dg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=605&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337598/original/file-20200526-106848-1o64dg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=761&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337598/original/file-20200526-106848-1o64dg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=761&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337598/original/file-20200526-106848-1o64dg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=761&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">John F Kennedy signing the Community Mental Health Act.</span>
<span class="attribution"><span class="source">wikipedia</span></span>
</figcaption>
</figure>
<p><a href="https://www.jfklibrary.org/asset-viewer/archives/JFKPOF/047/JFKPOF-047-045">Funding</a> was provided for the construction of 789 CMHCs. They were staffed by psychiatrists, social workers, psychologists and sometimes mental health aides from the local community.</p>
<p>The <a href="https://books.google.co.uk/books/about/Deinstitutionalisation_and_After.html?id=2jWgDQAAQBAJ&redir_esc=y">shift to community mental healthcare</a> was revolutionary. It ended the asylum era and helped reduce the stigma of mental illness. But it was not without <a href="https://journals.sagepub.com/doi/full/10.2466/16.02.13.CP.2.2">problems</a>.</p>
<h2>The fall of social psychiatry</h2>
<p>CMHCs were also meant to be preventive. But by 1970, few of their activities were focused on prevention. Instead, most of their efforts were spent on treating the chronically mentally ill.</p>
<p>This backwards step symbolised a broader malaise within social psychiatry. Within five years of Kennedy’s speech, hopes for a preventive approach to psychiatry were flagging. Problems were emerging both within social psychiatry and in the broader political context.</p>
<p>By 1968, the political sands were <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2016/05/25/how-did-the-1968-election-change-u-s-politics-so-dramatically-this-new-book-explains/">shifting to the right</a>. Kennedy’s successor, <a href="https://www.whitehouse.gov/about-the-white-house/presidents/lyndon-b-johnson/">Lyndon Johnson</a>, decided not to seek re-election. Republican <a href="https://www.whitehouse.gov/about-the-white-house/presidents/richard-m-nixon/">Richard Nixon</a> went on to defeat Democrat Hubert Humphrey.</p>
<p>The post-war economic boom that fuelled Kennedy’s New Frontier and Johnson’s <a href="https://www.washingtonpost.com/wp-srv/special/national/great-society-at-50/">Great Society</a> programmes was also ebbing. As John Gardner, secretary of health, education and welfare, <a href="https://www.tandfonline.com/doi/abs/10.1080/00031305.1968.10480432?journalCode=utas20">stated in 1968</a>, there was “a crunch between expectations and resources”. The Vietnam War also distracted from domestic policy.</p>
<p>Internally, social psychiatry was also at an impasse. Many large studies had been conducted. But many argued that more research was needed to cement the link between social factors and mental illness.</p>
<p>There were also debates about what action should be taken. Urban renewal proved to be a sticking point. Some argued that slum clearances would result in better mental health. But others, including sociologist Herbert Gans, argued that such neighbourhoods were not all bad. </p>
<p>Gans’ book <a href="https://books.google.co.uk/books?id=qEu4AwAAQBAJ&dq=%22urban+villagers%22+mental+health&source=gbs_navlinks_s">The Urban Villagers</a> studied the Italian community in <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/905174667AA7108B4E76D5F253C6FD3A/S0963926817000025a.pdf/remembering_the_west_end_social_science_mental_health_and_the_american_urban_environment_19391968.pdf">Boston’s West End</a>, which was cleared during the late 1950s. After spending eight months conducting participant observation, he concluded that the state of the West End did not justify clearance. Middle-class, educated urban planners had mistakenly interpreted it as a hopeless slum when – from the perspective of its residents – it was a functional and valued neighbourhood.</p>
<p>Others debated the extent to which radical change was needed. Harry Brickman, who led community mental health in California, wondered where the <a href="https://www.nature.com/articles/palcomms201624">balance</a> should be set between “ultra-safe” and “daring”, “more ambitious” approaches. Was mental health merely providing clinical services? Or was it about creating a more humane and emotionally healthy community?</p>
<p>For Matthew Dumont, who worked for NIMH on urban mental health, <a href="https://books.google.co.uk/books/about/The_Absurd_Healer.html?id=0CYlAAAAMAAJ&redir_esc=y">the answer was clear</a>. What was required was “a redistribution of the wealth and resources of this country on a scale that has never been imagined”. Not all <a href="https://pureportal.strath.ac.uk/en/datasets/social-psychiatry-oral-history-interviews">social psychiatrists</a> agreed with such bold statements, however.</p>
<p>And social psychiatry was only <a href="https://academic.oup.com/shm/article/21/3/541/1701613">one of many approaches</a> within psychiatry. On the one hand were more traditional approaches. These included psychoanalysis and biological psychiatry.</p>
<p>Both psychoanalysis and biological psychiatry focused on treatment, rather than prevention. Whereas psychoanalysts provided psychotherapy, biological psychiatrists emphasised the prescription of drugs.</p>
<h2>Caught in the middle</h2>
<p>On the other hand, some approaches were arguably more radical than social psychiatry. These included <a href="https://academic.oup.com/shm/article-abstract/27/1/104/1707848">radical psychiatry</a> and <a href="https://academic.oup.com/shm/article/33/2/622/5187392">antipsychiatry</a>. </p>
<p>Both radical psychiatry and antipsychiatry critiqued the notion of mental illness itself. Mental illness, to some, was an <a href="https://thepsychologist.bps.org.uk/volume-20/edition-7/agents-social-control">instrument of social control</a>. Or it was <a href="https://psychclassics.yorku.ca/Szasz/myth.htm">merely a myth</a>.</p>
<p>In this way, social psychiatry was caught in the middle. It was more radical than psychoanalysis and biological psychiatry. But it also conceded ground – and possible supporters – to more radical approaches.</p>
<p>In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders was published. <a href="https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm">DSM-III</a>, the American “psychiatric bible” signified a new focus on diagnosis and treatment. DSM-III showed that social psychiatry’s time was long gone. The emphasis on prevention declined with it.</p>
<p>Instead, biological psychiatry was in the ascendancy. It emphasised neurological, rather than social, explanations for mental illness. Drug treatment, rather than prevention, came to dominate.</p>
<p>The shift to biological explanations was accompanied by a focus on individuals, at the expense of the population. Instead of improving population mental health, the focus was on diagnosing Americans with an <a href="https://books.google.co.uk/books/about/Making_Us_Crazy.html?id=u6zuAAAAMAAJ&redir_esc=y">increasing list of mental disorders</a>. Most of these disorders were <a href="https://psycnet.apa.org/record/1998-07526-000">treated with drugs</a>.</p>
<p>During the past few years, however, concerns about rising rates of mental illness have put prevention <a href="https://www.mentalhealth.org.uk/a-to-z/p/prevention-and-mental-health">back on the agenda</a>. Although social factors – especially in light of COVID-19 – have been mentioned, there is not enough discussion of policy changes that could make a difference. This was also a problem during the heyday of social psychiatry.</p>
<p>My research on social psychiatry has convinced me that introducing <a href="https://basicincome.org/basic-income/">universal basic income</a> could <a href="https://theconversation.com/universal-basic-income-could-improve-the-nations-mental-health-123816">improve mental health</a>. But other progressive policies, ranging from reducing the working week to ensuring we all have ample time to commune with nature, could also make a difference.</p>
<p>The history of social psychiatry compels mental health professionals, charities and policymakers to put prevention at the heart of mental health policy. Doing so would reduce mental illness, but also help us all enjoy life a bit more.</p><img src="https://counter.theconversation.com/content/138152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Smith has received funding from the AHRC. </span></em></p>
Social psychiatry has fallen from favour. It’s time to revisit it.
Matthew Smith, Professor in Health History, University of Strathclyde
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/105758
2018-12-18T11:10:45Z
2018-12-18T11:10:45Z
The problem with using psychoanalysis on children
<figure><img src="https://images.theconversation.com/files/250969/original/file-20181217-181905-bwlz18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p><a href="https://www.bbc.co.uk/news/education-45760476">Children with problems or problem children</a>? That is the question often asked by parents and teachers alike. If a child is naughty in school, are they a “bad” child or are they facing mental ill health? </p>
<p>Most analysis focuses on <a href="https://www.telegraph.co.uk/education/educationnews/9173533/Bad-behaviour-in-schools-fuelled-by-over-indulgent-parents.html">children being the problem</a> – a highly individualistic take which resonates with Sigmund Freud’s theory of psychoanalysis. This is a theory which dates back <a href="https://www.psychologistworld.com/psychologists/sigmund-freud">well over a hundred years</a>, with strong roots in focusing on childhood problems influencing adult behaviour. </p>
<p>Psychoanalysis developed over the course the 20th century, and although the approach has been <a href="https://io9.gizmodo.com/why-freud-still-matters-when-he-was-wrong-about-almost-1055800815">dismissed by many</a>, we live in a society where there is still an obsession with “psychoanalysing” children. This inevitably labels children as a problem rather than recognising the problems that affect wider society. </p>
<h2>What drives behaviour?</h2>
<p>Psychoanalysis specifically relates to Freud’s own school of thought, which believes a person’s behaviour is determined by early childhood experiences. According to Freud, a person has instinctive drives within the unconscious that influences their behaviour – unconscious material can be found in dreams and unintentional behaviour. </p>
<p>Freud’s focus was on specific sexual stages of development that influence our personalities as we develop in life. At the oral stage of development for example, (from birth to one year) Freud implied that oral stimulation could lead to an “oral fixation” in later life – such as sucking your thumb in times of stress. </p>
<p>Psychoanalysts believe that therapeutic interventions can bring the effects of this unconscious material into consciousness with the aim of resolving these issues. </p>
<h2>Questioning Freud</h2>
<p>Freud’s psychoanalytical theory, and other versions of psychoanalysis, are problematic for so many reasons. For a start, Freud’s theories are based on the “unconscious mind”, which is difficult to define and test. There is no scientific evidence for the “unconscious mind”. And it would be difficult to say who would be qualified to make assumptions about this when nobody really knows what the unconscious mind is. </p>
<p>For children, this means teachers, social workers, nurses, psychiatrists and other professionals make assumptions about them based only on their present behaviour – and without considering any wider social issues. This makes psychoanalysis ignorant of difference and diversity, and over-generalised. Particularly so when directed at young children – given that personality and behaviour can change over the course of someone’s life. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/250976/original/file-20181217-185255-ixmb3t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/250976/original/file-20181217-185255-ixmb3t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250976/original/file-20181217-185255-ixmb3t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250976/original/file-20181217-185255-ixmb3t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250976/original/file-20181217-185255-ixmb3t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250976/original/file-20181217-185255-ixmb3t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250976/original/file-20181217-185255-ixmb3t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s no such thing as a ‘good’ or ‘bad’ child.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Research also shows that “naughty” behaviour in schools can be because <a href="https://www.bbc.co.uk/news/education-44568019">children lack aspirations and a drive to do well</a>. This can stem from many factors such as low self-esteem and high anxiety – as well as <a href="https://www.jrf.org.uk/sites/default/files/jrf/migrated/files/2123.pdf">growing up in a low income household</a>. Children who are in care, children with disabilities and children from Afro-Caribbean backgrounds are also more likely to be excluded from mainstream school <a href="https://www.theguardian.com/teacher-network/2015/feb/18/permanent-exclusion-disruptive-students">if they live in deprived areas</a>. </p>
<h2>Stop blaming children</h2>
<p>It is relatively easy to criticise the use of psychoanalysis, particularly when people are “psychoanalysing” without understanding what it is or isn’t. In this sense, Freud and the general idea of psychoanalysis has become a part of our language – and our analysis of trying to make sense of human behaviour. </p>
<p>And this is not without reason. Freud’s theories still play a role in the teaching and learning of many counsellors, psychologists and psychiatrists today, <a href="https://www.theguardian.com/science/2016/jan/07/therapy-wars-revenge-of-freud-cognitive-behavioural-therapy">despite facing much criticism since its inception</a>. Indeed, many types of therapies emerged post-Freud – including <a href="https://www.theguardian.com/science/2016/jan/07/therapy-wars-revenge-of-freud-cognitive-behavioural-therapy">transpersonal therapy</a> which is a more humanistic take on therapy – and many people have benefited enormously from these approaches.</p>
<p>But ultimately, the problem with psychoanalysis is that the focus is still primarily on the individual being the problem. And in the case of children, to keep focusing on them as the problem, while ignoring wider, social problems is dangerous. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/250977/original/file-20181217-185261-ht68c2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/250977/original/file-20181217-185261-ht68c2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250977/original/file-20181217-185261-ht68c2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250977/original/file-20181217-185261-ht68c2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250977/original/file-20181217-185261-ht68c2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250977/original/file-20181217-185261-ht68c2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250977/original/file-20181217-185261-ht68c2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Labelling a child as a ‘problem’ from a young age can have detrimental consequences.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Psychoanalysis does also not fully acknowledge <a href="https://www.huffingtonpost.co.uk/entry/labelling-in-education-supportive-or-stigmatising_uk_5a6ca38fe4b006be66080f17?guccounter=1&guce_referrer_us=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvLnVrLw&guce_referrer_cs=3uXXr6jCM2izbx0F8b-UDw">the power of labelling</a> and stereotyping that takes place within schools and in other aspects of a child’s life. It is almost like there is reassurance in focusing on a “problematic” child because there is always a box to tick, which might provide some idea of the “problem” and then result in a resolution. </p>
<p>But it is impossible to do this properly while ignoring the major issues children face in their world. This includes a lack of resources due to high poverty rates, alongside the increasing levels of <a href="https://www.theguardian.com/education/2018/jan/23/children-young-three-self-harm-mental-health">mental health issues such as self-harm</a>. Individuality can of course not be ignored but neither can the wider social problems that children face. This is important because ultimately it is these external factors that have the power to really influence the mental health and well-being of children.</p><img src="https://counter.theconversation.com/content/105758/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Richards does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Why psychoanalysis and children shouldn’t mix.
Michael Richards, Lecturer in Applied Health and Social Care, Edge Hill University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/94210
2018-04-17T07:44:51Z
2018-04-17T07:44:51Z
France’s autism problem – and its roots in psychoanalysis
<p>France has a problem with autism. The country’s highest administrative court <a href="http://www.lefigaro.fr/actualite-france/2018/01/25/01016-20180125ARTFIG00088-autisme-un-rapport-accablant-de-la-cour-des-comptes.php">estimates</a> that there are 700,000 autistic people in France. However, only 75,000 are diagnosed. Autistic children have historically been <a href="http://journals.sagepub.com/doi/abs/10.1177/1362361309354756">diagnosed later in France</a> than in neighbouring countries. They have often been <a href="https://search.coe.int/cm/Pages/result_details.aspx?ObjectID=09000016805c8e97">excluded from mainstream education</a> and <a href="https://rm.coe.int/ref/CommDH(2015)1">lacked access</a> to support services and extracurricular activities. </p>
<p>Many French autists are confined to day hospitals and live-in institutions, isolated from the community and frequently unable to communicate through speech – whereas in the US, for example, public schools are <a href="https://www.publicschoolreview.com/blog/autistic-children-and-public-schools">required by law to fully include autistic children</a> in mainstream classroom education. For years, families in northeast France have taken autistic children to Belgium, to access its superior services.</p>
<p>The French government recognises these shortcomings. It was forced to do so in 2004 by a combination of domestic campaign groups and international pressure: the Council of Europe <a href="https://www.coe.int/en/web/turin-european-social-charter/processed-complaints/-/asset_publisher/5GEFkJmH2bYG/content/no-13-2002-international-association-autism-europe-iaae-v-france?inheritRedirect=false">judged</a> France’s autism provisions to be in breach of the European Social Charter. This judgement has been repeated in several <a href="https://search.coe.int/cm/Pages/result_details.aspx?ObjectID=09000016805c8e97">subsequent cases</a>. In 2016, the UN Committee on the Rights of the Child <a href="http://www.refworld.org/docid/56c17fb64.html">also worried</a> that French autists “continue to be subjected to widespread violations of their rights” to education and support. </p>
<p>The response has been a series of “Plans Autisme”, so-called “Marshall Plans” directing investment towards improving outcomes. The latest such plan – the fourth – <a href="https://www.theguardian.com/world/2018/apr/06/france-to-unveil-340m-plan-to-improve-rights-of-people-with-autism">was launched</a> in early April by the French president, Emmanuel Macron, and will run until 2022. It seeks to recruit thousands of teaching assistants to enable autistic children to attend mainstream schools, as well as facilitating more diagnoses. Yet its very existence demonstrates that the results of the previous three plans were disappointing. </p>
<h2>The force of psychoanalysis</h2>
<p>Why has France lagged behind? The <a href="https://www.theguardian.com/world/2018/feb/08/france-is-50-years-behind-the-state-scandal-of-french-autism-treatment">blame appears</a> to rest with the dominant influence of psychoanalysis over French psychiatry in recent decades. Many psychoanalysts argue that autism is not a neuro-developmental disorder with, as is now globally accepted, a <a href="https://www.nature.com/articles/4001896">high degree of genetic heritability</a>. Rather, they see it as a psychologically-generated condition originating in a disturbed family environment – specifically, problems in the child’s relationship to its mother. </p>
<p>As analyst Charles Melman, a proponent of these views, put it in <a href="http://www.letelegramme.fr/france/autisme-un-plan-catastrophique-21-02-2014-10045201.php">a 2014 interview</a>, an autistic child:</p>
<blockquote>
<p>Has suffered from something very simple. His mother … has not been able to transmit the feeling that his birth was a gift to her … the prosody of the maternal discourse plays a role in the development of autism. </p>
</blockquote>
<p>Historically, many psychoanalysts – notably in the postwar US – have seen autism as a form of psychosis, or “childhood schizophrenia”. Such analysts advocated psychoanalytic psychotherapy as the main form of intervention, rather than the behavioural and communication-focused strategies which have <a href="https://www.tandfonline.com/doi/pdf/10.1080/15374416.2015.1077448">an increasingly strong evidence base</a> today.</p>
<p>Since the 1990s, change in France has been led by <a href="https://link.springer.com/referenceworkentry/10.1007%2F978-1-4614-4788-7_153">organisations formed by parents</a>, incensed that the medical profession appeared to be blaming them for their children’s condition.</p>
<p>The campaign group Vaincre l'Autisme <a href="http://vivrefm.com/infos/lire/1772/appel-a-manifester-contre-la-psychanalyse">staged a series of demonstrations</a> in 2012-13 denouncing psychoanalytic autism treatment. A 2011 documentary, <a href="https://www.dragonbleutv.com/documentaires/2-le-mur-ou-la-psychanalyse-a-l-epreuve-de-l-autisme">Le Mur</a>, attacked the psychoanalytic approach to autism, causing controversy when three psychoanalysts brought a lawsuit, and <a href="http://www.lemonde.fr/culture/article/2014/01/16/le-mur-la-psychanalyse-a-l-epreuve-de-l-autisme-a-nouveau-libre-de-diffusion_4349630_3246.html">temporarily succeeded in banning the film</a>. However, the case was overturned on appeal in 2014 – an indicator of the waning power of the French psychoanalytic lobby. </p>
<p>Increasingly, there is broad political agreement in France that psychoanalytic approaches to autism are discredited. A <a href="https://www.sciencesetavenir.fr/sante/la-france-en-retard-en-matiere-d-autisme-va-annoncer-un-nouveau-plan_122690">recent statement</a> by the minister responsible for the new plan, Sophie Cluzel, that France needs to “put science back into the heart of autism policy” comes in this context. </p>
<p>As a historian of ideas, I am interested in how France reached this point. The intellectual and cultural prominence of psychoanalysis in France since 1968 is unusual internationally. In the US, for example, psychoanalysis was definitively written out of the psychiatric manuals by the 1980s, when behavioural and communicative techniques emerged. Why didn’t France follow suit?</p>
<p>A recent <a href="https://www.independent.co.uk/news/long_reads/france-autism-treatment-care-support-french-healthcare-a8161416.html">article in The Independent</a> highlighted the importance of Jacques Lacan, the charismatic psychoanalytic theorist, and Bruno Bettelheim’s “<a href="https://en.wikipedia.org/wiki/Refrigerator_mother_theory">refrigerator mother</a>” theory, which postulated that autism was caused by a mother’s lack of emotional warmth. </p>
<p>Yet the impact of such thinkers only makes sense within a context in which psychoanalysis and psychoanalytic thinking had become deeply embedded in French culture. In France, psychoanalysis emerged strengthened from the cultural upheavals of the 1968 period – widely seen as a tool that could help “<a href="https://www.babelio.com/livres/Crozier-La-societe-bloquee/274979">unblock</a>” France from the perceived stuffy, regimented bureaucracy of its postwar period. Its influence accordingly spread out into many areas of French society. </p>
<h2>The impact of Françoise Dolto</h2>
<p>My research, for example, studies the impact of Françoise Dolto, a child psychoanalyst, who in the 1970s and 1980s attained a kind of “national treasure” status. Dolto had a <a href="http://www.ina.fr/audio/PHD99261777">hugely popular radio show</a> on the state broadcaster, France Inter, responding to members of the public who contacted her with child-rearing dilemmas. She launched a network of children’s centres, the <a href="http://maisonverte.org.uk/">Maison Verte</a>, partly staffed by psychoanalysts. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214493/original/file-20180412-536-dgkusa.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214493/original/file-20180412-536-dgkusa.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214493/original/file-20180412-536-dgkusa.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214493/original/file-20180412-536-dgkusa.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214493/original/file-20180412-536-dgkusa.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214493/original/file-20180412-536-dgkusa.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214493/original/file-20180412-536-dgkusa.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Françoise Dolto being interviewed in 1987.</span>
<span class="attribution"><a class="source" href="https://www.youtube.com/watch?v=zMRr4eOFM-U">Still from Apostrophes: Françoise Dolto répond à Bernard Pivot | Archive INA</a></span>
</figcaption>
</figure>
<p>She published over 40 books, in which she communicated psychoanalytic thinking to a broad audience, targeting mothers in particular. Her bestselling case study, <a href="https://booknode.com/le_cas_dominique_058007">Le cas Dominique</a> (or in English, <a href="https://books.google.co.uk/books/about/Dominique.html?id=fsDZAAAACAAJ&redir_esc=y">Dominique: Analysis of an Adolescent</a>), showed how “childhood psychosis” could result from the family environment. Books like this are still on the shelves of many French parents, grandparents and psychologists. Hundreds of schools and hospital wings in France are named after Dolto. </p>
<p>From this influential platform, Dolto claimed that childhood “regression” – autism and learning disabilities – was caused by pathogenic mothering. In <a href="https://books.google.co.uk/books/about/La_cause_des_enfants.html?id=BrrHkvi3kzIC&redir_esc=y">a 1985 book</a> she defined autism as “a reactive process of adaptation to an ordeal” in which the “affective or symbolic relationship with the mother” has been lost. Such arguments, combined with Dolto’s opposition to feminism, and assumption that it was preferable for a child’s development if its mother stayed at home, surely contributed to feelings of guilt among mothers of autistic children. Her work also buttressed later resistance by psychoanalysts to changing how autism is dealt with in France, since Dolto – the founding mother of French child psychoanalysis – was so clear on the point. </p>
<p>The autism issue shows that France’s unusual fascination with psychoanalysis, which Dolto’s career brings to the fore, has had real consequences. I don’t think its impact has been wholly negative. But where it has caused problems, as with autism, they have not proved simple to unravel.</p><img src="https://counter.theconversation.com/content/94210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Bates receives funding from the Arts and Humanities Research Council. </span></em></p>
France has launched a new autism plan – but why does the country lag behind in its provisions for the condition?
Richard Bates, Postdoctoral Research Fellow, Department of History, University of Nottingham
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/86497
2017-11-16T09:56:07Z
2017-11-16T09:56:07Z
Why Freud was right about hysteria
<figure><img src="https://images.theconversation.com/files/194238/original/file-20171112-29345-14j52jy.jpg?ixlib=rb-1.1.0&rect=1%2C39%2C1059%2C625&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sigmund Freud.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=5234443">Max Halberstadt/Wikimedia Commons</a></span></figcaption></figure><p>A 35-year-old woman loses the use of her legs, suddenly becoming paralysed from the waist down. In another case, a woman feels an overwhelming compulsion to close her eyes, until eventually she cannot open them at all. After numerous tests, nothing physically wrong was found with these patients, so what caused their symptoms? </p>
<p>Conditions like these used to be diagnosed as hysteria. In fact, they would fit neatly into the pages of Sigmund Freud and Josef Breuer’s <a href="https://en.wikipedia.org/wiki/Studies_on_Hysteria">Studies On Hysteria</a>, written over a century ago. </p>
<p>You might think our understanding has advanced since Freud, or, rather more fashionably, that Freud was just wrong. But this isn’t the case. </p>
<p>The term hysteria was dropped when the influence of a psychodynamic theory of mental ill health, with its concepts of unconscious mental forces affecting behaviour, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695775/">fell out of favour</a> in psychiatry. But while they turned to more measurable features and symptoms, the condition remains in what is now called “conversions disorder”.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=870&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=870&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=870&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1093&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1093&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1093&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Josef Breuer, co-author of Studies On Hysteria.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=2547712">Albrecht Hirschmüller/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>It was Freud who proposed that the memory of trauma which the patient fails to confront, because it will cause them too much mental anguish, can be <a href="https://www.penguin.co.uk/books/1034856/complete-psychological-works-of-sigmund-freud-the-vol-1/">“converted” into physical symptoms</a>. What is more surprising is that cases like this are typical of those routinely seen by neurologists today. </p>
<p>For example, the case of the 35-year-old woman (Ely), noted above, is given in Gordon Turnbull’s <a href="https://www.penguin.co.uk/books/1082467/trauma/">Trauma</a>, a book on the history and treatment of post-traumatic stress disorder. After X-rays for a bleed in Ely’s spinal cord came back negative, Turnbull tried a lumber puncture to extract fluid. Ely didn’t even wince as the needle went in. She seemed indifferent to her sudden paralysis. The nurses thought she was putting it on. </p>
<p>Perplexed, Turnbull’s mind “suddenly jumped to Freud”, who he recalls said that mental conflict could become physical disability. </p>
<p>On interviewing Ely, he eventually discovered that she had been raped by someone she knew. This caused the unbearable mental conflict that was “converted” into her physical symptoms. She evidently knew this, but had pushed its significance out of her conscious awareness to protect herself. She found that talking her experiences through repeatedly was cathartic – her pent up feelings were released. Two days later, she was able to leave the hospital, unaided.</p>
<p>The woman (Mary) who felt compelled to shut her eyes is one of many cases described by the neurologist Suzanne O’Sullivan in <a href="https://penguinrandomhouse.ca/search?search=suzanne%20o%27sullivan%20it%27s%20all%20in%20your%20head">It’s All In Your Head</a>. Her husband was on remand for child abuse, but she refused to think this might be an important factor in her illness. Treated with muscle relaxant drugs, she soon recovered. But a month later, she was readmitted, suffering from amnesia. Brain scans and an EEG were normal, but a neighbour told O’Sullivan that her husband had been released from prison. O’Sullivan is left wondering what this patient “could not bear to look upon” or “tolerate to remember”. </p>
<p>Despite the many new technical means of investigation, researchers have very little to offer beyond Freud to account for how psychological and emotional experiences manifest in physical symptoms. O’Sullivan writes that:</p>
<blockquote>
<p>… for all the shortcomings in the concepts proposed by Freud and Breuer in Studies, the 21st century has brought no great advances to a better understanding of the mechanisms for this disorder. </p>
</blockquote>
<h2>Publicly acknowledged, at last</h2>
<p>This is acknowledged more publicly now. For example, the neurologist Richard Kanaan in BBC Radio 4’s All In The Mind <a href="http://www.bbc.co.uk/programmes/b01681ky">states</a> that Freud still “looms quite large in our repertoire of explanations”. In fact, it would be a very small repertoire if you excluded Freud. </p>
<p>Since we can use sophisticated medical testing, we now know that it is not the neurological “hardware” that is damaged, so it must be the “software”, our psychological response to the meaning of trauma, that leads to conversion disorder. </p>
<p>Freud originally studied anatomy and neurology and wrote notable papers, some of which are still considered classics today, such as On Aphasia. But it was the limitations inherent in the brain sciences of his day that led him to develop a more psychological map of the mind. </p>
<p>In a radical departure from the practice of the day, which either paraded hysterical patients around at public demonstrations – as the French neurologist, Jean-Martin Charcot did – or treated them as malingerers, Freud sat his patients down and listened attentively to them. After ten years of this practice, Freud came to believe that behind every hysterical symptom, such as convulsions, paralysis, blindness, epilepsy, amnesia or pain, lay a hidden trauma or series of traumas. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Charcot demonstrating hypnosis on a hysterical patient.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=3820726">André Brouillet/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>In his many case examples, Freud carefully traces these initially hidden traumas. His accounts in Studies On Hysteria would still make exemplary reading for those working with conversion disorder patients today who also deserve to be listened to. </p>
<p>While conversion disorder has attracted suspiciously little academic attention, what research has been done tends to confirm Freud. </p>
<p>In 2016, researchers <a href="https://www.kcl.ac.uk/ioppn/news/records/2016/July/New-study-examines-Freuds-theory-of-Hysteria.aspx">discovered</a> that patients with conversion disorder had experienced a greater number of stressful life events than other people, and a dramatic increase in these events near to the time when their symptoms began. </p>
<p>This profile fits many of the cases described by Freud in Studies On Hysteria. For example, Katherina’s breathing difficulties and visions of a frightening face staring at her, came on after witnessing her father sexually abuse her cousin. The research also found that in some patients no stressors were identified, but one wonders if this is only because few researchers can replicate Freud’s skillful picking up of clues in his patients’ “free associations”? </p>
<p>Freud’s brilliance was in recognising that disturbing memories don’t just go away. His compassion lives to this day in the method he established for bringing them to light and reducing their negative and sometimes debilitating effects: psychoanalysis.</p><img src="https://counter.theconversation.com/content/86497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Nicholson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Sigmund Freud understood that mental conflict could become physical disability.
Chris Nicholson, Deputy Head of Department of Psychosocial and Psychoanalytic Studies, University of Essex
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/81674
2017-08-04T04:35:08Z
2017-08-04T04:35:08Z
The Goldwater rule prevents psychiatrists diagnosing Trump from afar but some say there’s too much at stake
<p>In the late 19th century, Sigmund Freud’s colleague Wilhelm Fleiss successfully diagnosed an illness in one of Freud’s relatives, without even having met them. Freud was so impressed by Fleiss’s “<a href="https://www.amazon.com/Freud-Surgery-Surgeons-Paul-Stepansky/dp/0881632899">diagnostic acumen</a>” that he went on to advocate the method in certain circumstances.</p>
<p>Freud would write that diagnosing someone without personally examining them was acceptable where the features of certain disorders, such as paranoid schizophrenia (then known as <em>dementia paranoides</em>), made the interview process counterproductive. Here, <a href="https://books.google.com.au/books?id=0b8m3UKieUcC&pg=PA84&lpg=PA84&dq=a+written+report+or+a+printed+case+history+can+take+the+place+of+personal+acquaintance+with+the+patient&source=bl&ots=yykz_qKyvr&sig=Ymkhlc59l1hb55TLoZycjQElPxQ&hl=en&sa=X&ved=0ahUKEwidpLCJpbLVAhUBLJQKHeElDtkQ6AEIKDAA#v=onepage&q=a%20written%20report%20or%20a%20printed%20case%20history%20can%20take%20the%20place%20of%20personal%20acquaintance%20with%20the%20patient&f=false">Freud noted</a> that “a written report or a printed case history can take the place of personal acquaintance with the patient”.</p>
<p>Now, a controversial debate about the ethics of <a href="https://books.google.com.au/books?id=SR5j5BpH2zAC&pg=PT13&lpg=PT13&dq=stepansky+freud&source=bl&ots=Mw_gSYCtVj&sig=IjpCnUaFCtp-Tm4Pb0OXdJ378cQ&hl=en&sa=X&ved=0ahUKEwjAgc2n7bTVAhUJS7wKHe8aBEYQ6AEIMzAD#v=onepage&q=%20distance&f=false">diagnosis at a distance</a> or <a href="https://www.psychologytoday.com/blog/impromptu-man/201608/the-real-story-behind-the-goldwater-rule">long-distance diagnosis</a> has arisen in the US. It has come about as commentators have proposed that President Donald Trump suffers from <a href="http://www.americanthinker.com/articles/2016/03/donald_trump_and_narcissistic_personality_disorder_an_interview_with_sam_vaknin.html">narcissistic personality disorder</a> <a href="https://qz.com/852187/coping-with-chaos-in-the-white-house/">(NPD)</a> and attention deficit hyperactivity disorder (<a href="https://medium.com/@geoffpilkington/donald-trump-and-the-mysteries-of-adhd-639ec8ac47b8">ADHD</a>), among other conditions.</p>
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Read more:
<a href="https://theconversation.com/the-appeal-of-narcissistic-leaders-is-also-their-downfall-49398">The appeal of narcissistic leaders is also their downfall</a>
</strong>
</em>
</p>
<hr>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/180652/original/file-20170802-11408-1bh3n42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180652/original/file-20170802-11408-1bh3n42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/180652/original/file-20170802-11408-1bh3n42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180652/original/file-20170802-11408-1bh3n42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180652/original/file-20170802-11408-1bh3n42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180652/original/file-20170802-11408-1bh3n42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180652/original/file-20170802-11408-1bh3n42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180652/original/file-20170802-11408-1bh3n42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sigmund Freud believed diagnosing people without examining them was appropriate in some circumstances.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/e/e9/Sigmund_Freud_1926.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Health professionals have weighed in as well. Psychotherapist and former assistant professor of psychiatry John D. Gartner has been particularly vehement in his <a href="https://www.usnews.com/news/the-report/articles/2017-01-27/does-donald-trumps-personality-make-him-dangerous">assessment of the President</a>. Gartner asserts that Trump suffers from malignant narcissism, a specific manifestation of NPD. </p>
<p>According to the DSM-5 — the <a href="http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">authoritative psychiatric manual</a> — this condition is characterised by various “traits of antagonism”, including “manipulativeness, deceitfulness, [and] callousness”. </p>
<p>Notably, the DSM-5 names the condition only once throughout its hundreds of pages; and some <a href="https://ccgt.nl/teksten/malignantnarcissism.pdf">academic psychiatrists</a> say the disorder is understudied and its features largely unsettled, with no treatment yet established. </p>
<p>Despite this, Gartner is <a href="https://www.usnews.com/news/the-report/articles/2017-01-27/does-donald-trumps-personality-make-him-dangerous">convinced</a> that the president’s conduct fulfils the criteria of malignant narcissism — even without having interviewed him:</p>
<blockquote>
<p>We’ve seen enough public behaviour by Donald Trump now that we can make this diagnosis indisputably.</p>
</blockquote>
<p>Recently, the American Psychoanalytic Association (<a href="http://www.apsa.org/">APsaA</a>) issued a <a href="http://www.apsa.org/sites/default/files/Harriet_Associaiton_email_July_6_17.pdf">memo to its more than 3,500 members</a>, advising they were “free to comment about political figures as individuals”, and that the APsaA did not regard “political commentary by its individual members an ethical matter”.</p>
<p>By contrast, the American Psychiatric Association (<a href="https://www.psychiatry.org/">APA</a>) has long maintained a <a href="https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2017/03/apa-remains-committed-to-supporting-goldwater-rule">strict ethical stance</a> on the open discussion of public figures’ mental states. Enshrined in the so-called Goldwater rule, the APA’s prescription cautions psychiatrists against diagnosis at a distance. </p>
<p>As former APA President Herbert Sacks <a href="http://psychnews.org/pnews/98-02-20/pres.html">put it</a>, psychiatrists should avoid engaging in “psychobabble”, especially when it comes to politicians. He said that, when “reported by the media”, such diagnostic speculation only “undermines psychiatry as a science”.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/180500/original/file-20170801-22136-8ewtke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180500/original/file-20170801-22136-8ewtke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/180500/original/file-20170801-22136-8ewtke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=797&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180500/original/file-20170801-22136-8ewtke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=797&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180500/original/file-20170801-22136-8ewtke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=797&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180500/original/file-20170801-22136-8ewtke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1002&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180500/original/file-20170801-22136-8ewtke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1002&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180500/original/file-20170801-22136-8ewtke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1002&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Goldwater rule is named after former Republican presidential nominee Barry Goldwater, who was defeated in the 1964 election.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/3/3f/Barry_Goldwater_photo1962_%283x4%29.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Although the Goldwater rule is not enshrined in Australian law, a <a href="https://www.ranzcp.org/Files/Resources/College_Statements/Practice_Guidelines/code_ethics_2010-pdf.aspx">code of ethics</a> provides guidance to Australian psychiatrists about their conduct in the media.</p>
<h2>What is the Goldwater rule?</h2>
<p>The Goldwater rule is named after an incident involving Republican presidential nominee Barry Goldwater. Having been defeated in the 1964 US election, Goldwater sued the editor of the short-lived political magazine “Fact” for defamation. </p>
<p>Just one month before the election, Fact’s front page had printed a controversial declaration: </p>
<blockquote>
<p>1,189 psychiatrists say Goldwater is psychologically unfit to be president!</p>
</blockquote>
<p>Fact had conducted a broad but clinically invalid survey, providing questionnaires to more than 12,000 psychiatrists whose details the magazine had obtained from the American Medical Association’s membership list. Of the 2,417 responses it received, some 1,189 psychiatrists asserted Goldwater was unfit for office. </p>
<p>In the feature article, Fact purported to <a href="https://readymag.com/flatfile/01-fact/7">quote many of the psychiatrists</a> it had surveyed, and used their words to suggest that Goldwater was a “megalomaniac, paranoid, and grossly psychotic”, and even suffering from “schizophrenia”.</p>
<p>In the trial that followed, Goldwater was awarded some <a href="https://readymag.com/flatfile/01-fact/7">US$75,000 in punitive damages</a> — enough to ensure that Fact never published another issue. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180314/original/file-20170731-728-1gj8ow9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180314/original/file-20170731-728-1gj8ow9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=774&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180314/original/file-20170731-728-1gj8ow9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=774&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180314/original/file-20170731-728-1gj8ow9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=774&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180314/original/file-20170731-728-1gj8ow9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=973&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180314/original/file-20170731-728-1gj8ow9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=973&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180314/original/file-20170731-728-1gj8ow9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=973&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fact magazine’s last issue, and the headline for which Goldwater sued.</span>
<span class="attribution"><span class="source">Courtesy FLAT File magazine at the Herb Lubalin Study Center, New York.</span></span>
</figcaption>
</figure>
<p><a href="http://law.justia.com/cases/federal/appellate-courts/F2/414/324/84727/">The ruling</a> raised disturbing questions for the APA, threatening not only the reputation of the psychiatric profession, but the future livelihoods of practitioners. In slightly different circumstances, a psychiatrist might face similar civil action, whether “<a href="http://jaapl.org/content/42/4/459">for invasion of privacy or defamation of character</a>”. </p>
<p>In 1973, some four years after the trial, the Goldwater rule was first published in the APA’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/11643545">professional ethical code</a>. In the <a href="https://www.psychiatry.org/psychiatrists/practice/ethics">most recent 2013 edition</a>, the rule reads as follows:</p>
<blockquote>
<p>On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. </p>
<p>However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.</p>
</blockquote>
<h2>The rule in dispute</h2>
<p>Many academic psychiatrists disagree with the rule. Some have suggested that breaking the Goldwater rule is ethical when it’s necessary to diagnose “<a href="https://www.healio.com/psychiatry/journals/psycann/2014-5-44-5/%7B77281d02-cbea-4f24-b5c3-250ec59f772f%7D/this-issue-justification-for-breaking-the-goldwater-rule-mass-murderers-diagnoses">mass murderers</a>” from afar, or when “the importance of the diagnosis of an individual … rise[s] to the level of a national threat”. </p>
<p>Others have <a href="https://www.ncbi.nlm.nih.gov/pubmed/27236179">criticised the rule</a> more generally, calling it “an excessive organisational response” to “an inflammatory and embarrassing moment for American psychiatry”. And one psychiatrist has recently described <a href="http://www.psychiatrictimes.com/blogs/couch-crisis/dealing-american-psychiatrys-gag-rule">the prescription</a> as “American society’s gag rule”.</p>
<p>In February this year, the New York Times published a <a href="http://www.lancedodes.com/new-york-times-letter">letter</a> signed by some 33 psychiatrists who blamed the rule for silencing them at this “critical time”. They wrote that “too much [was] at stake to be silent any longer”, and that Donald Trump’s “emotional instability” had made him “incapable of serving safely as president”.</p>
<p>The tension between the APA and its members, and between the APA and the APsaA, partly reflects the history of the two disciplines. Since the 1940s, psychiatry has increasingly focused on <a href="http://journals.sagepub.com/doi/full/10.1177/2156869313512211">medical interventions</a>, while tending to <a href="http://jamanetwork.com/journals/jamapsychiatry/article-abstract/1865001">neglect</a> the “in-depth talk therapies” which, despite their <a href="http://www.psychiatrictimes.com/psychotherapy/decline-psychotherapy">general decline</a>, remain central to the psychoanalytic method. </p>
<p>But the situation is still more complicated than this. After all, the methods of psychiatrists and psychoanalysts often overlap. In many practices, for instance, psychiatrists employ intuitive reasoning in the diagnostic process. </p>
<p>For some diagnosticians, the so-called “Praecox-Gefühl” or “<a href="http://pb.rcpsych.org/content/25/7/275">praecox feeling</a>” remains at the “<a href="https://www.ncbi.nlm.nih.gov/pubmed/16778451">clinical core</a>” of diagnosing schizophrenia, despite the method’s varied <a href="https://www.ncbi.nlm.nih.gov/pubmed/20639689">reliability</a>. First described in the 1940s, the praecox feeling is a complex, emotionally charged <a href="https://www.ncbi.nlm.nih.gov/pubmed/16778451">intuitive sense</a> that a psychiatrist sometimes gets when detecting the subtle symptoms of an emergent psychosis.</p>
<h2>What now for the Goldwater rule?</h2>
<p>That psychoanalysts may wish to distinguish themselves from psychiatrists on the Goldwater rule, and vice versa, is unsurprising. In countless ways — more than can be named here — <a href="https://www.ncbi.nlm.nih.gov/pubmed/6881395">psychoanalysts and psychiatrists adopt different views</a> of their roles in the diagnostic process. This is the result of their different training backgrounds, histories, and professional cultures. </p>
<p>Less expected, however, is the growing feeling among psychoanalysts and psychiatrists alike, that today, more than ever, the Goldwater rule should be set aside. While neither group may wish to admit it, the Trump era may have brought psychiatrists and psychoanalysts closer together — at least on this point.</p><img src="https://counter.theconversation.com/content/81674/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Rudge receives funding from the Australian Research Centre of Excellence for the History of Emotions.</span></em></p>
There’s a fierce debate about whether it’s ethical for mental health professionals to diagnose politicians they haven’t personally examined.
Christopher Rudge, Postdoctoral researcher, University of Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/61090
2016-08-12T03:40:26Z
2016-08-12T03:40:26Z
Explainer: what is psychoanalysis?
<figure><img src="https://images.theconversation.com/files/133873/original/image-20160812-11006-ni2dq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psychoanalysis is based on the belief our behaviours have an underlying cause from earlier in life. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Psychoanalysis or psychoanalytic psychotherapy is a way of treating longstanding psychological problems that is based on the belief behaviours have underlying drivers which may be unrecognised and unconscious. </p>
<p>With this understanding it’s possible to think about the meaning and reasons behind that behaviour and enable the possibility of change.</p>
<p>Although Freud’s <a href="https://books.google.com.au/books/about/Freud_Biologist_of_the_Mind.html?id=B7XcblnI620C&redir_esc=y">psychology of the mind</a> was premised on the existence of an unconscious, he was not the originator of the term. Seventeenth-century Western philosophers John Locke and René Descartes and, later, <a href="http://plato.stanford.edu/entries/leibniz-mind/">Gottfried Wilhelm Liebniz</a> grappled with the idea of an unconscious, <a href="http://www.richmond-philosophy.net/rjp/back_issues/rjp6_hill.pdf">speculating</a> the existence of something within the mind, beyond awareness, that also influenced behaviour. </p>
<h2>Reasons for seeking psychoanalytic treatment</h2>
<p>People seek psychoanalytic assistance for many reasons – patterns of failed or destructive relationships, work stress, depression or anxiety, personality disorders or issues around self-identity and sexuality. Some seek therapy after a significant loss, whether through death or divorce, or as a result of a traumatic event or abuse in childhood or adolescence.</p>
<p>People may see a psychoanalytic psychotherapist one or more times per week over months or years. A psychoanalyst may see someone four or five times a week. Consistent, regular appointments of 45 or 50 minutes enable over time the development of insight about patterns of thinking and behaviour and the way these affect the person in terms of their emotional state as well as relationships with partners, families, friends, work and the community. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/133874/original/image-20160812-12861-t6dj3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/133874/original/image-20160812-12861-t6dj3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/133874/original/image-20160812-12861-t6dj3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=964&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133874/original/image-20160812-12861-t6dj3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=964&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133874/original/image-20160812-12861-t6dj3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=964&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133874/original/image-20160812-12861-t6dj3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1212&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133874/original/image-20160812-12861-t6dj3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1212&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133874/original/image-20160812-12861-t6dj3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1212&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Although Freud is widely credited as developing the idea of an unconscious, he was not the originator of the term.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>In Australia, people who consult a psychoanalyst or psychoanalytic psychotherapist who is medically trained, either as a psychiatrist or other medical practitioner, are able to claim for sessions under Medicare on an ongoing basis. </p>
<p>People who are in therapy or analysis with non-medical practitioners may be able to claim up to ten consultations per calendar year under Medicare, depending on the therapist’s professional qualifications.</p>
<p><a href="http://www.apas.website/training/">Training</a> in psychoanalysis and psychoanalytic psychotherapy generally takes place over a period of at least five years. It is open to professionals from various disciplines such as psychiatry, general practice, psychology, social work and nursing.</p>
<p>The <a href="http://theppaa.com/training/">training includes a developmental perspective</a>, which considers the impact experiences in infancy and childhood may have on the individual in later life. </p>
<p>It involves theory, supervised clinical work and observation of an infant from birth for one year with accompanying seminars. All trainees undertake personal analysis or psychoanalytic psychotherapy for the duration of their training.</p>
<h2>The treatment process</h2>
<p>In a session, patients try to say all that comes to mind, allowing thoughts, feelings, memories and dreams to emerge. To enable this, some lie on a couch with the therapist sitting behind them; others sit face to face with the therapist. </p>
<p>In this confidential setting, and as trust develops, clues to the patient’s unconscious and internal world begin to form, and relationship patterns and avoidances become visible. </p>
<p>The analyst listens carefully to the patient’s reflections, dreams, memories and thoughts and tries to explore what they mean. </p>
<p>It is hoped the patient will develop insight into destructive life patterns and the way these were formed, and understand them as a response to their life events and relationships.</p>
<h2>Is it effective?</h2>
<p>There is considerable <a href="https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf">debate</a> about the effectiveness of psychoanalytic treatment. One problem is the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525087/">reluctance</a> of the psychoanalytic profession to recognise the value of formal research and evidence in the development of this work. Another is the difficulty of studying the treatment due to its long-term nature.</p>
<p>A <a href="https://theconversation.com/a-dangerous-method-in-defence-of-freuds-psychoanalysis-5989">2012 article</a> stated: </p>
<blockquote>
<p>… psychoanalysis is no longer recommended for treating mental illness due to a <a href="http://www.psychology.org.au/Assets/Files/Evidence-Based-Psychological-Interventions.pdf">lack of evidence</a>. A <a href="http://www.sciencedirect.com/science/article/pii/S0272735811001863">recently published review</a> was unable to find a single randomised controlled trial evaluating classic psychoanalysis and the evidence for long-term, ‘modern’ psychoanalysis was conflicting at best.</p>
</blockquote>
<p>However, since then studies with more <a href="http://psychoanalysis.org.uk/resources/evidence-base-of-psychoanalytic-psychotherapy">positive results</a> have been conducted and published.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/132708/original/image-20160802-17169-19agklz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/132708/original/image-20160802-17169-19agklz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132708/original/image-20160802-17169-19agklz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132708/original/image-20160802-17169-19agklz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132708/original/image-20160802-17169-19agklz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132708/original/image-20160802-17169-19agklz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132708/original/image-20160802-17169-19agklz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132708/original/image-20160802-17169-19agklz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The analyst listens to the patient’s reflections, dreams, memories and thoughts and tries to explore what they mean.</span>
<span class="attribution"><span class="source">from www.shutterstock.com.au</span></span>
</figcaption>
</figure>
<p>In 2015, <a href="http://onlinelibrary.wiley.com/doi/10.1002/wps.20267/abstract">the Tavistock Adult Depression Study</a> was published examining the effectiveness of psychoanalytic psychotherapy. The study used the random control trial model to examine the treatment of a cohort of patients diagnosed with long-standing major depression and who had failed at least two different treatments. </p>
<p>One group underwent psychoanalytic psychotherapy for two years; the other control group was treated with <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behavioural therapy</a> – where patients learn new ways to think and behave. </p>
<p>While the results were not significantly different between the two groups at the end of treatment, significant differences emerged during follow-up at 24, 30 and 42 months. Both observer-based and self-reported depression scores showed steeper declines in the psychoanalytic psychotherapy group, alongside greater improvements in how they coped socially, than in the cognitive behavioural therapy group. This suggests long-term psychoanalytic psychotherapy is useful in improving the long-term outcome of treatment-resistant depression.</p>
<p>A second <a href="http://onlinelibrary.wiley.com.ez.library.latrobe.edu.au/doi/10.1002/imhj.21553/abstract">study</a> led by the same author, published in 2016, looked at <a href="https://books.google.com.au/books/about/The_Practice_of_Psychoanalytic_Parent_In.html?id=Vz5s1y5JidMC&source=kp_cover&redir_esc=y">parent-infant psychoanalytic psychotherapy</a>, which aims to improve the interaction between parent and child. Participants were allocated randomly to parent-infant psychotherapy and to supportive primary care. </p>
<p>There was no significant difference in outcome on measures of infant development, parent–infant interaction or the ability of the parent to consider the baby’s mental state as well as their own. However, those who had received parent-infant psychotherapy showed improvements on several measures of maternal mental health, including parenting stress, and parental representations of the baby and their relationship. This suggested psychoanalytic psychotherapy has potential for improving the parent-infant relationship.</p>
<p>Critics of psychoanalysis have <a href="http://newsweekly.com.au/article.php?id=37">argued</a> against the length of treatment and that it is costly and thus the province of the “worried well” living in leafy middle-class suburbs. A patient seeking psychotherapy may not want nor require long-term treatment, seeking only to sort out a few matters. It may be that cognitive behavioural therapy or another therapy is the more appropriate option for a particular patient.</p>
<p>It is often not possible to sustain long-term psychoanalytic psychotherapy within the funding constraints of the public mental health and welfare system. More <a href="http://www.sfbta.org/about_sfbt.html">solution-focused</a> and <a href="http://www.bouverie.org.au/support-for-services/our-specialist-areas/specialist-area-single-session-therapy-sst-alternatively-referred-to-as-sin">single-session</a> therapies can be used with individuals and families in distress.</p>
<p>Psychoanalytic psychotherapy is not readily available in regional, rural and remote areas. While “<a href="https://books.google.com.au/books?id=BW4Z9oBqDKAC&pg=PA9&lpg=PA9&dq=Distance+Therapy+book&source=bl&ots=0vY9NmFdnb&sig=fWJNWZoL2rhsPZJhReNqo7Aa2sU&hl=en&sa=X&ved=0ahUKEwjIhOf0xafOAhWEmpQKHRyjA7IQ6AEIPTAF#v=onepage&q=Distance%20Therapy%20book&f=false">distance therapy</a>” is available via technologies such as Skype, Facetime, Zoom and telephone, this needs to be evaluated to see if it has the same effect as face-to-face therapy.</p><img src="https://counter.theconversation.com/content/61090/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Brett Vickers is a member of the Victorian Association of Psychoanalytic Psychotherapists and the Psychotherapy and Counsellors Federation of Australia. The views in this piece are entirely hers. </span></em></p>
Freud recognised the idea of an unconscious in his work in the late 1800s. He proposed physical symptoms often express deeply repressed conflicts and thoughts.
Christine Brett Vickers, Honorary Research Fellow in History, La Trobe University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/60869
2016-06-22T15:33:00Z
2016-06-22T15:33:00Z
Is psychology really in crisis?
<figure><img src="https://images.theconversation.com/files/127300/original/image-20160620-8861-ifipj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">I just can't seem to get my replication studies published.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=psychoanalysis&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=314294129">Photographee.eu/Shutterstock.com</a></span></figcaption></figure><p>Modern psychology is apparently in <a href="http://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-016-0135-2">crisis</a>. This claim is nothing new. From phrenology to psychoanalysis, psychology has traditionally had an uneasy scientific status. Indeed, the philosopher of science, Karl Popper, viewed Freud’s theories as a typical example of pseudoscience because no test could ever show them to be <a href="https://en.wikipedia.org/wiki/Falsifiability">false</a>. More recently, psychology has feasted on a banquet of extraordinary findings whose scientific credibility has also been questioned. </p>
<p>Some of these extraordinary findings include <a href="http://psycnet.apa.org/journals/psp/100/3/407/">Daryl Bem’s experiments</a>, published in 2011, that seem to show future events influence the past. Bem, an emeritus professor at Cornell University, revealed that people are more likely to remember a list of words if they practise them <em>after</em> a recall test, compared with practising them before the test. In another study, he showed that people are significantly better than chance at selecting which of two curtains hide a pornographic image. </p>
<p>Then there’s Yale’s John Bargh who in 1996 <a href="http://www.yale.edu/acmelab/articles/bargh_chen_burrows_1996.pdf">reported</a> that, when unconsciously primed with an “elderly stereotype” (by unscrambling jumbled sentences containing words such as “Florida” and “bingo”), people subsequently walk more slowly. Add to this Roy Baumeister who in 1998 presented <a href="https://bama.ua.edu/%7Esprentic/672%20Muraven%20%26%20Baumeister%202000.pdf">evidence</a> suggesting we have a finite store of will-power which is sapped whenever we resist temptations such as eating chocolates. Or, in the same year, <a href="http://psycnet.apa.org/psycinfo/1998-01060-003">Ap Dijksterhuis and Ad Van Knippenberg</a> showing that performance on Trivial Pursuit is better after people list typical characteristics of a professor rather than those of a football hooligan. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/127306/original/image-20160620-8867-ajehxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/127306/original/image-20160620-8867-ajehxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/127306/original/image-20160620-8867-ajehxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/127306/original/image-20160620-8867-ajehxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/127306/original/image-20160620-8867-ajehxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/127306/original/image-20160620-8867-ajehxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/127306/original/image-20160620-8867-ajehxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Does thinking about him really make you better at Trivial Pursuit?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=tN3OCDYxnajjaAjIbfrMCA&searchterm=professor&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=330576656">Dragon Images/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>These studies are among the <a href="http://digest.bps.org.uk/2014/09/the-10-most-controversial-psychology.html">most controversial</a> in psychology. Not least because other researchers have had difficulty replicating the experiments. These types of studies raise concerns about the methods psychologists use, but also more broadly about psychology itself. </p>
<h2>Do not repeat</h2>
<p>A survey of 1,500 scientists published in <a href="http://www.nature.com/news/1-500-scientists-lift-the-lid-on-reproducibility-1.19970?WT.mc_id=SFB_NNEWS_1508_RHBox">Nature</a> last month indicated that 24% of them said they had published a successful replication and 13% published an unsuccessful replication. Contrast this with over a century of psychology publications, where just <a href="http://pps.sagepub.com/content/7/6/537">1%</a> of papers attempted to replicate past findings. </p>
<p><a href="https://bmcpsychology.biomedcentral.com/articles/10.1186/2050-7283-1-2">Editors and reviewers</a> have been complicit in a systemic bias that has resulted in high-profile psychology journals becoming storehouses for the strange. Many psychologists are obsessed with the “impact factors” of journals (as are the journals) – and one way to increase impact is to publish curios. Certain high-impact journals have a reputation of publishing curios that never get replicated but which attract lots of attention for the author and journal. By contrast, confirming the findings of others through replication is unattractive, rare and relegated to less prestigious journals. </p>
<p>Despite psychology’s historical abandonment of replication, is the tide turning? This year, a crowd-sourced initiative – the <a href="http://science.sciencemag.org/content/349/6251/aac4716">OSC Reproducibility project</a> – attempted to replicate 100 published findings in psychology. The multinational collaborators replicated just over a third (36%) of the studies. Does this mean that psychological findings are unreliable? </p>
<p>Replication projects are selective, targeting studies that are cheaper and less technically complicated to replicate or those that are simply unbelievable. Other projects such as “<a href="http://econtent.hogrefe.com/doi/full/10.1027/1864-9335/a000178">Many Labs</a>” have reported a replication rate of 77%. All initiatives are non-random and headline replication rates reflect the studies that are sampled. Even if a random sample of studies were examined, we don’t know what would constitute an acceptable replication rate in psychology. This is not an issue specific to psychology. As John Ioannidis noted: “<a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124">most published research findings are false”</a>“. After all, scientific hypotheses are our current best guesses about phenomena, not a simple accumulation of truths. </p>
<h2>Questionable research practices</h2>
<p>The frustration of many psychologists is palpable because it seems so easy to publish evidence consistent with almost any hypothesis. A likely cause of both unusual findings and non-replicability is psychologists indulging in questionable research practices (QRPs). </p>
<p>In 2012, a <a href="https://www.cmu.edu/dietrich/sds/docs/loewenstein/MeasPrevalQuestTruthTelling.pdf">survey of 2,000 American psychologists</a> found that most indulged in QRPs. Some 67% admitted selectively reporting studies that "worked”, while 74% failed to report all measures they had used. The survey also found that 71% continued to collect data until a significant result was obtained and 54% reported unexpected findings as if they were expected. And 58% excluded data after analyses. Astonishingly, more than one-third admitted they had doubts about the integrity of their own research on at least one occasion and 1.7% admitted to having faked their data. </p>
<p>The problems associated with modern psychology are longstanding and cultural, with researchers, reviewers, editors, journals and news-media all prioritising and benefiting from the quest for novelty. This systemic bias, coupled with minimal agreement on fundamental principles in certain areas of psychology, means questionable research practices can flourish – consciously or unconsciously. Large-scale replication projects will not address the cultural problems and may even exacerbate them by presenting replication as something special that we use to target the unbelievable. Replication – whether judged as failed or successful – is a fundamental aspect of normal science and needs to be both more common and more valued by psychologists and psychology journals.</p><img src="https://counter.theconversation.com/content/60869/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keith Laws does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Only 1% of published psychology research papers are ever repeated. If psychologists want their discipline to be taken seriously, they’ll need to get their house in order.
Keith Laws, Professor of Cognitive Neuropsychology, University of Hertfordshire
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/49551
2015-10-26T15:36:35Z
2015-10-26T15:36:35Z
Forensic analysis of skin dust from Freud’s couch leaves much to be desired
<figure><img src="https://images.theconversation.com/files/99513/original/image-20151023-27592-7uodxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Adam Broomberg & Oliver Chanarin, Trace fiber from Freud's couch under crossed polars with Quartz wedge compensator (#1), 2015, unique jacquard woven tapestry, 2.9m x 2m.</span> <span class="attribution"><span class="source">© Adam Broomberg & Oliver Chanarin</span></span></figcaption></figure><p>In the middle of a rose garden, on a leafy road in northwest London, nestles the <a href="http://www.freud.org.uk/">Freud Museum</a> – though the petals, in October, are tumbling. The house, at 20 Maresfield Gardens, is the proud bearer of two blue plaques that adorn its frontage like war-medals: one for Sigmund Freud, and one for his daughter, Anna. Both lived at the house until their deaths in 1939 and 1982, respectively.</p>
<p>Inside, Freud’s study has been preserved intact. Everything that he owned in Vienna – prior to fleeing Nazi persecution in 1938 – was carefully imported and reassembled so that he could continue his work unabated: his books, his archaeological artefacts, his leather chair that so curiously and uncannily resembles a human form – and, of course, his famous couch.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/99516/original/image-20151023-27612-gcjoqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/99516/original/image-20151023-27612-gcjoqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/99516/original/image-20151023-27612-gcjoqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/99516/original/image-20151023-27612-gcjoqg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/99516/original/image-20151023-27612-gcjoqg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/99516/original/image-20151023-27612-gcjoqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/99516/original/image-20151023-27612-gcjoqg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/99516/original/image-20151023-27612-gcjoqg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Freud’s couch.</span>
<span class="attribution"><span class="source">© Broomberg and Chanarin</span></span>
</figcaption>
</figure>
<p>For the next few weeks, however, that couch is covered by a blanket. “Every Piece of Dust on Freud’s Couch” is an installation in Freud’s study by artists Adam Broomberg and Oliver Chanarin. Commissioned by the Freud Museum, it runs until the end of November. </p>
<p>At one end of the room, a carousel slide projector noisily rotates a series of monochrome slides. At the other end, a blanket covers Freud’s couch. The slides – highly magnified images of fibres – are the product of a forensic team’s investigation into the dust from the rug on Freud’s couch. The dust itself, a handout informs us, is largely keratin; in other words, skin. The blanket on the couch – which initially I had taken for something left there by accident – is actually a tapestry: the woven image of a highly-magnified fibre from that couch.</p>
<h2>Freudian dust</h2>
<p>This is not the first piece of art to be generated from Freudian dust. In 1996, Cornelia Parker created a piece called “<a href="http://workflow.arts.ac.uk/view/artefact.php?artefact=861790&view=98786&block=901687">Exhaled Blanket</a>” – a slide projection of dust and fibres also collected from Freud’s couch. The academic in me cries out for a reference.</p>
<p>According to the artists, this “exercise in forensics aspires to the language of science and, like psychoanalysis, it attempts something contradictory; the objective study of subjectivity”. I’m not sure there’s anything contradictory about the aim stated, but it’s true that Freud’s great project was to legitimise psychoanalysis as a “science”. Viewed in this light, the attempt to frame the physical traces of Freud’s sitters within a forensic, scientific context, has validity.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/99521/original/image-20151023-27631-16mh6e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/99521/original/image-20151023-27631-16mh6e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/99521/original/image-20151023-27631-16mh6e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=844&fit=crop&dpr=1 600w, https://images.theconversation.com/files/99521/original/image-20151023-27631-16mh6e6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=844&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/99521/original/image-20151023-27631-16mh6e6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=844&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/99521/original/image-20151023-27631-16mh6e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1061&fit=crop&dpr=1 754w, https://images.theconversation.com/files/99521/original/image-20151023-27631-16mh6e6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1061&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/99521/original/image-20151023-27631-16mh6e6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1061&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sigmund Freud, 1922.</span>
</figcaption>
</figure>
<p>But so many questions are left unasked.</p>
<p>We are told that the dust “may include traces” of some of Freud’s most famous cases. But of course we don’t know whether the dust thus magnified is actually that of, say, <a href="http://modernism.research.yale.edu/wiki/index.php/Dora:_An_Analysis_of_a_Case_of_Hysteria">Dora</a> or the <a href="http://www.jstor.org/stable/464701?seq=1#page_scan_tab_contents">Wolf Man</a>, or belongs to someone or something else entirely. We are not told whether the forensic team was able to discover anything beyond being able to identify any given fibre as “cushion” or “feather”. And so the claim that the tapestry is “an abstracted portrait of one of its sitters” does not quite ring true. And although we are told that most of the dust on the couch is composed of skin, the magnified slide images are not skin: rather each slide is labelled: Cushion, Feather, Hair, Coat, Rug.</p>
<p>I could fairly be accused of pedantry for picking on such details. But if we are aspiring to the language of science, then detail is key. Minor inaccuracies, such as stating that Freud’s final years were spent in London, grate. In fact, Freud spent only 15 months in London, 12 of which were at the house in Maresfield Gardens where he died in September 1939, just weeks after the start of World War II.</p>
<p>This pedant will further admit to disliking the tired trend that insists artworks be accompanied by explanatory – yet inadequate (and inaccurate) – prose. But in the context of Freudian psychoanalysis, the misfit is even more pronounced.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/99518/original/image-20151023-27580-1nl4c98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/99518/original/image-20151023-27580-1nl4c98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/99518/original/image-20151023-27580-1nl4c98.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/99518/original/image-20151023-27580-1nl4c98.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/99518/original/image-20151023-27580-1nl4c98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/99518/original/image-20151023-27580-1nl4c98.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/99518/original/image-20151023-27580-1nl4c98.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Forensic art.</span>
<span class="attribution"><span class="source">© Broomberg and Chanarin</span></span>
</figcaption>
</figure>
<h2>Searching for meaning</h2>
<p>Psychoanalysis seeks for meaning beneath the surface. Bloomberg and Chanarin’s work overlays meaning clumsily on the surface, obscuring what lies beneath. This “blanketing” is made manifest – unconsciously, one must presume – by the gaudy tapestry overlaying the couch. I suppose one could make the argument that Freud himself, and certainly many of his followers, did precisely as the artists here have done: superimpose their own impenetrable and subjective meaning over their complex subjects like a dense and opaque blanket.</p>
<p>Alone in an upstairs room, the actual rug from Freud’s couch is still on display. Covered in dust, it somehow has the moribund air of a viewed corpse prior to a funeral. Perhaps more so knowing that the dust covering it is largely composed of human skin.</p>
<p>It’s impossible to know to whom those human fragments belonged, just as if they were specks of ash, cremations. To know that Freud’s life and death in this house came so swiftly on the heels of war, and in the context of Nazi persecution, adds a sobering dimension to the fragments of human skin on the couch. The shadow of the Holocaust looms large.</p>
<p>This was not perhaps the meaning the artists intended, but it was the one I took away with me, into that London street, amongst the dropping October rose petals; through memory, association, and a series of unconscious displacements.</p><img src="https://counter.theconversation.com/content/49551/count.gif" alt="The Conversation" width="1" height="1" />
In the middle of a rose garden, on a leafy road in northwest London, nestles the Freud Museum – though the petals, in October, are tumbling. The house, at 20 Maresfield Gardens, is the proud bearer of…
Victoria Anderson, Visiting Researcher in Cultural Studies, Cardiff University
Licensed as Creative Commons – attribution, no derivatives.