Psychoanalysis and Psychotherapy

Mental Space

| Contents | Preface | Acknowledgements | Chapter:1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | Bibliography|Chapter Nine

MISPLACED CONCRETENESS AND HUMAN STORIES

Our humanity and civility are being squeezed from a number of directions. One is philosophical in a formal sense. That is, the legacy of the combined revolutions in science, philosophy and religion has left precious little space for thinking about our humanity which is not impoverished, reified, alienated and wretched. It would be silly and inconsistent with my own critique to think of psychoanalysis as lying completely outside these traditions, since Freud saw himself as a scientist, was philosophically sophisticated, focused on the individual in the family and was heir to the Judeo-Christian tradition. Indeed, two of the most interesting interpretative works about him (both regularly reprinted) are Philip Rieff Freud: The Mind of the Moralist (1960) and David Bakan's Freud and the Jewish Mystical Tradition (1958). I mention these studies, concerned, respectively with the central roles of morality and Judaism in his work, lest it be thought that the strand of scientism is dominant in Freud. I see his work as profoundly of its culture and involving scientific, philosophical, humanistic, moral and religious strands. My aim in the foregoing chapters has been to explore the ways we think about the inner world in the hope of helping to make our ways of doing so more congenial, more capacious, more constructive and more hopeful. But even when we try to free our notions from a reifying scientism we come up against what Freud would call realism but feels, to me at least, like extreme pessimism, though, if it is realistic, it behoves us to know what we are up against. This is the second direction whence comes constriction of our humanity and civility. In the concluding section of chapter two I said that worse was to come from Bion and other Kleinians, and I have sought to add that perspective in chapters five, six and seven, in which I have characterised the forces which constrain and constrict mental space and thereby eliminate or pollute our capacity to live constructively, generously, hopefully. Put simply, Bion and other followers of Melanie Klein have argued that primitive, psychotic processes play a much larger role in our lives - especially in groups, institutions and culture - than was evident in classical Freudianism. This is another way of saying that the primitive is never transcended. One could say that the essence of the Freudian position is that the bulwarks of civilization are designed to keep at bay something which is crazy enough, thank you: polymorphously perverse sexuality, in particular, incest. But the Kleinian position emphasises something even more primitive and claims that much, if not most, of our group behaviour and institutional arrangements are quite specifically and exquisitely designed to avoid consciously experiencing psychotic anxiety. Moreover, psychotic processes are in danger of breaking through from moment to moment. Since the structure of groups and institutions makes up a large portion of the extended sense of culture I outlined in chapter two, these findings should be integrated with psychoanalytic ideas about 'high' and popular culture. As we have seen, the psychoanalytic writers who have had most to say about these matters are Bion, Elliott Jaques, and Isabel Menzies Lyth. Much of their work had been admirably summarized and illustrated in R. D. Hinshelwood's What Happens in Groups, while his A Dictionary of Kleinian Thought provides the best single source of understanding of Kleinian concepts. A useful summary of this way of thinking, which shows clearly how it connects to Freud's writings on groups and culture, is the conclusion to Bion's contribution to the book from which Winnicott's paper on transitional phenomena was excluded, New Directions in Psychoanalysis: The Significance of Infant Conflict in the Pattern of Adult Behaviour (Klein et al., 1955). Bion's essay, 'Group Dynamics: A Review' summarises pioneering work he did with soldiers during World War Two and which he carried on at the Tavistock Institute of Human Relations. It is no exaggeration to say that it laid the foundations for the tradition of 'group relations' work which has inspired (with other contributions) over twenty institutions around the world, for example, The Grubb Institute, The A. K. Rice Institute, The Australian Institute of Social Administration. The ideas in this essay were distilled from a series of papers which he collected in his classic, Experiences in Groups (1961) and which have been described and quoted above (pp. 96-100, 144-6). He concludes the essay by saying, 'To recapitulate: any group of individuals met for work shows group activity, that is mental activity designed to further the task in hand' (Bion, 1955, p. 476; 1961, p. 188). I think of such people operating within the boundaries of civilized behaviour, sublimating, suffering guilt, getting on with it. But the veneer of civilization is thinner and more vulnerable than we may have thought. Group processes evoke psychotic anxieties appertaining to primitive part-object relations and are 'the source of emotional drives to aims far different either from the overt task of the group or even from the tasks that would appear to be appropriate to Freud's view of the group as based on the family group' (Bion, 1955, p. 474). I shall now sketch Bion's three basic assumptions, but it is not part of my purpose to explore them. I am at present concentrating on the kind and level of feelings and their relations with classical Freudian ideas of the inner world. The first basic assumption is dependency: 'that the group is met in order to be sustained by a leader on whom it depends for nourishment, material and spiritual, and protection' (p. 444). The basic assumption of pairing involves a Messianic hope that something or someone as-yet unborn, not-yet present or not yet in role will save the group 'from feelings of hatred, destructiveness and despair, of its own or of another group, but in order to do this, obviously the Messianic hope must never be fulfilled' (pp. 446-8). The third basic assumption is fight or flight: - 'that the group has met to fight something or run away from it' (p.448), the emotions appropriate to the physiological emergency response of the sympathetic nervous system, energised by adrenaline. He contends that 'panic flight and uncontrolled attack are really the same' (p. 469). Menzies Lyth comments that 'They have in common massive splitting and projective identification, loss of individual distinctiveness or depersonalization, diminution of effective contact with reality, lack of belief in progress and development through work and suffering' (Menzies Lyth, 1959, p. 21). Bion stresses that these are in no way voluntary, conscious reactions: 'Participation in basic assumption activity requires no training, experience or mental development. It is instantaneous, inevitable and instinctive...' (Bion, 1955, p. 449; cf. p. 458). All of the basic assumptions involve a leader, but this need not be a person; it could be an idea or inanimate object (p. 450). When the 'leader' is a person, he or she 'is as much the creature of the basic assumption as any other member of the group... The "loss of individual distinctiveness" applies to the leader of the group as much as to anyone else - a fact which probably accounts for some of the posturing to which leading figures are prone' (p. 467). These defensive actions derive from group processes which lead individuals to regress. Once again, he places the main emphasis on the primitiveness of the reactions: 'It will be seen from this description that the basic assumptions now emerge as formations secondary to an extremely early primal scene worked out on a level of part objects, and associated with psychotic anxiety and mechanisms of splitting and projective identification... characteristic of the paranoid-schizoid and depressive positions. Introjection and projection of the group, which is now the feared investigator, now the feared object of investigation, form an essential part of the picture and help to add confusion to the scene unless recognised as being very active' (p. 457). In my critique of Freud's reductionism I lamented his swingeing reductionism of group, social and cultural phenomena to the familial and to the interplay of id, ego and superego. Bion shares Freud's view but insists that the true sources lie even deeper in the individual, as indicated above. He adds here, in a footnote which partly anticipates his conclusions, that 'there are aspects of group behaviour which appear strange unless there is some understanding of M. Klein's work on the psychoses' (p, 461n). In the very next chapter in New Directions, 'Social Systems as Defence Against Persecutory and Depressive Anxiety', Elliott Jaques draws on Kleinian ideas in the context of his research in industry. He begins by commenting that 'many social phenomena show a striking correspondence with psychotic processes in individuals'; that 'institutions are used by their individual members to reinforce individual mechanisms of defence against anxiety, and in particular against recurrence of the early paranoid and depressive anxieties'; that mechanisms of projective and introjective identification operate in linking individual and social behaviour; and he puts forward the hypothesis that 'one of the primary cohesive elements binding individuals into institutionalised human association is that of defence against psychotic anxiety' (Jaques, 1955, pp. 478-9). Jaques starts out from Freud's ideas in Group Psychology and the Analysis of the Ego (1921), in particular, the phenomenon of identification with the leader and other members of the group. He quotes Freud on how primitive this mechanism is: 'identification is known to psycho-analysis as the earliest expression of an emotional tie with another person' (Jaques, 1955, p. 480). He also refers to Paula Heimann's claim 'that introjection and projection may lie at the bottom of even the most complex social processes' (p. 481). We are immersed here in the alimentary view of experience, knowledge and culture discussed in chapter three. Once again, all knowledge is mediated by the mother's body; the primitive is never transcended and continues to operate. Heimann says, 'Such taking in and expelling consists of an active interplay between the organism and the outer world; on this primordial pattern rests all intercourse between subject and object, no matter how complex and sophisticated such intercourse appears. (I believe that in the last analysis we may find it at the bottom of all our complicated dealings with one another)' (quoted by Jaques, p. 481n). Jaques' model emphasises the role of unconscious defences: 'I shall try to show how individuals make unconscious use of institutions by associating in these institutions and unconsciously co-operating to reinforce internal defences against anxiety and guilt. These social defences bear a reciprocal relationship with the internal defence mechanisms. For instance, the schizoid and manic defences against anxiety and guilt both involve splitting and projection mechanisms, and, through projection, a link with the outside world. When external objects are shared with others and used in common for purposes of projection, phantasy social relationships may be established through projective identification with the common object. These phantasy relationships are further elaborated by introjection; and the two-way character of social relationships is mediated by virtue of the two-way play of projective and introjective identification' (pp. 481-2). You will recall that Meltzer made relinquishing excessive projective identification the prerequisite for attaining mental four-dimensionality, i. e., a mind with the capacity to contain experience and to develop. He also argued that since Klein first described the mechanism, her followers had come to see it as 'the mechanism of narcissistic identification and could be confidently looked to as the basis of hypochondria, confusional states, claustrophobia, paranoia, psychotic depression and perhaps some psycho-somatic disorders' (Meltzer et al., 1975, p. 228). He sees it as 'the mechanism par excellence of narcissistic identification in a three-dimensional world' (ibid). In a lecture given in 1990, he added that it is used as the defence against schizophrenic breakdown by excessively conformist, ambitious and competitive adherents to institutions - people who inhabit a world of projective identification which he calls 'the claustrum', inside the anus. Introjective identification, by contrast, is described as 'coming into play to raise the mental life out of the sphere of narcissism in specific connection with four-dimensionality' (Meltzer et al., 1975, p.228). I can think of no more convincing and sobering example of Bion's (and Jaques' - see above p. 97) conclusions than Isabel Menzies Lyth's classic study of group dynamics in nursing, aspects of which were considered in chapter seven. After Bion's Experiences in Groups, this is probably, and rightly, the best-known piece of research to emerge from the work of the Tavistock Institute of Human Relations. Combined with her other Kleinian investigations of social and institutional settings, her collected papers constitute, in my opinion, the most important body of psychoanalytic work on the social bearings of the psyche. She has turned her approach to such diverse topics as the wearing of crash helmets on motorcycles, the dynamics of the Fire Brigade, family patterns of consumption and the fantasies surrounding ice cream, conflicts between psychiatric hospitals and the communities they serve (Menzies Lyth, 1988, 1989). The intimate and confidential nature of much of the research she has undertaken means that it is often difficult and sometimes impossible to publish her findings. For example, she was asked by the British Psycho-Analytic Society to look into the structure and consequences of its fifty-year-long compromise, whereby the training and committee structure of the Institute should be balanced so as to protect the interests of all three of the prevailing tendencies: Contemporary (or Anna) Freudian, Kleinian and Independent Groups. Her brief, presumably, was to look into the consequences of this long-standing 'gentlemen's (actually ladies') agreement' to see if it may be appropriate to make other arrangements, perhaps even to dissolve the groups and attempt to function as a single group with a mixture of tendencies and beliefs. The prevailing structure was created in order to avoid a split in the Society in the wake of the acrimonious Controversial Discussions between the followers of Melanie Klein and Anna Freud and those who had no wish to be followers of either woman. There is no doubt that the present arrangements - whereby there is representation of each group on all main committees and training involves a commitment to one group with exposure to the ideas of the others - has kept a species of peace. There is also no doubt that the British Psycho-Analytic Society has been remarkably prolific of ideas and has had (perhaps unique) world-wide influence throughout the period of this pact. It could be argued, however, that there are sclerotic aspects of the structure and that it institutionalises conflicts, projections and reprojections which might otherwise wane. We may never know what she has discovered and recommended. I am told that it is unlikely that her findings will ever be published. On the other hand, there is a precedent in the publication of the original Controversial Discussions half a century after they began (King and Steiner, 1991). There is more in this example than gossip. First, this investigation is an excellent example of the work at which she excels, and the whole psychoanalytic culture stands to benefit from her counsel, even if her report remains confidential. Second, it illustrates - with wonderful irony - that psychoanalysts (and psychotherapists, for that matter) are not immune to the processes that they investigate. As Bion pointed out, the therapist or leader in group processes is not immune to such processes. He said elsewhere that the problem in analysis is like that in war: to somehow manage to think under fire. It is a feature of analytic institutions that they exhibit the same factionalism, splits and other forms of primitive processes that other institutions do. A prominent non-Kleinian member of the British Psychoanalytical society is fond of saying that there was something 'really crazy' about the Controversial Discussions. It has always struck me that this is the simple truth, and it would be unsurprising to him if he was a Kleinian. This problem of 'physicians' who cannot heal themselves is particularly ironic in the case of the group relations movement. It turns out that the world centre of such researches - The Tavistock Institute of Human Relations - underwent a series of the very kind of splits that its members were renowned for illuminating in their research and consultancy work. My response to this is ambivalent. Part of me is sad and sardonic and asks how one could have thought it would be otherwise. Doctors are notoriously bad patients, and people who have insight about others when in role cannot be expected to be so good at it when outside the consulting room or consultancy role. But another voice says that it reflects on psychoanalysis and the group relations movement - consummately reflexive disciplines - if their practitioners behave in their institutions as badly as lay people and if group relations consultants cannot conduct civil group relations in their own institutions. The truth is that they have had acrimonious splits, with lamentable departures of key personnel, some of whom have remained embittered. The analogy which occurs to me is those evangelical preachers who keep getting caught at the very forms of sinnin' that they so vehemently denounce from their pulpits. This is not, of course, only ironic, since we set out to help others in the spheres where we are - or have been - troubled and hopefully have made some progress, however fragile. One might think that institutions explicitly designed for the enhancement of human welfare and the alleviation of suffering would be altruistic through and through. Put another way, one might hope that the 'helping professions' would be helpful in their institutional arrangements. Yet another formulation, which would seem only common sense, is that 'the first duty of a hospital is not to spread disease'. Yet that is exactly what Menzies Lyth's most celebrated study shows that they do - not bacteria and viruses, mind you, but something as distressing: defences against potentially overwhelming feelings which lead to inhumanity. I worked for a number of years as a psychiatric aide, nurse and medical student, before I began teaching in a university and medical school. I was appalled by the rigidity, thoughtlessness, even callousness and cruelty I saw and - to some extent - got caught up in. I did not stay in any role or institution long enough to become fully socialised into a professional identity, but my distress about these matters has remained fresh in my mind. I am sorry to say that when I was subsequently in institutions long enough to gain some insight into their dynamics, they have always had a large component of the features described by the writers on group relations. I have found this in medical and academic institutions, cultural politics, television, publishing and the subculture of psychoanalysis and psychotherapy, especially their training institutions (Young, 1981, 1986, 1990a, 1993a, 1993b). Lest it be thought that I am taking swipes, I remind the reader that distressing factional and personal relations were characteristic of Freud's inner circle, as Phyllis Grosskurth has shown (1991). But the same can be said of the building of the great civil engineering projects in and around New York City (Caro, 1974) and of the political process in the United States (Caro, 1983, 1990) and of espionage (Wright, 1987) and of making movies (McClintick, 1982; Bach, 1985; Boorman, 1985). It was always thus. What has changed is people's willingness to write about such matters in a way which is not idealised and not merely prurient. I have had occasion to work closely with many Victorian lives and letters, where a veil was drawn over the intimate relationships and unadmirable aspects of great men (Young, 1987). It was a breath of fresh air when Lytton Strachey began writing biography which gave due weight to people's less admirable qualities (1918). I believe that writings about people and their milieus has benefited greatly by a more balanced rendition of the mixture of Eros and Thanatos in their characters and careers, even though opinions will differ about the authors' motives - to tell as much of the full truth as they can (Lash, 1971, 1980; Hodges, 1983; Grosskurth 1985; Branden, 1986; Gay, 1988; Sutherland, 1989; Brady, 1990; Monk, 1990; Richardson, 1991; McBride, 1992) to be iconoclastic (Goldman, 1981, 1988), to criticise (Bower, 1991; Cannon, 1991; von Hoffman, 1988) to make lots of money (Kelly, 1986, 1991). I believe that reading biographies which let it all hang out helps my clinical work as well as being illuminating and entertaining. They also make the point that lives are stories, narratives lived inside history and subject to a whole variety of determinations which are not reducible to a single, scientistic account of basic mental mechanisms. For reasons which this whole book has sought to make attractive and persuasive, I believe that the training and the reading habits of psychoanalysts and psychotherapists would do well to include a significant component of biographical reading. Biographies and accounts of activities like making movies or surviving as a hostage certainly make it abundantly clear that containment and the lack of it are not the exclusive prerogatives of the analytic consulting room. Human nature should be told about in human stories, told as fully as one can manage. One of the conclusions toward which my entire account in these pages has been meandering is the advocacy of narrative and story telling as more illuminating than formalistic and scientistic accounts. Narrative, sensitively crafted, is the epitome of evocative knowledge. A flood of light was cast on the complex and distressing relations between individuals and institutions which I had experienced in various contexts when I read Menzies Lyth's study of the institutional arrangements in the nursing service of a general teaching hospital in London. Among the problems that led to commissioning the study was the high dropout rate among trainees and those who completed the training. This amounted to a wastage rate of 30-50% in various hospitals (Menzies Lyth, 1959, p. 61), and those who left were among the most sympathetic nurses. There were also problems in the internal arrangements which threatened a complete breakdown in the system of allocation of practical work (p. 45). What she discovered is what we would expect from the work of Bion (her analyst) and Jaques (on whose work hers was modelled): nursing is highly stressful work which evokes primitive anxieties, so that the institution will go to absurd lengths to avoid its staff having to experience them. The trainees are socialised into these arrangements, however bizarre and inhuman they seem, because they unconsciously want a place to hide from psychic pain. 'The objective situation confronting the nurse bears a striking resemblance to the phantasy situations that exist in every individual in the deepest and most primitive levels of the mind. The intensity and complexity of the nurse's anxieties are to be attributed primarily to the peculiar capacity of the objective features of her work to stimulate afresh these early situations and their accompanying emotions' (pp. 46-7). She provides a lucid exposition of the parallel between the infant's developmental experiences and their revival in the stressful, existentially life-threatening hospital setting. I shall not attempt to summarise her account but heartily commend it to the reader. The accumulated, relentless evocations of infantile anxieties lead members of the organisation to develop 'socially-structured defence mechanisms, which appear as elements in the organisation's structure, culture and mode of functioning' (p. 30). Menzies Lyth spells out the relationship between the individual and the institution. Individual defences come to match those of the social defence system. If the discrepancy is too great, some breakdown between individual and institution 'is inevitable' (p. 73), whether it be illness, acting out, becoming a rebel, getting expelled/sacked, leaving. The chances of an individual bringing about reform are slight, and those of a group doing so are remote. I shall list the defensive techniques she discovered and then add a few examples: splitting up the nurse-patient relationship; depersonalization, categorisation, and denial of the significance of the individual; detachment and denial of feelings; the attempt to eliminate decisions by ritual task-performance; reducing the weight of responsibility in decision-making by checks and counter-checks; collusive social redistribution of responsibility and irresponsibility; purposeful obscurity in the formal distribution of responsibility; the reduction of the impact of responsibility by delegation to superiors; idealisation and underestimation of personal development possibilities; avoidance of change (pp. 51-63). Two examples rang painfully true to my own experience. The first falls under the category of 'depersonalization, categorisation, and denial of the significance of the individual'. 'The protection afforded by the task-list system is reinforced by a number of other devices that inhibit the development of a full person-to-person relationship between nurse and patient, with its consequent anxiety. The implicit aim of such devices, which operate both structurally and culturally, may be described as a kind of depersonalisation or elimination of individual distinctiveness in both nurse and patient. For, example, nurses often talk about patients not by name, but by bed numbers or by their disease or a diseased organ: "the liver in bed 10" or "the pneumonia in bed 15". Nurses themselves deprecate this practice, but it persists. Nor should one underestimate the difficulties of remembering the names of, say, thirty patients on a ward, especially the high-turnover wards' (p. 52). The patient is not seen as whole person needing care but a number, an illness, or a damaged part of the body, that is, 'a part-object only, the retreat into part-objects being another feature Bion attributes to basic assumption group phenomena' (Menzies Lyth, 1969, p. 16). A similar depersonalization occurs for the hospital staff through the use of identical uniforms with a rigid hierarchy of roles and tasks appropriate to various levels of seniority. The nurses become their roles and skills, and are thereby experienced and experience themselves less as individuals: charge nurse, staff, student, aide. Like a soldier or policeman, they are cloaked in their uniforms and positions in society and are thereby more respectable (one of Florence Nightingale's intentions), while both less vulnerable and less accessible. The starch is a powerful barrier; so are the colours of the uniforms and their quasi-military markings. The bizarre hats are part of a code whereby those in the know can locate a nurse's training hospital in the complex culture of the hierarchy of trainings, like a college or club tie or the insignia of a nun's order. The problem of depersonalization is made even more acute by the fact that shortages - due to the factors here described - lead to increased use of agency nurses who are quite often present on a given ward for a single shift and in an entirely different hospital the next working day. Callousness can also be born of boredom and doing routine tasks with only prostrate bodies for company. If one is sitting alone in a recovery room waiting for a patient to come round from an anaesthetic, conversation from a passing colleague is very welcome and unlikely to take account of the fact that the patient may be taking in what is said as he or she regains consciousness. When I was thirteen, I was wheeled in my bed from my hospital room for a test. On the way back, when the nurses pushing the bed thought I was asleep or unconscious, they were discussing my alarmingly low pulse and respiration rates and speculating that I would not survive another night. Once I realised what was being said, I kept quiet for fear of being caught eavesdropping. My second example is of underemployment of nurses and getting them to do stupid things. This is the example always cited from the paper, because it is so familiar to people who have spent time in hospitals. Hospital routines are 'routinely' followed slavishly to the point that common sense utterly disappears: 'Underemployment of this kind stimulates anxiety and guilt, which are particularly acute when underemployment implies failing to use one's own capacities fully in the service of other people in need. Nurses find the limitations of their performance very frustrating. They often experience a painful sense of failure when they have faithfully performed their prescribed tasks, and express guilt and concern about incidents in which they have carried out instructions to the letter but, in so doing, have practised what they consider to be bad nursing. For example, a nurse had been told to give a patient who had been sleeping badly a sleeping draught at a certain time. In the interval he had fallen into a deep natural sleep, Obeying her orders, she woke him up to give him the medicine. Her common sense and judgement told her to leave him asleep and she felt very guilty that she had disturbed him' (p. 69). In industry this is called 'working to rule' and is considered to border on industrial sabotage. Doing exactly what one is told is a characteristic of the roles of prisoners, people in the military and children under the yoke of particularly authoritarian parents. And to follow orders to the letter, without using one's discretion and common sense, very frequently leads to disaster, which is why so much slapstick comedy illustrates this form of revenge against silly rules and rulers. The outstretched hands, accompanied with a shrug and a look of pseudo-innocence, completes the moment of Oedipal triumph, just before the chase by the would-be punisher begins. Having been addressed like an idiot and told to do 'exactly as I say', one then behaves like a fool, thereby protecting the vulnerable, sensible self from further humiliation. Charlie Chaplin, Harold Lloyd, Stan Laurel and Lou Costello got some of their most reliable laughs this way. The defences described here and in the essays by Bion and Jaques do not, to say the least, bring out or reflect the best in people. 'These defences are oriented to the terrifying situations of infancy, and rely heavily on violent splitting which dissipates the anxiety. They avoid the experience of anxiety and effectively prevent the individual from confronting it. Thus the individual cannot bring the content of the phantasy anxiety situations into effective contact with reality. Unrealistic or pathological anxiety cannot be differentiated from realistic anxiety arising from real dangers. Therefore, anxiety tends to remain permanently at a level determined more by the phantasies than by the reality. The forced introjection of the hospital defence system therefore perpetuates in the individual a considerable degree of pathological anxiety' (pp. 74-5). My reaction to this outcome is to feel that we have been here before - in Whitehead and Burtt's descriptions, discussed in chapter one, of the impoverishing effect on our humanity of the reifications of the scientific world view: the Cartesian ontological dualism of mind and body and the associated epistemological dualism of subject and object. The problems I have been discussing here take us full circle and back to the question of finding a place for our humanity in a world of material, extended substances and descriptions of mind as analogous to the conceptual languages of the natural sciences. Indeed, the effect on our humanity is surprisingly parallel to the effects of scientific reductionism. In the passage immediately following the one quoted above, Menzies Lyth points out that the effect of these defences is, in effect, to push the nurse out of the symbolic and cultural realm: 'The enforced introjection and use of such defences also interferes with the capacity for symbol-formation' (p. 75). She refers us to a previous passage about pathological symbolic equation. Through the projection of infantile phantasy situations into current work situations, 'the individual sees elements of the phantasy situations in the objective situations that come to symbolise the phantasy situations. Successful mastery of the objective situations gives reassurance about the mastery of the phantasy situations. To be effective, such symbolisation requires that the symbol represents the phantasy object, but is not equated with it. Its own distinctive, objective characteristics must also be recognized and used. If, for any reason, the symbol and the phantasy object become almost completely equated, the anxieties aroused by the phantasy object are aroused in full intensity by the symbolic object. The symbol then ceases to perform its function in containing and modifying anxiety' (p. 49). 'The defences inhibit the capacity for creative, symbolic thought, for abstract thought, and for conceptualisation. They inhibit the full development of the individual's understanding, knowledge and skills that enable reality to be handled effectively and pathological anxiety mastered. Thus the individual feels helpless in the face of new or strange tasks or problems. The development of such capacities presupposes considerable psychic integration, which the social defence system inhibits. It also inhibits self-knowledge and understanding, and with them realistic assessment of performance' (p. 75). Once again, I have the strong feeling that we have been here before. She has given, quite independently as far as I know, a description of the institutional equivalent of Whitehead's fallacy of misplaced concreteness (above, ch. 1), whereby abstractions are created for a quite distinct purpose, but that purpose is forgotten and one becomes stuck with them and equates them with reality, substituting them for direct experience, which comes to be experienced in terms of the equation between that set of abstractions and reality itself. At the heart of both Whitehead's and Menzies Lyth's critiques lies a single humanistic impulse. In her case, the infantile phantasy situations are symbolically equated with the realistic situations (pp. 49-50), while in his 'we have mistaken our abstractions for concrete realities' (Whitehead, 1925, p. 69). Life and mind thereby become impoverished to the point that our humanity is squeezed out of the conceptual scheme of modern thought, leading to a scientized form of psychoanalysis in which structures, forces, energies, economics, biological development and adaptation come to replace resonant accounts of people's lives. The parallel in institutionalised defence systems has been movingly described in her account of the world of nursing (and in others; see especially 'Action Research in a Long-Stay Hospital' (1987). In my view, this form of impoverishment is the consequence of the same set of impulses which framed the conceptual scheme of the modern era, whereby our humanity was brought to conform to a set of arrangements which subordinated individual consciousness and welfare to the requirements of a mode of production that placed order, quantification and profit before human welfare. The scientific revolution, capitalism and Protestantism brought us to this pass, so it should not be surprising to find astonishingly congruent critiques by profound analysts of different aspects of the overall system - Whitehead and Burtt on the philosophical basis of the external world and Bion, Jaques and Menzies Lyth on the social bearings of the most primitive aspects of the inner world. In a passage immediately preceding the ones quoted above, Menzies Lyth recalls a thought of Fenichel (1945) which perfectly echoes, with respect too institutional arrangements, the notion of misplaced concreteness as applied to the scientific world view: 'He states that social institutions arise through the efforts of human beings to satisfy their needs, but that social institutions then become external realities comparatively independent of individuals which affect the structure of the individual' (Menzies Lyth, 1959, p. 74). Are they so independent that the despair one might derive from Freud's pessimism, driven deeper by the role of psychotic anxieties in the erection of our group relations and institutions, should lead to a truculent stoicism? I hope not. It is time to take stock and conclude. I began in chapter one by pointing out the baleful consequences of Cartesian dualism in modern thought and drew particular attention to the fact that mind, feelings and the personal realm were left with no language of their own within the scientific world view. I drew on the writings of Burtt and Whitehead to show just how fundamental this problem is in the metaphysical foundations of our ontology and epistemology. Both were quite explicit about the disastrous effects of success in physics for being able to think about beauty and human nature. The history of attempts to represent mental phenomena is one of analogies drawn from physics, chemistry, biology and other formalistic disciplines which are scientistic, for example, linguistics and systems theory. Orthodox psychoanalysis has been no exception to this rule, and the use of concepts of force, energy, cathexis, etc. became fashionable in orthodox Freudian and neo-Freudian accounts of the inner world. The other domain in which people have thought about themselves is the humanities, and this made up some of the most profound dimensions of Freud's thought and has been reasserting itself in recent claims that narratives and stories can and should lie at the heart of the psychoanalytic project, just as it does in the best of other branches of the humanities and what is often, contradictorily and confusingly called 'the human sciences'. I next offered accounts of culture drawn from psychoanalysis and drew attention to the regrettable reductionism in Freud's own analysis of civilization and its discontents. The argument could have stopped there and turned away from psychoanalysis for illumination of group, social and cultural phenomena. I want to repeat here that I in no sense wish to claim that psychoanalysis can do the work of historical, ideological, social, cultural, economic and political analysis. On the other hand, I do think that by going deeper than the Freudian level we can gain much more insight into these matters than might be thought. By that I mean that when we recombine psychoanalytic and other modes of discourse, psychoanalysis will make a more subtle and profound contribution to a full account. In the succeeding chapters I attempted to do just that by analysing concepts which I believe to be foundational for a non-scientistic account of psychoanalysis: countertransference, psychotic anxieties, projective identification, transitional phenomena and the exploration of these concepts at work in group and social settings, in particular, institutions, racism and virulent nationalism. There is a congruence between what the reductionist side of Cartesian dualism and the reductionist tradition in psychoanalysis do to our humanity, on the one hand, and what psychotic anxieties and the defences we mount against them do to individuals and groups, on the other. That is the beauty of the example from Menzies Lyth given above. When I said at two points, 'We have been here before', I was drawing attention to that congruence between three forms of alienation, reification and misplaced concreteness: in the modern world view, in psychoanalytic theory and in the effects of primitive defences on people in stressful institutional settings. It should be obvious from the examples I have used and the texts I have drawn upon that I believe that Kleinian ideas are relatively free from scientistic and mechanistic reductionism which characterises much of orthodox and neo-Freudian theory. This strong bias on my part will put some people off, even though one of my motives in writing about them was to make them more accessible and attractive. Regardless of whether I have succeeded or failed in that aim, my general point about mental space does not depend on my Kleinian perspective. I think it does depend on turning away from physicalist analogies, and I have found Kleinian ideas very resonant with my own personal and therapeutic experience. I also think that any body of ideas which promises to help us must be one which looks deeper into human desperation in an attempt to account for our destructive and desperate feelings and activities. I want to turn, in closing, to the work of Richard Rorty, which I make no pretence of summarising, since, like that of so many writers I have mentioned in the foregoing chapters, I'd much prefer to entice you into reading. My reason for doing so is that I want to end on a note of pointing to broader horizons for the ideas I have been advocating, and I believe that his perspective is very hopeful and enabling. His writings bear on the philosophical status of the system of ideas I was outlining and criticising in chapter one. He has set out to persuade his growing audience that there is a perfectly credible alternative to systematic and scientistic philosophy. He urges us to see such ideas as just another way of framing reality and sets alongside it edifying writers who place narrative prose, stories, and just plain yarns on a par with the intimidating systematics and abstruse philosophising of the world view of modern science and the framers of scientistic analogies in the human sciences and humanities. As I have said, he argues that truth is made, not found, that poetry and metaphor are as valid as any other path to the illumination and edification of human nature. In a powerful and brilliant essay on 'The Contingency of Selfhood' (Rorty, 1989, ch. 2), he attributes to Freud profound support for the humanistic, as opposed to the scientistic, way of thinking. His text is an extended reflection on the last part of a poem by Philip Larkin (p. 23): And once you have walked the length of your mind, what you command is as clear as a lading-list. Anything else must not, for you, be thought To exist. And what's the profit? Only that, in time We half-identify the blind impress All our behavings bear, may trace it home. But to confess, On that green evening when our death begins, Just what it was, is hardly satisfying, Since it applied only to one man once, And that one dying. Having explored the competing claims of different ways of framing the individual and having concluded that none should be seen as truer or more basic than the others, he comments: 'Strong poetry, common-sense morality, revolutionary morality, normal science, revolutionary science, and the sort of idiosyncratic fantasy which is intelligible to only one person, are all, from a Freudian point of view, different ways of dealing with blind impresses: or, more precisely ways of dealing with different blind impresses - impresses which may be unique to an individual or common to the members of some historically-conditioned community. None of these strategies is privileged over others in the sense of expressing human nature better' (pp. 37-8). Rorty wants to undermine the privileged standing of systematic, formal and scientistic thought and give at least equal warrant to poetry and fiction: 'The final victory of poetry in its ancient quarrel with philosophy - the final victory of metaphors of self-creation over metaphors of discovery - would consist in our becoming reconciled to the thought that this is the only sort of power over the world that we can hope to have. For that would be the final abjuration of the notion that truth, and not just power and pain, is to be found "out there"' (p. 40). I find this inspiring and liberating, and it confers on mental space a liberation from Cartesian dualism and scientism which is profoundly human, but the price of this abjuration is that the depressive position requires that pain of contingency be borne in the mixture of experiences and concern for others. It cannot be avoided by system, formalism, groups or institutions, unless one is prepared to pay the price of impoverishment of experience, diminished imagination and debased culture. To my own decades-long period of rumination of Willie Nelson's lines: You'd think me loco To rub for a genie While burning my hand on the lamp

I now have to say yes to all three: yes, loco; yes, rubbing; yes, burned. The geenie may not have appeared, but the lamp is burnished.