Considering the Ideal Institute, or Reflections on How Not to Know Best
“Our ideals, like the gods of old, are constantly demanding human sacrifices.”
-George Bernard Shaw
Psychoanalytic Institute, ideal, or otherwise, is an oxymoron, deserving a place among holy hell, friendly fire, and kosher ham. The contradiction in terms results from the fact that, typically, an institute suggests an organized group of experts committed to teaching what they know to students who can learn and then demonstrate such knowledge. Psychoanalysis, on the other hand, is a field of study where what is being studied is how to get at-and what to do with—what is unknown. It has produced voluminous amounts of literature comprising both theoretical and applied suggestions on how to think about our quest for the elusive. Further, the vast majority of mainstream institutes and academic centers are based on bodies of knowledge that are generalizable; what one learns within the academic setting can be applied outside it. For example, in engineering or medicine, the principles and techniques behind expansion bridges and heart bypass surgery can be learned and productively employed in similar situations with similar needs and similar results. This is not the case with contemporary psychoanalysis. What we learn in analytic training is that almost nothing is generalizable and that in the ever-changing terrain of our own and our patients' psyches, we need to be constantly vigilant to keep from making any assumptions whatsoever.
Far more challenging than looking for a needle in a haystack, psychoanalysis sets out to look for something we do not yet know nor can we name, other than to say it is "unconscious," which is a fancy way of saying it is "something we don't know." So to presume that there is an organized, linear, a priori means of knowing the unknown, and that this knowing of the unknown can be taught, is a curious suspension of the one thing we can be sure of, which is that we don't know what we're looking for.
Freud wrote extensively about the difficulty in recognizing the limits of psychoanalytic knowledge. He realized the pull to both over- and underestimate what the psychoanalyst actually knows at any given point in a treatment. Since Freud, there has been significant debate on just this issue. What, then, does it mean to be an expert in a field in which the major emphasis is on how to best ferret out that with which we are most unfamiliar?
The very word expert suggests concrete, quantifiable skill reflecting a concrete quantifiable body of knowledge that represents the truth about things. An expert skier, marksman, or surgeon all conjure up precision, replication, certainty. And yet this picture breaks down a bit with expert art forger, expert witness, expert impersonator. 1 On one hand, expert suggests skill that is aligned with whatever is true, real, and measurable. On the other. it suggests skill but not truth. Take expert witnesses, for example; both defense and prosecuting attorneys use expert witnesses to bolster their respective cases. Both are experts, both stake their reputation on their interpretation of the evidence. Both are skillful, but can they both be true? Well, maybe.
The word expert comes from the Latin expertus, past participle of experiri, "to try, test." The noun sense is a "person wise through experience." Expertise is from the French expertise, "expert appraisal, expert's report." 1 Iris Murdoch's (977) stimulating monograph is a good discussion of how Plato wanted to banish all the artists who did not, by definition, have the knowledge they suggested they had in their representations of reality.
If we apply the term as meaning "an expert through experience," it starts to make more sense in the context of psychoanalysis. An expert psychoanalyst would be someone who has experienced the humble-jumble collision of his and others' conscious and unconscious processes and in that experiencing can be trusted to do something more productive, insightful, helpful than a nonexpert. So, in that case, the psychoanalytic institute would focus its training on the candidates' experience of doing psychoanalysis. And, sure enough, this is indeed one of the main purposes of analytic supervision for many psychoanalytic institutes."
I said 'hey senorita, that's astute, ' "I said 'why don't we get together and call ourselves an institute?'"
- Paul Simon
Sitting in the waiting room of a senior training analyst's office one day during my first or second year of training, I took off my glasses and rubbed my eyes. The patient I was presenting was my first analytic control case, a person who was adamantly opposed to discussing our relationship. This posed a Significant problem for me, since my institute was an Interpersonal one, which means that there was a belief that the examination of the relationship between the patient and the therapist was essential to the analysis. As I was staring off blearily into the waiting room, I saw a small sign on a bookcase across the room. I had seen it many times before. It was one of those small white cardboard signs from the American Cancer Society that said, "Thank you for not smoking." On this particular day, glasses off, feelings mussed, I read to myself, "Thank you for Nick Samstag."
I shared this incident with my analytic supervisor, and we laughed. I discussed how under-appreciated I felt and how this patient was so frustrating that sometimes I wished I had not given up smoking. And I remember saying that it felt good, too, to have the reverie of being thanked for not doing something I wasn't doing anyway—after all, I wasn't being thanked by my patient for what I was doing with her; she refused to talk about our relationship. At the time, I found this to be a very helpful conversation to have with this supervising analyst. I enjoyed being surprised by my own unconscious process; I felt secure enough with the supervisor to acknowledge my myopia, both literal and psychological, and I found what the supervisor had to say always interesting and more often than not right on target. But what was the target? To deepen my understanding of my patient? To know more about my own unconscious process? To acknowledge my frustrations? These are all admirable goals for the training of a psychoanalyst, and in this example, it all came together for me. But how do we think of this as an institute issue? How does a faculty set out to do all this, and how are candidates expected to learn this? Surely my supervising analyst did not consult a manual on how to deal with his supervisee's misreading a no-smoking sign, and before seeing him I certainly did not anticipate that I would be having such a musing.
Chief among the paradoxes facing a psychoanalytic candidate may well be, as Adam Phillips (1997) has commented, that in psychoanalytic training you spend a great deal of time and money studying with leading experts who (at least in the Interpersonal/Relational tradition, by their own admission) are experts mostly in articulating what they do not know. How this is possibly helpful to anyone concerned is a good question. For in most, if not all, reasonable professions, once you get your degree or certificate, it is a sign that you have mastered a certain amount of material in your given field and, when called on to perform certain tasks for the public that you perfected in the academy, you can predictably do so, and competently at that. The same is both true and not true of psychoanalytic training, given that its chief area of study is the unconscious. As both destination and starting point of psychoanalytic exploration, the unconscious mocks our attempts to know it, in any usual sense of the word. It bubbles up in unexpected places. We can't leave home without it.
It appears that a reasonable attitude toward the appreciation of unconscious processes is humility, considering that expertise in this area has more to do with receptivity to multiple impressions than with mastery and replication of discrete data; or that mastery here is the capacity to resist the seduction of certainty in order to court new possibility. This acknowledgment of the elusiveness of psychoanalytic knowledge prompts us to reexamine what it means to know things in the first place. Perhaps the ideal institute would require us to do just that.
Different Types of Knowing
A statement attributed to Dorothy Parker, that she never wanted to tell anyone anything that they didn't know already, often came to mind while I was in training. In one of my earliest, and most frequent, training experiences I was being questioned by supervising analysts as to why I thought I knew anything. I would commiserate with my candidate colleagues that psychoanalytic training seemed to have much to do with the unpacking of pronouns. It goes something like this: "The patient went shopping with her sister and said she enjoyed it," I would say. Supervising analyst: "What's 'it'?" "Shopping," I'd reply. Supervising analyst: "What about the shopping?" "I don't know," I'd say. Or, "The patient claims that his mother is always exaggerating his accomplishments, and he says this 'makes him nuts," I would observe. Supervising analyst: "What's 'this'?" "The exaggeration of his accomplishments," I'd reply. Supervising analyst: "What about that makes him nuts?" "I don't know," I'd say.
Another paradox of contemporary psychoanalytic work, of course, which is shared by both cognitive and neural science, is that we all know certain things at all times that we are not aware of knowing. This kind of knowing is not exclusively factual, although it is often the case that the facts that we do know can prove to be elusive. This is an organized, ongoing sort of knowing, based in multiple chains of associations across and within all sensory domains, in and out of language and awareness. These associational links can slip into awareness gradually or come crashing into consciousness with an astounding "aha!" So, while it would be hard to tell someone something they did not already know, it is possible to help people re-cognize what they don't know they know, by knowing it with them. That is what we as analysts try to do with our patients, and that is a large part of what an ideal institute would provide for its candidates.
Of course, the pronoun that is most difficult to unpack is the one that calls the most attention to itself, standing, as it does, at perpetual attention. This monadic sentry, like Janus, looks at both the past and the future simultaneously, while being firmly rooted in the present. Its necessary capitalization, regardless of surrounding syntax, alerts us to its centrality in sense-making. It is the "I," after all, that the psychoanalytic institute is most hoping to affect. Its cultivation is the primary task of psychoanalytic education, for it is within the "I" that all other knowledge is synthesized. An ideal institute would acknowledge that there is no absolute knowing of "I," of one's particular voice, but there is the possibility of developing a relative fluency in the finding and losing of it in a sea of other competing voices. These voices include those of psychoanalytic writers, supervisors, and fellow candidates, in addition to all those others, living or dead, real or imagined in the candidate's life.
Candidates will, one hopes, come to realize, in their slouching toward Bethlehem (to borrow from Nina Coltart), that for each case, the psychoanalyst and the patient will come together at a particular point in both their lives. Illness, health, marriage, divorce, birth and death, joy and sorrow, fulfilled and frustrated expectations, and all the other ontological accretions that constitute human life will commingle to inform the context of the analysis. The participants will agree to have conversations that they hope will allow the patient to develop a greater sense of personal fluency, and the analyst an opportunity to ply his craft and make a living.
To be fluent with one's self suggests a talent for reading and accepting one's emotional responses, however challenging, and a capacity for being curious about how one construes meaning in the face of conflict. It is reasonable to assume, at least, that the analyst has had more experience than his patient in the struggle for personal fluency and that the analyst will allow himself, when necessary, to acknowledge that struggle in clinically appropriate ways. This is the greatest awareness the ideal institute can impart to its candidates.
Knowing How to Not Stop Knowing
The bible tells us that knowing not only can be dangerous but also can result in a shameful self-consciousness. Adam and Eve learned this the hard way after tasting ofthe Tree of Knowledge. Knowing can also be sexy and generative, as in "Abraham knew Sarah, his wife, and she who was thought to be barren, gave birth to Isaac." These types of knowledge are inextricably linked to specific emotional states-feelings of danger, shame, sexual arousal, and pride. Psychoanalytic candidates are subject to all these states, while in the intense process of unlearning what they thought they knew about themselves and their patients, under the watchful eyes of training and supervising analysts, who, in an ideal institute, would be open to unlearning what they thought they knew themselves, as well.
Unlike other forms of institutional learning, where, typically, in stepwise and linear fashion, trainees are expected to progress through an established series of study gaining greater mastery of the material as they pass from one year to the next, analytic candidates are expected to demonstrate their knowledge, in large part, by questioning it. Doing so is not to be considered a conceit, but rather an integral part of what many contemporary thinkers across diverse disciplines believe to be at the heart of perception and experience, namely, one's irreducible subjectivity. The paradoxical golden rule of psychoanalysis is that the patient is expected to say whatever comes into her mind, so as to free up associations that will perform the function of threatening an essentially defensive linear narrative. That is, the patient is required not to make sense, in an attempt at self-discovery. Similarly, candidates feel pressure to be open to their unconscious process and to use what they did not know they knew in getting to know how their patients do not know themselves.
Free associations, as Freud called them, are simply distractions about which one becomes curious. Free, or relatively free, from conscious awareness, these seemingly arbitrary mental wanderings carry within their twists and turns chains of associational meaning that, when considered from a variety of angles, inform us as to our most personal, and heretofore secret, agendas. We seem to be inherently unreasonable, yet it is in our unreason that our deepest sense is made. The trap is to think there is a formula or a particular way to achieve this.
The need to establish a formulaic way of conducting psychoanalysis can be found even in the cases of certain psychoanalytic writers favoring a dialectical constructivist or even a Buddhist sensibility, where there has been a studious effort underway not to have a way, which, in palpable paradox, becomes the nonway, way.
Unlike pretty much any other institution, the ideal psychoanalytic institute would, primarily via the training analysis, encourage candidates to learn how to not know, best. But what does this mean? It would, one hopes, mean facilitating a greater openness to juggling diverse feelings and thoughts, and receptivity to discovering what they did not know they knew. A kind of funhouse mirror meets Oracle at Delphi meets Colombo. Surrender to your distortions, court inspiration, ask a lot of (sometimes painfully obvious) questions. Remind me again why we didn't all go into investment banking?
At the beginning of my training analysis, during which period my analyst and I were getting to know "the lay of the land," as he put it, he asked me why I had so many names. I had mentioned, apropos of what I do not remember, that I had four given names. I told him what I was told as a child. My father was married five times and had three sons. I was the youngest. My mother told me that my middle-half brother was poisoned against our father by his mother and that he was named Nicholas, too, and that when I was older he might want to sue me. And so I was named Nicholas George John Frederick to distinguish myself from Nicholas Anthony. After I said all this, there was a pause and my analyst said, "Does that make sense to you?" I started to laugh and realized for the first time in my life that this was a crazy story and made no sense whatsoever. So I began to think about this and over a few sessions came to see that my naming was far more charged, and made a very different kind of sense, than I had ever imagined.
Was this realization a training success? The insight I achieved in this instance and over the course of seven or eight years was invaluable to me. And it is reasonable to think that my analysis, in helping me acknowledge what I did not know I knew, helped me help my patients more than if I had not had an impactful analysis. But are we to assume that this successful analysis equipped me to help everyone similarly? No, of course not. My ability to be of most use to my patients has something to do with how familiar I am with my own blind spots, but I still have some. And my ability to recognize and acknowledge my blind spots may well help me to help some of my patients, some of the time. But how could we institutionalize this? How do we generalize in a field where the specifics of each participant-and how they fit or misalign with one another-are key to the success or failure of the analytic endeavor?
The central topic of this discussion, the "ideal institute," needs further consideration. In fact, it parallels the paradox that patients are often seeking ideal solutions from analysis. Ideal, used colloquially, suggests states of being without any irritating conflicts. An obvious example is the concept of the "ideal mate." This notion suggests a fantasy person with whom one can perfectly reenact one's most formidable neuroses without any adverse consequence—someone who will always be there, ready, and eager to fulfill all our desires in exactly the right way. There would be an absence of conflict with the ideal mate. In its place would be a kind of beatific deadness. The wish for the ideal can be seen as a wish for deadness, for a permanent nonresolution of conflict, an ironic wish for a psychoanalytic institute, given that in the absence of conflict there is no need for one.
So it seems we must recast all this and accept the multiple paradoxes that shape our profession. We can learn how to be more aware of ourselves through our analyses; we can learn to be more comfortable with our own unconscious processes through analytic supervision; we can learn various ways of thinking about all this from the psychoanalytic literature. But at the end of the day there has to be something about the fit between psychoanalytic candidate and supervisor, between analyst and psychoanalytic candidate, and between patient and psychoanalyst that allows each person in the dyad to be engaged in the process. And that can not be taught.
Perhaps the ideal institute would be a collective body of reasonably well-analyzed psychoanalysts who would be good enough in their sensitivity to a candidate body whose training would require a beneficent deconstruction of what they thought they knew about themselves and their patients. In the casting off, and analysis of the yearning for the ideal, in spouse, analyst, or institute, it is to be hoped that humanness would not be considered a liability, but an essential asset in engaged living.