Psychoanalysis - for whom?

Feelings of anxiety and restlessness are to a certain degree completely normal and inherent to our condition as human beings from the moment we are born into this world. As babies, we are subject to so many new experiences which need to be absorbed into our mental lives that it makes babyhood and infancy a crucial time in our development.

When we get a bit older, people might ask us: “How old are you?”

How old are you for what? Say if you are only 3 years old! But from the time you are born you are old enough to die! Isn’t this quite distressing in itself?

Therefore, this feeling of anxiety becomes one of the familiar companions of every human being. It is what we call “real anxiety”.

But when can this emotion be said to be troublesome or even disturbing?

When it pops up “automatically”, without any prior indicator or sign, and sweeps away all our psychic defences, leaving us with a feeling of helplessness which leads to other emotions such as fragmentation, disintegration, dissolution, groundlessness, weakness and even futility.

It is one thing having ordinary anxieties but quite a different thing to be permanently upset by unwelcome sensations of restlessness or uneasiness. These assault the individual at any given moment, taking them by surprise, producing all sorts of symptoms, from simple or complex inhibitions, which might impair their daily activities, to dreadful, painful, attacks of disintegration of the self.

Most frequently people try to automatically account for their pain by seeking a motive; this is what psychoanalysis calls ‘rationalization’, which is an attempt to make the pain more bearable, in order to avoid the core situation. But most of the time these are only secondary causes. The real one should be looked for by means of some “talking work” within a psychoanalytical relationship, which might uncover the “mysterious” underlying facts.

There are many “causes” for permanent anxiety, some are easily graspable and become available for treatment and consequent relief and some others are found at a deeper level or have remained pent up within the individual’s personality, without specific treatment. All of them are potentially “understandable”, and it is important to confront them, so as not to let them develop into organic, psychic pain, which happens quite often.

It is also quite clear that there are different strengths of anguish and anxiety feelings and reactions, depending on personal background and education, as well as parental relationships.

Sometimes this degree of anxiety organizes itself into a variety of symptoms, such as phobias or fantasies of body illness or in other cases stays free, lying dormant, waiting for an unconscious reason to trigger an episode. But if any physical damage should be inflicted this anguish must be promptly treated.

When the psychic symptom has been structured, as in the case of phobias or even some addictions or obsessions, then comes the struggle to fight against these symptoms. This becomes the most important goal requiring quite an amount of energy, taking away from the individual’s potential strength and resources.

All anxiety, be it realistic anxiety, from which it is possible to free oneself and get on with living, or the automatic or traumatic anxiety, which will make one feel that one does not have peace of mind of any kind anywhere; with no-one at no time, no matter what one does to prevent it, it renders the suffererhelplessin thatall attempts to cope efficiently and pleasantly with daily challenges and activities become futile.

So, what is it that psychoanalysis offers? Perhaps the opportunity to soften or mitigate this pain and even get rid of this suffering - to just put up with it.

Treatment with a specialist in psychoanalysis, over a period of time, will let this anxiety find and/or create the symbolic roots and will let the lost psychic resources recover. This may bring about a real enrichment as well as a feeling of resourcefulness and healing, opening new possibilities of facing life with more pleasure.

THROWING A DIFFERENT LIGHT ON DEPRESSION

Despair, helplessness, hopelessness … these are words commonly used when we talk about and write about Depression. Winston Churchill’s now famous phrase “the black dog” has gained currency for its economy of graphic expression. Patients with depression frequently talk about “black holes”. This phrase, too, succinctly conveys both the blackness and the quality - borrowed from the world of physics – of sucking in and crushing everything, with no light being able to emerge. Depression involves this particular hopelessness – the sense that there will never ever be any light again; both “light” as in something to see by and “light” as in a relief to the heaviness.

We are hoping to convey that we psychoanalysts are dependent on language for patients to describe to us in available words and phrases what it is like for them to suffer from depression. Our language, however, is sometimes inadequate to the task of conveying the feelings in our minds. Anguish is a stronger term for mental pain. Mental pain? Yes, a pain as real as physical pain. The old-fashioned term “melancholia” tried to grasp it.

The pain of “depression” can take many forms: tiredness, hopelessness, helplessness, despair, unexplained sadness, disinterest, listlessness, a sense of emptiness, purposelessness and so on.

We are all comfortable with that part of our brains and minds that does mental arithmetic and has memories. But referring to the part of our mind that hurts is not so easy. Why and how someone’s mind hurts is a much more difficult thing to understand.

To coin a phrase used some years ago in a paper about suicide, we can suffer from "psych-ache".

“Psych-ache” is when our psyche hurts. It is very different from a “head-ache”. We are familiar and comfortable enough with “psych” when used in psych-iatry and psych-ology, perhaps less comfortable with psycho-therapy and psycho-analysis. But it is from the endeavours of psychoanalysts that we best learn from our patients the language and descriptions of what it feels like to suffer with depression – and if you listen sensitively enough and long enough, you usually find out why someone is depressed.

When it comes down to the individual who is suffering, only the actual relationship which forms with the analyst can reveal what is going on in this person’s mind and in their experience of their own life.

If, however, the mental pain and anguish being described do not fall into easily recognizable patterns, then more talking and listening is called for until that person’s psych-ache becomes better understood by both clinician and patient.

All this takes time - and patience. Finding adequate words is often difficult and exploring possible reasons for suffering depressed feelings is often painful in itself.

Let us acknowledge that there are some relatively readily recognizable patterns of symptoms in depression which do respond well to medication or cognitive techniques – but what about the others?

Psychoanalysts’ clinical experience suggests that “the others” fall into two groups: depressions of loss, and depressions of not having had (enough). Losses and deprivations: losses of parents, children, spouses and other important relationships; losses of jobs or losses of self-esteem; losses of mobility or even body parts resulting from illness or accident. Optimally, we should go through a period of mourning and grief for our losses – but all too often, mourning and grief are complicated by mixed feelings and the pain goes “underground” and disrupts our well-being.

“Depressions-of-loss” are often hard to identify because the very reasons they have been too painful to work through in the first place, cause them to be disguised and hidden from awareness – not necessarily awareness as “facts”, but awareness as to their relevance to our suffering. Sensitive listening on the part of the clinician is often necessary to help make connections between onset of depressive symptoms and a preceding episode of significant loss. Sometimes many smaller and larger losses occur in a short space of time which might cumulatively overwhelm our ability to digest them.

“Depressions-of-not-having-had” are much longer term problems where the whole personality is and has been “depressed”; opportunities in life have not been able to be taken and potential has not been able to be realized.

Youth suicide, a tragic example of this unrealized potential, often involves an intuitive feeling of this kind of despair, hopelessness and sometimes, self-hatred, which cannot be articulated. Understanding often brings about relief of suffering and certainly offers us a better perspective. Again, the relationship which develops in the analysis is the vehicle which provides opportunities for changes in previously self-defeating behaviours.

An adequate number of therapy sessions with a psychoanalyst to try to understand and then work through the issues are what is required. What is “adequate”? That varies from person to person. But, to give the therapy the chance for the depression to begin to be understood and then relieved, will require sufficient sessions to to reach the point of feeling that the psychoanalyst is able to “throw light” on the heaviness and offer hope in continuing the psychoanalytic process.

An all too uncommon reason for which some people seek treatment is the experience of persistent dissatisfaction with their life: they feel empty, bored and even nihilistic. They may have experienced several unsatisfactory relationships – or may not have succeeded in establishing any relationships at all.

Such people find that they derive no pleasure from their work and feel hopeless about improving this situation.

They may not regard themselves as being “depressed” – yet they share many features with people who would be diagnosed with depression: lack of enjoyment, poor appetite, trouble sleeping, lack of an enjoyable sexual relationship, in fact little interest in anything at all. Such people might even attract a diagnosis of clinical depression and might have anti-depressant medication offered to them.

Whatever it is that causes this chronic dissatisfaction does not respond to anti-depressant medication. The underlying causes and explanations can only be reached in the context of an analytically guided therapeutic relationship in which the person’s current experiences as well as their past experiences are explored within the safety and confidentiality of the therapy relationship.

It will take time (and courage) – but there is hope that satisfaction and purpose can be achieved.

Substance abuse problems and other “addictions” are – unfortunately – very widespread and take many different forms. Alcohol abuse is probably the most common, but the use and abuse of illegal drugs – as well as the abuse of prescribed drugs are also serious problems.

Uncontrolled gambling may well be an addiction too.

When people think of “addictions”, they may not readily think of eating disorders as addictions [see also: Eating Disorders] – or of shopping addictions – or of addiction to sex.

Nevertheless, all these behaviours, which are normal when undertaken within acceptable (i.e.not damage-causing) limits, can be understood to be “addictions” when they “get out of control”. The problem is that the “sufferer” of the addiction in question is often in strong denial as to the damaging nature of their own behaviour and it is often someone close to them who needs to make them aware of this – who may indeed be suffering much of the damage caused, be it violence (due to alcohol or drugs), loss of money (due to gambling), personality changes (due to almost any of the addictions) and so on.

Partners and children of “alcoholics” and “addicts” often bear the brunt of the addict’s disorder. Workmates often do too.

In our society almost everyone from health care professionals, politicians, ministers of religion, policeman, magistrates and judges, “ex-addicts” and the man-in-the-street all have their own opinions about addictions: these opinions vary from "addiction-is-a-medical-illness" to "addiction-is-a-moral-failing".

Psychoanalysts differ from almost all of these in considering that all forms of addiction are potentially understandable!

If we make a subtle, but important, change in word from “addiction” to “compulsion”, we can then ask the question why a person is unconsciously compelled to mis-use alcohol, drugs, gambling, eating, shopping, etc. in order to control unpleasant and unbearable feelings relating to their personal lives. They are in a “perverse” way "medicating" themselves or soothing themselves by misusing these otherwise usually normal human activities.

A motivated person, who wishes to be courageous enough to explore – with a trained psychoanalyst - the reasons for their using any of these “addictions” will almost certainly come to understand what “leads them” – or indeed compels them – into these ultimately highly self-destructive behaviours. Psychoanalysts consider that making conscious what was previously un-conscious offers both a better sense of well being and the hope of changing behaviour – the first steps toward healing.

The psychological meaning of a given addictive behaviour varies considerably from person to person. The behaviour may have a symbolic meaning – or it may be a kind of displacement activity. It may serve as a substitute for some other important need – or it may serve a destructive purpose. This by no means exhausts the possibilities.

A problem with all forms of addictive behaviour is that it all too readily gets in the way of having to think about oneself. In fact, addiction is the enemy of thinking! It is too easy to get drunk, go on a “spree”, go on a “binge”, have a “hit” or a “fix” and so on. So much so, that the idea of undertaking a psychoanalytic exploration of one’s problems is very difficult when one is actively under the sway of one’s addiction. A period of detoxification or “drying out” is often advisable in conjunction with considering a psychoanalytic treatment.

Nevertheless, understanding does offer the hope of some conscious control over previously “mysterious” forces influencing one’s behaviour. Also, the psychoanalytic relationship will bring many important aspects of one’s personal issues to light in the hope of dealing with them too.

The combination of the patient's courage and motivation, together with the psychoanalyst’s expertise, offers the best hope of getting free of the compulsive aspects of any of the addictive disorders.

Eating disorders are rife, almost epidemic, in our wealthier countries today. In spite of all the gains women have made in terms of the freedom to be who they wish to be, the cultural demand for them to be thin and well-toned has resulted in great unhappiness for many who find it difficult to be continually on a diet. The following symptoms have been noted: acute anxiety, depression, low self-esteem, binge-eating and/ or starving. Diet pills, diuretics and laxatives as well as smoking cigarettes are often used in order to lose weight as well as plastic surgery and liposuction. (Although most of those suffering are women, many of today’s men are also affected by this pressure).

A psychoanalytic exploration can enable you to try to understand the myriad reasons you have “bought into” a cultural demand that is not only unhealthy but often physically impossible. Together with a psychoanalyst you can explore the hidden and often unconscious roots of the need to conform and not stand apart from the crowd. You can explore the range of your “orality”, the meaning of food since your infancy, your individual history of maternal and other nurturance, feelings of being loved or unloved, acceptable or unacceptable. You can explore your “anality”, the meaning of food as something to be held onto or eliminated and your early proneness to negativity and/or need for control over your bodily functions. Patterns of passivity or rebelliousness are established early on. You can explore the healthy and not so healthy history of relations with the opposite sex in the context of paternal love and approval (which is often related to being “fat” or “thin”). What you do to win love is formed early on in relation to your parents, feeling loved by them, and that they find you desirable and attractive. This pertains to the early years as well as to the stormy years of adolescence.

In psychoanalysis you are given the opportunity to examine your feelings and fantasies about the analyst in order to better understand what is being repeated from early relationships and what goes on in your relationships outside the analytic situation. Psychoanalysts consider that eating disorders have much to do with unconscious fantasies about getting love from others, holding their attention, getting them to look at one’s body in order to consolidate one’s body image – or even expressing their anger at significant others.

The aim of psychoanalytic treatment is to enable you to find healthy physical and psychological solutions for your entire life.

While psychoanalytic theories are of great value in understanding “human nature” itself and its cultural products in the fields of literature, theatre and, especially, cinema, they are also invaluable to individual people who are troubled by their own distressing feelings and behaviour.

People who may be severely and chronically anxious or depressed, people who may have repeated difficulties in relationships, people who may have difficulty forming any relationships at all, or people who feel an unexplained emptiness in their lives, can benefit significantly from psychoanalytic treatment.

Psychoanalysis occupies a very complicated place in the modern world: it has a great deal to offer in helping to understand one’s own “self”, and how one’s own mind operates – as well as helping to understand much of how other peoples’ minds work!

Yet, by its very nature it leads us into often quite threatening and unwelcome territory.

When “Psychoanalysis” as a treatment technique was discovered by Sigmund Freud in the very early 1900s, he quite quickly understood that his findings – through his clinical work with patients – would “disturb the world”. This has proved to be true and nowadays even the mention of the word “psychoanalysis” attracts a hostile response from many people.

Nevertheless, for those with the courage to persist – either as patients, or students of the human mind – in trying to understand what psychoanalysis has to offer, there will be considerable reward.

Psychoanalysis, by its very nature, delves into the world of the unconscious mind. It operates on the basis that our early experiences – of whatever nature – strongly influence how our minds develop and how we interact with the other people around us.

Many significant psychoanalysts have contributed to our understanding of mental development and the operation of mental processes – especially the so-called defence mechanisms – and how these help us to deal with the world around us. While “psychoanalysis” is still almost automatically connected to “Freud”, this does not acknowledge the very many advances in both theory and technique which have resulted from psychoanalytic therapeutic work and research over the past 100 years.

Psychoanalysts have also worked with very highly disturbed patients, who would otherwise be diagnosed as “psychotic” by many psychiatrists. But if both the patient and the psychoanalyst have the required motivation and courage, good results can be obtained. Nowadays, medication is sometimes used alongside the psychoanalytic treatment, although reliance is heavily on the part of the treatment which is the relationship formed with the analyst.

Further information about psychoanalysis and what it has to offer will be found in other “pages” on this website.