21 April 2014

On nuances of loss

I've just finished Stephen Grosz (2013) The Examined Life: how we lose and find ourselves (London, Vintage).  As so often, it comes with lots of hype on the cover, but for once it may be justified.

It is a series of essays, perhaps meditations, or even reflections on some of his patients, their experiences and the experience of therapy. They are not case-studies—that term implies far too much distance. It is very readable, moving and thought-provoking.

Grosz is a psychoanalyst. That has always been a confusing label. He is not a medical doctor, not a psychiatrist. It's not even clear whether he is a psychologist (clinical psychologists treat behavioural and psychiatric problems in ways which do not involve medication or other physical interventions, usually based on established treatment protocols originating from academic and clinical research). He is a psychotherapist, technically, in that he practises "talking cures", but that is too broad a label, in that it now includes practitioners of cognitive behavioural therapy (CBT), who are very effective for "routine" cases of depression etc. (I hasten to add that there is nothing at all "routine" about the experience of clinical depression.)

Grosz is a lay (non-medical) psychoanalyst. Technically that implies that he is a follower of Sigmund Freud, but that is much less likely to be the case than 25 years ago, when he began to practice. Freud's daughter, Anna, gets a look-in in the book, but only when a young patient mixes her up with Anne Frank. Sigmund gets one mention in the bibliographic notes. So does Dr Seuss.

I labour this point a little because psychoanalysis (now much more a critical "lens" for the humanities than a serious approach to the treatment of neurotic disorders) does have a few very distinctive features:

It takes its time. As Grosz puts it;
"Most of my work [...] has been with adults in psychoanalysis--meeting with one person for fifty minutes, four or five time a week, over a number of years. I have spent more than 50,000 hours with patients." (p. xi)
It takes as long as it takes. It has to be acknowledged that "efficiency" is not psychoanalysis' strong suit, particularly when patients sleep all through their allocated time, and the analyst lets them ("Through Silence" p.199). And it does tend to support David Cohen's observation (from memory) about psychiatry in the USA, that the better qualified and the more skilled the practitioner, the more trivial the problems he deals with... And of course there is the skewed demographic profile of patients, because it is extremely expensive. But the other side of the story is that there is no need to push patients into pigeon-holes. (I remember a couple of professionals in the field--no idea of their professional labels--catching up  before a case-conference settled down to business. One said, "Oh, her? British Standard Low Self-esteem, level 3!")  Grosz readily admits formulating initial hypotheses about the problem, and then abandoning or refining them, or waiting months for the evidence to test them.

It contextualises the presenting problem within the life-space of the individual patient--and perhaps their family or immediate relationships. There's almost no jargon in this book, and indeed some trenchant dismissal of conventional wisdom (especially the "closure" myth; "My experience is that closure is an extraordinarily compelling fantasy of mourning. It is the fiction that we can love, lose, suffer and then do something to permanently end our sorrow..." (p. 209). Instead, there is a much more dynamic view, characteristic of humanistic depth psychology at its best: What is the point of this behaviour/reaction/experience? What does it do in this particular setting/relationship/personal history? What is it preferable to (i.e. defend against)? What is involved in giving it up?

This is, I think, the defining characteristic of psychoanalysis and its variants. Freud was wrong about practically everything, but every great innovator is practically bound to be. So was Marx. So was Darwin (less so, of course; he just didn't have the tools we have today). Initial formulations are simply starting points. But the recognition of what lies behind trivial issues and interactions (such as vacillating about whether or not to take off one's shoes before getting on the traditional couch [p.169]) and how minutiae can expose great themes is a transformative framework.

The sub-title, "how we lose and find ourselves", suggests that loss will be a major theme, as indeed it is. The section on "Changing" (pp. 121-196) discusses the issues of loss implicit in even the most beneficial change. It's long been an interest of mine, but while I have tried to explore some of the general principles in respect of learning (“Learning as Loss”), Grosz engages with specific instances and manifestations in the lives of specific individuals. His stories are far more nuanced than anything I could aspire to.

Incidentally, I was also reminded of a psychodrama exercise; the Magic Shop (Moreno, 1948), which focuses on the “bargain” of change, and how everything has to be paid for. It is a far blunter* instrument than Grosz would use, but I've used it effectively (I think!) in the past in an educational context.

* I almost wrote that it was a far too "gross" instrument... Now what would that imply?

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