Undercurrents

Part of what the Psychoanalyst does while listening with freely floating attention to the free associations of his patients is to allow the ripples arising form the depths to nibble at his attention until the vague hints and inchoate clues coalesce into a form that can be put into words.  From the undercurrents that animate our patient's words we begin to sense rather than actually see the patterns and structures that inform our patients conscious experience.  When such work is disrupted there is often a powerful reason.  A brief vignette from early in my career might be helpful:

A very brilliant middle aged woman, stuck in an unsatisfying job and an unsatisfying marriage entered Psychoanalysis for help in understanding her pervasive feelings of inadequacy and unhappiness.  On the surface she had all the gifts one might wish for; she was bright, attractive, wealthy enough that work was an option rather than a financial requirement, with interesting friends and a devoted husband.  Her history was most significant for what we didn't know rather than any particular trauma.  She had grown up in a middle class suburb of Philadelphia, went to an Ivy league school, had a brief failed marriage at a too young age, and had been married for 15 years to a man who cared deeply for her, was an intellectual equal, and appeared to be everything she wanted in a partner.

Early on it became clear that there was something amiss in her treatment.  She appeared to adapt to the process easily and naturally.  She was able to freely associate in ways that only very few patients seem to ever approximate, yet after several months during which I learned innumerable details about her life, her childhood, and her relationships, I realized that I actually knew very little about how my patient actually experienced the world she was so exhaustively describing.  I was quite puzzled by the apparent disconnect between her behavior on the couch and my growing conviction that I was missing the most crucial elements; worse, I had no idea what I might be missing.  I cautiously brought this conundrum to her attention.  I mentioned that though I thought I now knew a lot about the details of her life, I didn't feel that I knew much about how she experienced her life.  What did she feel when these events took place?  What did she think about the event she described?  It took quite a long time to discover what was going on.

In my work I try to be careful not to "put words into my patient's mouths."  I am very cautious about interpreting how my patient feels in the absence of good evidence.  Clenched teeth are highly suggestive of anger, but in cases where my patient is less aware of her own interior life and emotional states, an incorrect reading of her state can be unnecessarily disruptive.  (At a different, later, stage in therapy it can be especially necessarily disruptive, leading to explorations of the various transference and counter-transference elements of my empathic failure but that was not the issue in this early phase of her treatment.) 

This woman was always very contained and careful to maintain a relatively neutral surface appearance.  I began to wonder about the relative lack of affect in the sessions; she would describe feeling angry or sad or happy but didn't appear to fully inhabit the states; it was as if she were describing someone else's emotional states.

After some time I realized that I had been particularly diffident in confronting this particular patient.  Her recollections always sounded so clear and convincing that I had not thought to wonder how she might be distorting reality.  I could not understand my behavior and wondered if it represented an enactment with her of some problematic early relationship (a transference-countertransference enactment.)  I considered the possibility that the inchoate discomfort I was experiencing in her sessions was related to significant unconscious, intense emotional states. When she described an interaction at work in which she had evinced a profound disappointment over what sounded like her boss's less than enthusiastic approval, I offered a mild, trial interpretation:  I asked her if she might have been over-reacting.  Her reaction was instructive and almost frightening.  She told me that my question was insensitive and annoying.  She was describing events exactly as they had happened and for me to accuse her of lieing was infuriating.  For the next few minutes she escalated until she was ready to quit her therapy and renounce Psychoanalysis as a  sadistic form of abuse.  However, she did not quit her therapy but instead spent the next several months periodically erupting in quasi-paranoid rages at my perceived abusive indifference and intrusiveness.  It marked the beginning of  a long, difficult, though ultimately very successful, treatment.

The reason I bring up this old case is that it taught me a great deal about myself and the workings of the therapeutic relationship.  I realized in retrospect that I had been subtly avoiding doing anything that might provoke her and that is why the analysis had felt so removed and superficial.  I had noted her underlying rage without fully being aware of it.  My unconscious need to avoid her rage colluded with her unconscious need to avoid her primitive annihilating rage.  We had both colluded in elevating "peace in our time" above the goals of understanding and solving her various problems.  Of note, our avoidance did not diminish her rage or resolve any of her conflicts; it merely allowed her to continue to express her rage in disguised and ultimately quite destructive ways.  Without her treatment she would have destroyed her marriage and prevented herself from ever finding her way to the highly rewarding and successful work she desired.

The relevance to our current cultural predicament is clear.  Whenever I read someone who soft-pedals the risk from Islamic terrorists, or from radical Islam, whenever I contemplate such exercises in appeasement as the Annapolis conference, or the muted reaction of Western officialdom to such outrages as an English woman/teacher being threatened with jail and 40 lashes for naming a teddy bear "Mohamed", or a 19 year old Saudi rape victim receiving 200 lashes for being responsible for her own rape, I consider the likely outcome of avoiding the paranoid rage that is always lurking just below the surface of public Islam.  This is not to re-engage the question of Moderate Islam; in point of fact if the public face of Islam is rage and it is constantly amplified by the MSM and official government actions (both in the Muslim world and in the West), the existence of a significant Moderate Muslim cohort becomes mooted.  The important point from my work is that rage avoided is rage that can only grow; rage that is confronted and dealt with can be understood, channeled, and contained.

We do neither the Muslim world nor the West any favors by behaving as if their rage is so terrifying that we must avoid it at all costs.  If we do not vocally address and confront the rage and its derivatives, we will  one day, once again be forced to confront its violent fruition.