Thursday, June 4, 2015

45 Years on the Couch

Psychoanalysts have been thrilled to see that the New York Times’s “Couch” column has now presented a case study of a treatment that lasted 45 years.

More often than not, the cases in this fascinating column present a less than favorable picture of psychoanalytic psychotherapy. See the case of Will Lippincott, via my post.

Yesterday, it published an account of a 45 year psychoanalysis. The patient was philosopher Gordon Marino. The analyst was Beatrice Beebe.

Since Marino is largely pleased with his treatment, analysts have touted it as a counterweight to the current movement toward short term, cognitive treatments, the type that Lippincott found via Marsha Linehan.

Of course, we should not draw quick conclusions from Marino’s case. One case is nothing more than an anecdote. It does not prove anything. Anecdotal evidence does not make for science.

Be that as it may, what does philosopher Marino tell us about his treatment?

When it began he was in serious trouble. He explains:

I was a 19-year-old undergrad at Columbia University. Back then, when the froth of my inner life came to a boil, I had no way of calming myself down and would invariably transform inner theater into street theater. One evening the play took the form of an overdose of Valium, a half-gallon of wine, a street brawl and being clubbed unconscious. Another night, it was something darker. I was on the brink of a transfer from Columbia to Rikers Island.

One should mention—because Marino does not-- that in 1970, the time when he engaged his treatment cognitive therapy barely existed and SSRIs were not available. Thus, psychoanalytic therapy was the only game in town.

When Marino first met Beatrice Beebe, he was struck by her good looks and her sex appeal:

I was assigned to Beatrice Beebe, who I would come to find was a mere six years older than me and had only to log a certain number of clinic hours in order to take her Ph.D. in clinical psychology. In his Symposium, Plato teaches that erotic desire is the initial pathway to wisdom, perhaps to self-knowledge and a semblance of self-control as well. Beatrice was attractive. After glimpsing her figure, mischievous smile and warm brown eyes, I figured I had hit the jackpot.

Fair enough, a seriously Freudian treatment runs on libido. Jacques Lacan happily compared the psychoanalytic transference to the kind of erotic love that Plato celebrated in his Symposium.

One doubts that Aristotle would have agreed. Many other philosophers and poets would argue that erotic love is not the pathway to wisdom, but that is for another day.

When Marino first began treatment he was not lying on a couch. He was talking to Beebe face-to-face. Apparently, she was very good at keeping him engaged in treatment. At a time when he was skipping classes he did not miss any of his sessions with Beebe.

One might chalk it up to her professional abilities, but Marino seems to present it as a form of erotic attachment. Strangely enough, he does not provide many instances of her exceptional professional acumen or skill.

What mattered to Marino was the human connection he was forming:

With great kindness and epiphanic insight, she tendered a story about my inner life that gave me some distance from the mayhem. Still, it was her warmth and consistency as much as her illuminations that were nudging me away from my puppetlike relation to my impulses.

Those who are familiar with orthodox Freudian psychoanalysis know that Freud’s treatment model seriously discouraged analysts from forming a human connection with their patients. Only when analysts are strictly blank screens can they allow their patients to mistake them for their parents, that is, to take them for people they are not.

Those who are not familiar with Freudian psychoanalysis would do well to read my book, The Last Psychoanalyst.

If Beebe was not conducting classical psychoanalysis, she was certainly conducting something that therapists these days call psychoanalytic psychotherapy. As opposed to Freud, who is logically consistent and theoretically rigorous, this new form of psychoanalysis is theoretically muddled and confused.

Given this confusion, it is not surprising that, as I put it, psychoanalysis in New York has gone the way of alchemy.

My former colleagues in France, who are far more rigorous about theoretical matters, continue to practice strict Freudian analysis. Theirs resembles a thriving profession. Not so much because they are skilled clinicians, but because they can offer their patients membership in a Freudian cult, something that most New York analysts avoid.

Marino was pleased with the early years of his extended treatment that he even offered a summary of its positive effects:

I eventually managed to control myself enough to graduate and even to begin grad studies in philosophy, but there were always major fires, the smoke from which made it impossible to talk about bedrock issues. There was a disastrous marriage and a divorce. I dropped out of graduate school three times and stumbled from job to job.

At one point, I was hospitalized and plied with meds that purportedly “put a floor” under my depression. Within a few weeks, I was released and went to stay with my brother in Maine. There, I would park for hours, almost catatonic and staring into a space occupied by images of hangings and other suicidal delights. On a hoary winter afternoon, I was sitting on the floor in his cellar and peering over the lip of doom. Teary-eyed, my brother put his hand on my shoulder and asked what I wanted him to do if I chose the rope and beam.

One is slightly aghast at the idea that Marino’s life, one that filled with massive amounts of Sturm und Drang was “smoke” that made it impossible to talk about important, by which I assume he meant childhood, issues.

I suspect that his analyst refused to help him deal with the chaos that was enveloping his life. Had she done so, perhaps he could have been more engaged in his life, more thoughtful about his decisions, and less fixated on her beauty.

In any event, if psychoanalysts want to claim credit for such an outcome, they have a problem.

At one point, Marino describes the fact that throughout his perambulations and peripatetic voyages Beebe clung to him. At some level it was clear that she had faith and confidence in him, so perhaps that helped him. Or else it made him feel that his affections were reciprocated.

I have come to think of profound psychological change as akin to the long slow arc of a supertanker shifting direction in mid-ocean. By increments, my relationship to Beatrice changed my relationship to myself. I am not certain of much but I am certain my life would have been otherwise without her, my Freudian bodhisattva.

One accepts that his life would have been different had he not met Beebe. It may have been worse but then again it may have been better.

Evidently, the reference to Buddhism suggests that he lived a religious experience.

I am not sure whether the analysis has ended or whether it has become what Freud called an interminable or endless treatment. When Marino explains that his current conversations feel like those between friends rather than between patient and analyst, it sounds like the analysis has moved to a better place.

Marino offers what a very recent exchange. Since it is the only exchange that he recounts literally, it is worthy of some attention:

One night not long ago, I was waylaid by a dream that a family member’s cancer had come raging back. I was unable to scream, but with my arm around my wife, I tried to form the words: “Beatrice, help. Save me.” It was the first time that Beatrice had ever bubbled up like that in a nightmare. With her in New York and me in the tundra of Minnesota, where I now live, I called to talk with her about the dream. A virtuoso of self-scarification, I insisted, “The dream is proof that not everyone who dies in their sleep dies peacefully.” Beatrice chuckled and assured: “It was a good dream. Good in the sense that you could allow yourself to call out to me.”

Think about this.

For Beebe a good dream occurred when a family member’s cancer “came raging back.” To my mind nightmares are not good dreams, but then again I wasn’t there.

Also, once awakened by the dream Marino, with his arm around his wife tried to call out to Beatrice to save him. Why didn't he call out to his wife? 

One recalls that a character named Beatrice figures very prominently in Dante’s Divine Comedy. Surely, a philosophy professor knows about Dante’s Beatrice.

Read through Marino's text and you discover that he always refers to his analyst as Beatrice. One suspects that he has a Dante complex.

And yet, while Dante espied the fair Beatrice (a slip of a girl at the time) once, in a church and at a distance, Marino saw his Beatrice in person face-to-face and on a telephone for 45 years.

Presumably, this makes him worthy of salvation.

Beyond that, it is curious that Marino calls out to his analyst while he is holding his wife. One wonders why he calls out to Beatrice to save him or to help him when the dream is about a family member having a recurrence of cancer.

As for Marino’s dazzling insight, we can easily agree that he is entirely correct. Not everyone dies in their sleep peacefully. Why it took 45 years of psychoanalysis to come to this conclusion escapes me.

When Beebe responds that the good thing about the dream was that it allowed him to call out to her, she shifts the focus to her and to the extended relationship the two have been having for these many years.

If his dream is trying to tell him something about your life, Beebe’s efforts to draw him out of his life and into his relationship with her feel counterproductive.

One does not understand why Marino would, upon hearing that a loved one was dying from cancer, call out to his analyst to save him, but perhaps it’s all about his eventually passage through the gates of Heaven, led, like Dante, by a Beatrice.

For my part I would be more encouraged if Marino were living his life and not continuing to live in a fictional relationship with his analyst.


Ares Olympus said...

re: If Beebe was not conducting classical psychoanalysis, she was certainly conducting something that therapists these days call psychoanalytic psychotherapy. As opposed to Freud, who is logically consistent and theoretically rigorous, this new form of psychoanalysis is theoretically muddled and confused. Given this confusion, it is not surprising that, as I put it, psychoanalysis in New York has gone the way of alchemy.

I have no hope or wish to judge the success or failure of a 45 year therapy, although it does sound excessive on the surface.

But it does make me curious about "classical psychoanalysis" vs something else. At least we can agree there are different methods done, and if Freud was overly objective and nonrelational, clearly there are other approaches. Calling Freud "logically consistent and theoretically rigorous" might be a good approach for fixing a car, and you've expressed about the same idea before, that we're social beings who learn in social settings, face to face, where we can see how we're affecting another, and when we're not.

So I'll certainly agree its "muddled" to call "classical psychoanalysis" a success if you're evaluating something else. But what is this something else?

Wikipedia finds her name here, in a very short article.
The term "intersubjectivity" was introduced to psychoanalysis by George E. Atwood and Robert Stolorow (1984), although this philosophical concept dates back to "German Idealism".

Trends in intersubjective psychoanalysis have accused traditional or classical psychoanalysis of having described psychic phenomena as "the myth of isolated mind". Psychoanalyst and philosopher Jon Mills, has criticized this accusation as a misinterpretation of Freudian theory.

Heinz Kohut is commonly considered the pioneer of the relational and intersubjective approaches. Following him, significant contributors include ... Beatrice Beebe.

So apparently we're evaluating "Intersubjective psychoanalysis" rather than classical?

Language is strange the article starts with "...I can attest to, since I have been on the couch for almost 45 years with the same person." and later says " There was no couch, just a couple of chairs in a small cubicle. We sat facing each other."

But the article never otherwise mentions "intersubjective" if that's what she calls it formally? I'm still guessing.

It also makes me consider if this man had a "45 year relationship" with his priest or pastor, we'd think nothing of it, but I don't think most religious counsellors get directly paid for their services. So for me its only the profit motive that looks suspect.

I can't easily let go of the idea you're "paying someone to care" so it seems like a rich person's indulgence rather than a serious treatment, or as you say a "fictional relationship", assuming fiction is always demeaning.

In my own mental fiction, I think I'd be frustrated as a therapist for taking so long, so rather than trying to make a life long relationship with patients, I'd teach them to be "fishers of men" like a good saint, so whatever they learn with me is something worth sharing with others, and analyzing people in general is rude anyway.

And in all that "transference stuff", you imagine anyone who sees you "one up" eventually rebels in some way, and when that happens, then you can stop playing guru, and force them to clarify their new claimed authority, and ideally the stop needing your approval or disapproval or whatever. Or at least they say parents have to do the same for their adult children. I read more than I really understand of course.

Yes, 45 years is too long.

priss rules said...

Emma Sulkowicz is a real piece of work.

NancyB said...

How did he pay for 45 years of therapy? What did Beebe charge?