Wednesday, October 7, 2015

Talking Cures

Whatever their rationale, psychoanalysts have always avoided face-to-face contact with their patients. Beginning with Freud they have traditionally sat behind their prostrate patients, looking off into space while their patients were gazing at the wall.

Considering that treatment traditionally involved an hour a day every week, that’s an awful lot of avoiding non-face-to-face contact. Of course, you want to know what the deeper meaning of the practice. Here it is. The attitude signifies rejection.  Analysts who engage this practice are saying that their patients are not good enough to face them.

Many of today’s psychoanalysts believe that they have made a great leap forward. They have rearranged their furniture so that they can look at their supine patients. Most often, however, their chairs elevate them above their patients so they are more likely to look down at their patients than to look them in the eye. It doesn’t signify rejection. It is closer to condescension. Nothing about that should surprise anyone.

Amazingly, some analysts think it’s some kind of major achievement to look a patient in the eye. In truth, it ought to be a given.

I have often opined that psychoanalysis produces more depression than it cures; now we know one way that it does so.  New research has shown that if you want to overcome depressive tendencies you should, among other things, converse with people face-to-face.

In the old days when psychoanalytic orthodoxy ruled, it was commonly said that the inferior kind of treatment-- known at the time as psychotherapy-- was distinguished by the fact that patient and analyst had face-to-face meetings. The superior kind of treatment-- known as psychoanalysis-- was said to have begun when the patient lay down on the couch and abandoned the “crutch” of speaking to his analyst face-to-face.

Then, analysts overcame their tendency to converse with their patients. They listened with rapt attention to communications that were coming from their patients’ unconscious minds. They called it free floating attention, but it was more like daydreaming and tuning the patient out.

Of course, failing to take a patient at his word is a way to reject him, to diminish and demean him.

You get the picture.

Current research has addressed the negative emotional consequences of communicating via written and not spoken media. It distinguished between texting and speaking to someone face-to-face. It even found that phone calls were less effective than immediate contact. It concluded that: the more face-to-face contact you have with other human beings the less likely you are to be depressed.

Want to improve your mental health? Instead of lying on a couch and babbling about green fields, try sitting up, looking your therapist/analyst in the eye, and having a conversation with him. That assumes that he knows how to do so.

Replacing face-to-face contact with friends and family with emails, text messages and phone calls could double the risk of depression, a major study suggests.

Research on 11,000 adults found that those who meet friends and family at least three times a week are far less likely to suffer from depression.

Individuals who had such contact just once every few months had an 11.5 per cent chance of later suffering from depressive symptoms two years later.

By contrast, those who met up with family and friends at least three times a week had the lowest level of depressive symptoms, with rates of 6.5 per cent.

And also:

Dr Alan Teo, lead author and assistant professor of psychiatry at Oregon Health and Science University, said: "We found that all forms of socialisation aren't equal. Phone calls and digital communication, with friends or family members, do not have the same power as face-to-face social interactions in helping to stave off depression."


Dr Teo said: "Research has long supported the idea that strong social bonds strengthen people's mental health. But this is the first look at the role that the type of communication with loved ones and friends plays in safeguarding people from depression."

Connecting to other people is better than not connecting with other people. If your mood is markedly improved by having a direct conversation with someone for three times a week think of all the damage you do by meeting five times a week with someone who will not face you and who makes looking you in the eye a major personal psychodrama.

For the record, analysts who need to psychoanalyze themselves before they can look their patients in the eye are simply rationalizing their failure to do so from the onset.

Here, the history of psychoanalysis is relevant. Freud performed his initial self-analysis by writing letters to his friend Wilhelm Fliess. Ever since, people have called it his writing cure. Everyone has seen it as distinct from psychoanalysis proper, which has been  known as the talking cure.

By all appearances, however, psychoanalysis is much more like a writing cure spoken out loud than a talking cure. If that is the case—the latest research suggests as much—we should not call it a cure at all.

Strangely, this research comparing the relative value of direct spoken communication with written communication reflects on a practice that is called deconstruction. You may or may not know it, but this pernicious practice—it’s a fancy philosophical term for pogrom—has claimed that Western civilization is based on a systematic repression of writing in favor of speech.

Deconstructionists argue that the speech act involves presence and the use of the voice. It also, obviously enough, involves face. All of that is reasonable enough. This being the case, when you are speaking to someone face-to-face you will have much more difficulty avoiding responsibility for what you say.

Writing can be performed anonymously. When your reader reads what you wrote, you will very likely be absent. Writing silences your voice.

This means that you can say more stupid things in writing than you can in speech and can more easily evade responsibility for your actions. The argument suggests that by overcoming the cultural prejudice toward speech you can get in touch with your inner demons and allow them to express themselves freely.

You can say offensive and insulting things and no one will know that you were the one who said them. When it is not trying to make us into junior brown shirts deconstruction is trying to make us all into internet trolls.


Ares Olympus said...

Stuart: ...when you are speaking to someone face-to-face you will have much more difficulty avoiding responsibility for what you say.

I can go back and forth on all of this. I'd tend to consider that it is easier to take responsibility in writing because
(1) You have time for a measured response, compared to a gut reaction in person that might be unkind
(2) You can't undo what you've written and shared, while ignoring recording devices, you can deny what you just said, or claim you said something else, or meant something else.

And I don't feel rejected when someone isn't looking at me. I might feel more self-conscious and distracted by continual eye contact.

But of course the advantage of face-to-face communication (or one-on-one in general) is that you can adapt what you're saying based on how the other person is responding, so like if they seem bored or distracted or upset, you'll know you're probably not being heard, and you can halt and see what the other person needs before trying to continue.

I've heard it claimed, maybe first by Deborah Tannen, that women will tend to communicate face-to-face more, and men side-to-side more, without paying attention to facial clues. OTOH, vision however quick, might be the least accurate of our senses, and listening how someone says something might be more important. Of course you can do both, but not everyone might be as skilled in taking in sight and sounds and "hear" both well?
Here's one:
• The Vis-à-Vis Frame. When two people come together, they greet and address each other in a face-to-face position. They will adjust the distance between themselves according to their ethnic traditions, their level of intimacy, their prior relationship, their business together, and the available physical space and circumstance. The vis-à-vis frame is a prerequisite for making eye contact.

• The Side-by-Side Frame. Often, this is a communication choice, especially among men. It precludes eye contact. However, sometimes unrelated people assume a side-by-side position by accident or because of the physical nature of their circumstances. They happen to be walking in the same direction or they sit down on the same bench or the same seat on a bus. In this case, they may have no other relation to each other.

Mat said...

That makes me all religious. Seeing God's face is man's desire.