Poetry Leeds Winter Edition 2003      LITERATURE AND PSYCHOANALYSIS ISSUE ONE

LITERATURE AND PSYCHOANALYSIS ISSUE ONE

THE MAN ON THE TELLY

 All smarm and snide

One fat cat’s ride

Is nearly said and done

The truth is very nearly out

And then he’ll fucking run.

The brogue that once

Was ironed out by elocution skills

Begins to break into his speech

As he clings on beyond his reach-

Far better to stay dumb

Than uttering the platitudes

That every fat cat can:

“He was a charming man who gave us no concern,

‘Attempting murder on parole?’ Well, it was never proved”

The key report stuck in the post

Was one he tried on me –

Its just he puts awkward mail

Under lock and key.

“We only look at someone in a general kind of way

This record for mass murder’s sad you seem to say

But I’m not here to make things clear, my job’s

Not on the line, I’ve never broken rules about

A patient’s confidence, its just complaints I hate.

I bin the lot and stop the care, not punishment

But savoir faire and bend consultants ears to mine

And talk about promotion further down the line.”

“The views of service users is manifesto crap

 I’ll pay lip service all the way but power’s in my hands to stay

Board members can be silenced, councillors ignored,

MP’s baffled, even ministers taught

I’ve friends that can’t be touched, my record’s

Clean as anyone’s, not tarred with any brush that would ever

Stand up in court. THREE MURDERS IN BACK ALLEYS,

HALF A DOZEN RAPES, but he had rights and I have power

Reports, investigations, I’ll stall and stall and stall.

They put me in as recompense for excellent PR,

Public safety’s not my pitch, my contracts tight 

As is my right, I’ve worked for all I’ve got.

AS FOR QUESTION PUTTERS I’D HAVE THE BUGGERS SHOT

I’M HERE FOR BEER AND BRANDY, CIGARS AND CHAUFFEURED CARS

POETS STUCK ON BENCHES, RELATIONS OF THE DEAD,

NONE OF THIS CONCERNS ME LEGALLY I’M IN THE CLEAR

SO FAR I’VE BEEN COURTEOUS BUT NOW GET OF HERE

TO FOUR PSYCHOANALYSTS - RICHARD CHESSICK,

JOHN GEDO, JAMES GROTSTEIN AND VAMIK VOLTAN

What darkness have you lit up for me

What depths of infinite space plumbed

With your finely honed probes

What days of unending distress lightened

With your wisdom, skills and jouissance?

Conquistadores of the unconscious

For three decades now often have I come to you

And from your teachings gathered the manna

Of meaning eluding me alone in my northern eyrie?

Chance or God’s guidance - being a poet I chose the latter -

Brought me to dip my ankle like an amah’s blessing

Into the Holy Ganges of prelude and grosse fuge

Of ego and unconscious, wandering alone

In uncharted waters and faltering

Until I raised my hand and found it grasped

By your firm fingers pulling inexorably shoreward.

Did I know, how could I know, madness

Would descend on my family, first a sad grandfather

Who wrought destruction on three generations

Including our children’s?

                        I locked with the horns of madness,

Trusted my learning, won from you at whose feet I sat

Alone and in spirit: yet not once did you let me down,

In ward rounds, staying on after the other visitors -

How few and lost - had gone, chatting to a charge nurse

While together we made our case

To the well meaning but unenlightened psychiatrist,

Chair of the department no less, grumbling good naturedly

At our fumbling formulations of splitting as a diagnostic aid.

When Cyril’s nightmare vision of me in a white coat

Leading a posse of nurses chasing him round his flat

With a flotilla of ambulances on witch’s brooms

Bringing his psychotic core to the fore and

The departmental chairman finally signing the form.

Cyril discharged on Largactil survived two years

To die on a dual carriageway ‘high on morphine’

And I learned healing is caring as much as knowing,

The slow hard lesson of a lifetime, the concentration

Of a chess master, the footwork of a dancer,

The patience of a scholar and a saint’s humility,

While I have only a poet’s quickness, a journalist’s

Ability to speed-read and the clumsiness

Of a Circus clown.

SOME NOTES FOR MENTAL HEALTH CARERS

I have been a mental health carer for over twenty years. The National Schizophrenia Fellowship has recently begun some local workshops and the government passed the Carers and Disabled Act 2000 which has given carers some recognition of their role and established that they must be ‘listened to’. Carers have a right to a ‘Carer’s Assessment’ from local social services departments, though what this may achieve in practice remains to be seen.

During the time I have been a mental health carer I have looked in vain for some basic guide book and in frustration I decided to write some brief notes myself based on experience and that is something I, like most mental health carers, have more of than I would like and much of it very negative. Sitting in A&E depts with a patient waiting for a bed to be found (my record to date is eight hours) is something anyone can understand, as are long periods waiting by a phone but the levels of anxiety an mhc can suffer and the stresses they are often subject to and which can cause mhcs to suffer extreme mental distress and end up seeing a psychiatrist themselves are not.

If a mhc tells people outside the mental health system how their day-to-day lives are caught up in a series of crises the listener tends to recoil in horror. A friend from my childhood simply stopped calling me because she became terrified that someone in her remarkably sane family might become ill and she would be put in the mhc role.

This is how it usually starts. A family member develops a mental illness - usually manifested in the form of breakdown and possibly a hospital admission - the team looking after the patient will expect a relative to take on the mhc role interfacing with nursing and medical staff, providing details of the  family history, taking the patient off the ward for periods and taking very considerable responsibility for the patient once they have been ‘discharged into the community’ which may vary from a few days to many months after the admission.

No training is given and beyond the phone network of local carers groups that is the situation mhcs usually find themselves in, at at the very deep end, we need to be clear about that.

There are ‘Carers Centres’ of varying quality but one I had the misfortune to encounter was run by a draconian manager who in my opinion discriminated against mhcs as not being ‘real carers’ (i.e. carers for the physically disabled). My complaint against the person involved has dragged on for nine months and has yet to be resolved.

When patients are discharged they must by law be provided with a CPA discharge which is called an ‘enhanced plan’ if the patient is severely ill his plan lists various facilities the patient has been referred to (eg. day hospitals, ‘drop ins’ and day centres) treatment (eg. medication and psychotherapy) and a series of phone numbers for members of the mental health team assigned to the patient. Most important is the key worker i.e. the mental health professional designated to carry overall responsibility for the patient’s welfare on a day-to-day basis.

The key worker may be a CPN (Community Psychiatric Nurse), but there is a national shortage of CPN’s and another member of the mental health team may take on this role.

Useful as a rule of thumb guide qualifications may be, in a crisis it is the ones who really put themselves out to help that matter.

There are some very good consultants but also sadly, some very inept ones. Often those in the latter category are locum consultants ‘filling in’ for a few weeks to a few months while a permanent appointment is being made. Nationally there is s shortage of 400 consultant psychiatrists and the most frustrating situation of all is when one locum is replaced by another ad infinitum. Some locums are passable but some are dreadful and if you feel your patient is suffering poor quality treatment due to an inept consultant you should make your concern known to the care co-ordinator, whose name and phone number will be found on the CPA discharge plan you will have been provided with a copy of.

If you get nowhere make a written complaint via the complaints manager to the Chief Executive of the Mental Health Trust responsible for your patient. If this doesn’t work go to the Medical Director of the Trust and to your local Community Health Council (soon alas to be abolished). If all else fails contact the Strategic Health Authority, whose telephone number will be available from your local library.

The mhc needs to know as much as possible about mental illness. Start with the appropriate section in your local library  Once you get the hang of the basic vocabulary you’ll find it much easier to get a hearing with the mental health team. The more you read the more notice you’ll be taken of.

Since writing this article I have discovered ‘MENTAL ILLNESS- A handbook for MENTAL HEALTH CARERS’, edited by Rosalind Ramsay. Published by Jessica Kingsley at £15.95 (ISBN 1-85302934-3) This is an excellent and well-researched book (over 300 pages) by a large range of specialists from the mental health field. An absolute must for all mental carers. The one thing I can’t find is a section on ‘How to Make Complaints’. I’ve yet to meet the carer who doesn’t have any and they can - and indeed must - be resolved. If this book runs to a second edition - as surely it will - this is an area that needs to be addressed.

BEYOND BEDLAM: POEMS WRITTEN OUT OF  MENTAL DISTRESS

Ed. by Ken Smith & Matthew Sweeney, Anvil Press ISBN 085646 2969 9. £7.95

This is an outstanding anthology, though not quite in the way the blurb might lead us to expect. Most of the poems are by well-known long-dead poets but it is an excellent idea to have in a ‘thematic’ collection such as this. Eliot, Rimbaud, Roethke, Ginsberg, Lowell, Berryman, Sexton and Plath all wrote on aspects of mental illness and the recent critical reaction against ‘Confessional Poetry’ is more than adequately rebutted by this wide ranging selection e.g. Lowell’s ‘Walking in the Blue’:

Azure day

makes my agonised blue window bleaker.

Crows maunder on the petrified fairway.

Absence! My heart grows tense

as though a harpoon were sparring for the kill.

(This is the house for the mentally ill)

Although there are three poems by Anne Sexton, her best, ‘You, Dr. Martin’ is omitted. Arguably it’s the best poem by any poet about the experience of being a psychiatric in-patient.

Poems by well-known contemporary poets are less good. The two poems by Peter Reading are clever-clever and the second, ‘The Euphemisms’ is ethically dubious to say the least. In fact the whole section of fashionable poets - Jean Binta Breeze, Ken Smith, Matthew Sweeney, Selima Hill and Ian Duhig would have been better omitted. The poem by David Constantine starts well, but as usual, ends in bathos.

The only sixties poet to be included is John Horder. His poem ‘The Sick Image of my Father Fades’ is taut, intensely dramatic and sweats the remembered terrors of childhood.

My father said, shall I break your legs

Before throwing you over? You should then land

On the sand without the sudden crunch

of breaking bones.

Of the 5000 poems the blurb says were submitted by poets working as individuals or in groups, like Survivors Poetry’, there seem precious few usually very short and mostly not very good. Bill Lewis’s ‘Therapy Room’ is good - but the two poems by Angela Hart seem weak. (Incidentally I wondered if this was the same poet as Angela Hart and represented in the Leeds Survivors Poets’ anthology, and the world had really changed? The style’s so banal you can’t tell.)

I submitted some poems by Brenda Williams but she wasn’t represented, yet James Kirkup wrote of her poem, ‘Death and the Maiden’:

“it is an oratorio on a grand scale, and I can hear the kind of music and the singers it needs to fulfil its hidden dramas and contestations - choir against choir, soloist both with and against soloist. An achievement!

Iain Robinson of ‘Oasis’ called her “a remarkable poet” and her work has been favourably reviewed by David Holiday in ‘Iota’ and Dr Ken Smith in ‘Pennine Platform.

Judge for yourself?

You stand at the terminus of the one

Three nine and the shops of West End Green are

Closing round us over reflection

From another time somewhere in a far

Place other than this where we are patients

Pausing on our way from a nearby day

Hospital and mourning both for time and once

Known and the pain of time to come that lay

As an endless June rain an evening

Settling softly about us. The same age

And yet the same loss experiencing

Itself through knowledge that cannot assuage

The emptiness of unborn children or

Those who have grown and gone from the heart’s core

THE FREUD ENCYCLOPEDIA

Ed by Edward Erwin. Routledge  £115.00. ISBN 0 415-936677-2.

You get a great deal for your money - over six hundred double column A5 pages and I have put mine next to the OED as an indispensable for-the-rest-of-my-life reference book. Most topics have been researched in great detail and are provided with excellent bibliographies. My one grouch is that major figures from the seventies onwards, such as Kernberg ,Grotstein, Gedo and Roy Schafer, don’t have entries and I would gladly have sacrificed the country-by-country potted histories to see them there. Professor Erwin is a philosopher and, however distinguished in his field, could not be said to represent the ‘cutting edge’ of contemporary  psychoanalytic thinking.

In an interview with Peter Rudnytsky (Psychoanalytic Coversations: Interviews with Clinicians, Commentators and Critics  Analytic Press 2000 ISBN 0-88163-328-3), Stephen Mitchell makes the comment “I don’t think Sulloway is fair-minded. Sulloway has a very antagonistic attitude towards psychoanalysis.” I am afraid I agree with him and seeing his name on the Advisory Board depressed me. Morris Eagle and Robert Holt, I admit, are as good-as-you-get but the names of the three Associate Editors are completely new to me.

There are no entries for analytic journals where the battle lines have been drawn up and this does seem to me an unfortunate omission.

For my money John Gedo, Robert Chessick or James Grotstein- all of whom have immensely distinguished reputations - would have made much more suitable editors.

Reviewing an encyclopaedia is rather like reviewing a poetry anthology - everybody would do it differently. In spite of my quibbles and qualms this book is an absolute must-have for anyone seriously interested in analysis.

A STROLL ROUND THE ANALYTIC PRESSES

1: KARNAC. The Other Press

Karnac Books has been trading for the last 50 years, and is dedicated to psychoanalysis, psychotherapy and related subjects such as organisations, family and child and adolecent studies.

We have two retail outlets in London which stock and sell a very wide selection of titles in our specialist field from all publishers in the English Language.

You can order books via www.karnacbooks.com, or email us at shop@karnacbooks.com. You can also telephone us at +44 (0) 20 8969 4454, or fax us at +44 (0) 20 8969 5585 or write to us at Karnac Books, 6 Pembroke Buildings, London NW10 6RE.

Alternatively you can visit us at Karnac Books, 118 Finchley Road, London, NW3 5HT or at our branch in the Tavistock Clinic at 120 Belsize Lane, London, NW3 5BA.

42 LIVES IN TREATMENT:

A Study of Psychoanalysis  and Psychotherapy

by Robert S. Wallerstein. Other Press £45.00 ISBN 1-892746-48-4

This is a fascinating study, running to nearly 800 pages. The span of observation is thirty years under the auspices of the Menninger Foundation. In his preface to this paper back edition, Wallerstein insists that:

‘true structural change’ can be the result of supportive therapies as much as analysis proper: By the time Forty-Two Lives has appeared, the rigid constraints of the Eissler model had been largely dissipated through the efforts of many analytic workers - the “alliance” concepts of Elizabeth Zetzel and Ralph Greenson, the humanization of the analytic interchange articulated by Leo Stone, the focus on the analyst as a new object (in addition to being the reactivated transference-drenched old object) with whom “integrative experiences” could (should) be achieved, as reconceptualized by Hans Loewald, amongst those foremost in bringing about this shift in analytic climate - and yet the coercive aura of Eissler’s original dictum still somehow survived, still coloring psychoanalytic superegos. What was said by so many, in response to my Boston presentation of our PRP findings, was that this was such a “courageous” talk - a feeling that I had not especially experienced - since it confronted Eissler’s “interpretation only” thesis so directly. “You give us permission to say what we really do in our every day analytic work, and not have to confine what we experience to corridor confessions to trusted colleagues, nor have to hide it from our analytic seniors or omit it from our case write-ups.”

I think this extract speaks more eloquently for the book’s quality than any words I might write.

PRIMITIVE MENTAL STATES VOL 11

Ed. by Shelley Alhanati. Karnac  £43.99

ISBN 1-892746-91-3.

PSYCHOANALYTIC THEORIES OF AFFECT

By Ruth Stein. Karnac. £18.99

ISBN 1-85575-231-X.

AFFECT REGULATION, MENTAL ISOLATION AND THE

DEVELOPMENT OF THE SELF

Fonagy, Gergely, Jurist and Target. Other Press £47.50

ISBN I-892746-34-4.

FREUD’S TECHNICAL PAPERS

By Stern J. Ellman. Other Press £22.50

ISBN 1-59051-011-9.

The trouble with really important analytic texts is that they have become extremely difficult to understand. When I read André Green’s ‘Private Madness’ in 1989 I found it just about comprehensible after three readings and I attempted to read the rest of his work, first in French, then in the recent spate of translations and finally with both French and English texts side-by-side.

Much of Green I still find incomprehensible and Otto Kernberg, in his forward to Green’s ‘The Work of the Negative’, cheerfully warns all but the philosophically knowledgeable away from the opening chapters. The problem with Green is that he is steeped in Hegelianism and the Mandarins, of whom Green is one, have an innate tendency to write in an impenetrably difficult style. ‘On Private Madness’ is considered Green’s easiest book but try this for size.

It follows that the other’s wish, which I adopt, becomes the basis for the division within myself: in other words, the unity acquired a great expense by the ego, through narcissistic cathexis, can be attained only by referring to the pairs persecuted/persecutor, ego/object, inside/outside, conscious/unconscious. The conjunction-disjunction. The internal conscious ego/external other’s unconscious - is reflected in the conjunction-disjunction - internal conscious ego/other’s internal unconscious.

I never found ego psychology difficult, which is probably why (if I were an analyst and not a  poet) I would still give them, warts and all, my adherence.

Clearly Klein’s concept of ‘Projective Identification’ is probably the most important concept to emerge from the period  1950-2000 and in itself is comprehensible but when concepts from cognitive neuroscience are used as ‘back up’ material the lay reader rapidly gets lost.

Allen N Schore (lead article title of fifty pages with over fourteen pages of references) is hugely learned but it was only on a second reading I managed to follow it. Ditto James Grotstein’s ‘Projective Identifications and its relationship to Infantile Development.’ Though I have read much of his very neglected work - with two hundred articles published there are only three books in print to date.

Grotstein is an excellent teacher and his contribution is unusually helpful in this complex field, covering Ogden, Cramer, Bion, and Fairbairn, Meltzer as well as Klein.

He ends by quoting  Leiman’s words on  Bahktin’s contribution to dialogics (?)

My response to Bahktin’s poignant appeal is that we must ultimately release words from the selfish embrace of our understanding and desire and allow them their freedom as immortal blithe spirits that must always be welcomed to taunt, tempt, and challenge us so that, as “aleatory Ariel’s” “blithe spirits of chance,”  they help us retrieve “all the unpublished virtues of this earth,” or the all too dormant unconscious that is ever creatively willing to meet us halfway. Words - are its obligatory tempters. In this release of words from our selfish embrace, we mark the transition from projective identification as a defence which is allied with the Idol-worshiping of nonseparateness and counter posed  to the experience of separateness - and the beginning of the free-falling adventure into “0,” where we are sanguinely available for the unexpected rendezvous with the always known and never realized; where aleatory creative projective identification arises with a flourish as the muses smile.

This is the ‘pure poetry’ as the French from Mallarme onwards always sought. The rest of the book is almost as good.

Ruth Stein’s ‘Psychoanalytic Theories of Affect’  first came out in 1991 from Praeger in New York, priced £60. My local library - astonishingly - bought the book and I’ve borrowed it so often its beginning to fall apart. It is a masterpiece, a text book that has become a text, a summery that is Aquinas-like in its perfection of compression.

There is, of course, Freud and then Jones, Brierley (previously much unnoticed) Glover, Ego Psychology, Klein, Bion, Sandler, Kernberg; Ruth Stein even makes André Green comprehensible, at least in this part of his theorising;

In the unconscious, writes Green, there exist ‘meaning chains,’ which are concatenations of things, words, affects, body states, and actions. All of these various elements are regarded as semantic meaning units. Within such a chain, affect has a full semantic function and is equivalent to the other elements of meaning (signifiers) in the unconscious. These elements taken together set up a flowing, ever-present chain of signification. This chain is not  linear, as is language, but polygraphic and polysemic; that is, it has multiple forms and meanings, as has the unconscious itself, in which psychic material is coded in diverse keys. Green regards affects as having the same status as language, which is likewise a product of psychic work; both have the function of representation, which Green deems the fundamental and most profound psychic activity.

It is rare that the writers of dust-jacket notes get a mention but whoever wrote them for ‘Affect Regulation, Mentalization and the Development of the  Self’ deserves to be quoted in full.

Historically, human emotion has been marginalized within the philosophy of the mind. Fonagy, Gergely, Jurist and Target argue instead for the importance of attachment and emotionality in the developing consciousness, employing an extensive body of recent literature to support their claims.  They explore and refine the concepts of mentalization and affect regulation, then present case studies that illustrate the lasting detriment resulting from environments that do not foster mentalization and affect regulation.

But ‘Affect Regulation, Mentalization, and the Development of the Self’ does not leave us in despair of a potential solution to this developmental obstacle; rather, the authors offer models of psychoanalytic practice that can enable the gradual acquisition of mentalizing skills over time, even in patients with long histories of violence or neglect. The book demonstrates that an analyst can, through an active and supportive therapeutic stance, influence a patient to develop the self-reflective capabilities so necessary to navigating the emotional, cognitive, and profoundly social world in which we live.

The term ‘mentalization’ derives from developmental theory and defines the process by which we realise ‘that having a mind mediates our experiences of the world;’ (p3).

A central theme of the book is to integrate developmental theory with psychotherapy and psychology. Wisely, the authors point out that many, including Andre Green, by no means accept this integration.

Steven J. Ellman’s ‘Freud’s Technique Papers’ is a tour de force, carefully elucidating changes in Freud’s theories and highlighting the attempts of later analysts to modify them in contrasting ways.

Kohut conceives of the continuation of the positive transference states as helping to form adaptive structures for the analysis: and Brenner sees the positive transference as embodying conflict. Kohut advocates that the positive transference should not be interpreted until there is a break in the patient’s perception of the analyst as an empathic figure. Thus it is only when there a perceived break in empathy that Kohut advocates interpreting the transference. Brenner and Gill, on the other hand; would advocate interpreting the transference whenever it appears prominently in the analysis. Freud, as we know, would agree with Brenner that the eroticized transference should be interpreted as it emerges in the treatment. But, as we have previously stated, Freud does not propose that one interpret the unobjectionable transference; here Brenner departs from Freud’s ideas.

SHAZAM!

BARRY TEBB

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