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Kavanaugh - The Impossible Patient Meets the Impossible Profession Under Impossible Conditions

The Impossible Patient Meets the Impossible Profession Under Impossible Conditions
Implications for Psychoanalytic Education ©

by Patrick B. Kavanaugh, Ph.D.
Copyright, 1996


The Impossible Patient... asks a very central question as it applies to patient, profession, and conditions, namely, Impossible in relation to what?.   And secondly, it considers recentering the analytic question from the Oughts to the Is.  That is, The Impossible Patient... recenters the focus of analysis to where the individual Is without regard for what the necessary conditions, criteria for participation (analyzability), and theoretically anticipated outcome ought to be.  Emphasis is placed with the practitioner's understanding and relationship to language, reality, and metaphor in working with people; impossibility of patient and profession is considered to be a function of the degree of frustration of therapeutic ambition in not reaching the idealized ought to be in terms of outcome.  Impossible Conditions are considered in the context of the, often times, unrecognized power of the institutional discourse and ethic of the culture.

Introduction: Dr. Hyman's comments have provided for us a succinct and comprehensive survey of the "What" as in what has come to be represented for many in the practice community as the defining characteristics of psychoanalysis. His introduction highlights what some of the conditions "ought" to be for something to be considered to be psychoanalysis and for psychoanalysis to take place; how the patient "ought" to think and act in order to be considered for analysis, participate in analysis, and to reasonably expect to reach certain theoretically anticipated treatment objectives which "ought" to happen as a consequence of having been in analysis; and, how the analytic process itself "ought" to move toward this theoretically anticipated outcome. This series of "oughts" has become embedded in the criteria and evaluative standards of psychoanalysis for determining treatability. This series of "ought to be's" regarding the conditions, the patient, and the profession is inextricably linked to that which makes certain individuals considered to be "impossible" for participation in analysis. It is this series of "Oughts" to which I will be referring to in the following discussion as "The Question of the Oughts".

Dr. Young's presentation has provided for us her thinking and work with "The Man Who Made Time Stand Still". Her presentation of material has provided sufficient cause to question these defining characteristics of psychoanalysis. The material gives serious reason to reconsider some of the basic theoretical propositions of psychoanalysis regarding the "Impossible Patient", and, to draw into question and reexamine a whole series of questions related to this "Question of the Oughts" as it relates to: the Who, the What, the When, the Where, and the "Why" of psychoanalysis? The material prompts such a reexamination of the "Question of the Oughts" in each of these areas, as much of mainstream psychoanalytic theory and thinking would maintain that either the analytic process just presented would not, should not, or could not have taken place. Or, that which took place is, by definition, not psychoanalysis because the conditions, the patient, or the anticipated course or outcome of analysis does not meet the criteria of the "oughts". The necessity and the importance of such a reexamination of theory and technique relates quite directly to the ever widening scope of psychoanalysis, as it is from material such as we have heard today that previously unquestioned theoretical axioms are jarringly disturbed. Such disturbance carries with it both hope and promise: the hope and promise for a reconsideration of the theoretical axioms, the potential for generating questions which might lead in new and unforeseen directions in our thinking in working with the "impossible patient", and certainly the raising of questions and suggesting directions for the future of psychoanalytic education.

Taken together, Dr. Hyman and Young's presentations have suggested the following directions for the discussion: (1) to consider a very central question regarding the "Impossible Patient" meeting with the "Impossible Profession" under "Impossible Conditions"; namely, "Impossible" in relation to what? , and "Why?", (2) to reconsider the conceptual parameters of exclusion as have been established by the "Oughts", and, to consider recentering the analytic question from the "Oughts" to the "Is". That is, to recenter the focus of analysis to where the individual "Is" without regard for where they "Ought" to be prior to analysis, during analysis, or at the conclusion of analysis; and, (3) to raise some questions and consider some implications for psychoanalytic education. It is this "Question of the Oughts" and the consideration of this "Question of the Is" which will provide the underlying framework, focus and, direction for the following discussion of the Impossible Patient meeting with the Impossible Profession under Impossible Conditions.

With these preliminary remarks, I would like to turn directly to:

The "Impossible Patient", And "Impossible Profession": "Impossible" in relation to What?

The profession of psychoanalysis qualified as one of the "Impossible Professions" as a consequence of the frustration of the analyst as the patient never quite reaches the analyst's theoretically anticipated goal of the analysis: that which "ought" to have happened did not. There are always unsatisfying results as the "ideal outcome" is never quite realized. (Freud, Analysis Terminable and Interminable, 1937), Nowhere has the "Question of the Oughts" more clearly functioned as "conceptual parameters of exclusion" than in the determinations as to Who might be permitted entry into an interpretive psychoanalytic process of understanding, and, in the predetermined specification as to What the objectives and outcome of psychoanalysis "ought to be". Nowhere is the issue of conceptualization more obviously crucial.

In traditional psychoanalytic thinking, evaluative procedures to assess treatability have occupied a very central role. Within the structural framework of ego psychology, for example, the "Question of the Oughts" provides the evaluative standards which guide a systematic assessment of the individual's various ego functions, capacities, and psychic structures for the purpose of determining the question of one's suitability and treatability by psychoanalysis. The assessment proceeds from a conceptualization of psychoanalysis as being a set of procedures and a process which emphasizes that the individual be able to cognitively capture objects and events, pull them inward for categorical inspection, and to analyze them into component parts or to see certain dynamic connections---And, it rests upon a Cartesian construction of "Self". The assessment procedure is quite directly related to the understanding of the therapeutic task and the anticipated "Ideal" outcome: "....... to modify the infantile repression through the confrontation of infantile instinctual conflicts by the more mature ego." (Sandler, p. x). Obviously, with this theoretical understanding of psychoanalysis and the subsequent therapeutic task, it becomes quite important to assess those abilities and capacities which would permit an individual to participate in such a process of introspective "uncovering" and to be able to benefit from such interpretive "insight".

Thus, the assessment of the individual's suitability and treatability to participate in this process of analyzing is crucial. Severity of infantile trauma(s) and degree of ego distortion(s) can place severe limits upon both participation and that which could hope to be achieved in analysis. The "Question of the Oughts" as related to treatability has been organized around those ego functions, capacities, and structures which "ought" to be there but, for the "Impossible Patient", are found to be lacking: lack of insight, lack of motivation, lack of ability to regress and then to progress in order to "make use of" an interpretation, lack of an observational ego, and a lack of "reality testing" in particular might be some of the initial diagnostic impressions of severe structural defects contraindicating an interpretive analytic treatment. Traditionally, it has been around this breakdown of "reality testing" that psychosis has been defined, e.g., the breakdown of the distinction between the internal and external world. (Freud, 1924a, 1924b) This more traditional conceptualization of psychoanalysis proceeds from a philosophic premise of an objective, mind independent and knowable world--a world that exists independent of the person's perceptions ... And it rests upon a Cartesian construction of the world. For many, it has been and remains axiomatic that a fundamental prerequisite for the analytic situation requires making a pact "….with a nonpsychotic 'I' with a positive orientation toward reality". (Rosenbaum & Sonne, 1986) From this rather traditional understanding and conceptual framework of psychoanalysis, it has been simply impossible for the "Impossible Patient" to participate in the procedures or the process which places conceptual primacy upon the role of cognition, a "mature ego" to recognize and confront the conflicted issues of infantile origin, and appropriate "reality testing". This largely unquestioned Cartesian construction of the "Self" and of the "World" is of major consequence in psychoanalysis as it conceptually determines if an individual becomes, in the mind of the psychoanalyst, one of the "Impossible Patients". Further, this more traditional conceptualization rests upon a particular understanding of the relationship between reality, language, and metaphor and carries with it subsequent implications for psychoanalysis in terms of technique and objectives. **************Aristotle broadly defined metaphor as:

"............. consist(ing) in giving the thing a name that belongs to something else; the transference being either from genus to species or from species to species or on the grounds of analogy." (Turbayne, 1970)

Memory experiences which have become associatively linked in an individual's mind on the basis of contiguity, similarity, or some other associative principle, transfer experiential, sensual meanings between the different internal mental representations one has of, for example, "self" and "other". It is this transfer of experiential meaning between different mental representations which is the essence of metaphor. Aspects or elements of one object are transferred to another object so that the second is spoken of as if it were the first. (Arlow, 1989) The economic condensation of many meanings into a single action or verbal statement speaks to this multi-dimensionality of metaphor. (Sledge, 1977) ********* The more prevalent view of metaphor has been that of a "special" linguistic device which can be employed at different times to:

"....... achieve specific prejudged effects. These aid language to achieve what is seen as its major goal, the revelation of a 'reality' of a world that lies unchanged beyond it…………."  Hawkes, 1972, p. 90

This understanding of metaphor as a "special linguistic device" is one which presumes the existence of some ultimate essence, truth, or reality about which one can speak "in the metaphor". In the Cartesian-Newtonian world there is but one world and one reality and words have a fixed, stable, and static meaning corresponding to and representing this world. Language is precise as only an object based language can be. The more precise the language, the more precisely and accurately one's representation of that world can be. And, thus, the more precisely and accurately theory can be in representing that objective world and the actually occurring causal relationships believed to exist within it currently and, as having existed within it in the past. This understanding of metaphor would view and locate the psychotic individual's internal subjective experience as being gross distortions taking place within the larger context of a largely unquestioned objective reality. Thus, the "break with reality" which has defined psychosis in such a way so as to constitute a "conceptual parameter of exclusion" in the psychoanalysis of the modem era.

Further, ego distortions of this objective world and its reality occurs, it has been theoretically asserted, either as the consequence of desperate defensive measures--or--the lack of development of certain functions, capacities, or psychic structures be the ego or self. This defensive psychic posture related to the repression of infantile conflicts, or, to the lack of development of psychic structure and function has been conceptualized as the consequence of real traumatic events, disturbed relationships of childhood, and subsequent disordered development. This particular understanding of language, reality, and metaphor places considerable emphasis upon the role of an objective and knowable Other in the childhood surround and --very importantly-- rests upon certain Newtonian based conceptualizations of linearized time and space-- conceptually creating an objective and knowable world that existed in time past.

From this conceptual position of the "oughts", the view of psychotic communication might range, at one end of a continuum, from the most prevalent and conclusionary of positions that they are quite arbitrary, meaningless, and capricious, and, at most, their communicative value lies in representing a "Cry for Help" wrapped around a "Kernel of Truth"--To-- at the other end of the continuum, the position that the person's communications do, indeed, have associative meaning and significance, and that it is of importance to acknowledge the internal experience, meaning, and reality held for the person. The objective of such interpretive understanding, however, would be to address these internal experiences so that ego or self functions can be strengthened and psychic structures developed so that the person can eventually leave the psychotic metaphor, deal directly with the objective and knowable world, and negotiate more appropriately to the world "as it really is". The theoretically anticipated results of that which "ought" to occur.

Recent years have witnessed a Widening of the Scope of Psychoanalysis in which there has been the development of different conceptual frameworks of psychoanalysis, each of which has a distinctly different understanding as to theory and therapeutic task, formulation, technique and methodology, purpose and objective. (Applebaum, 1987) That which is considered to be the therapeutic task and the theoretically anticipated outcome which "ought" to take place in psychoanalysis varies as a function of one's theory and conceptualization of psychoanalysis and its related technique --- And, most importantly in this consideration of the "Impossible Patient", therapeutic task and theoretically anticipated outcome varies as a function of one's understanding of philosophic underpinnings, particularly as it relates to the "nature of reality". The "nature of reality" carries with it vast implications for one of the most central and pivotal of concepts in defining the "Impossible Patient": the concept of "reality testing". Thus, that which an individual "ought" to have by way of prerequisites to participate, and, what "ought" to happen as a result of having participated, also, varies as a function of theory, conceptualization, and philosophic underpinnings. In her presentation this afternoon, Dr. Young has presented material and theoretical formulations which directly confront and contradict the conceptual position of the "Oughts" that proceeds from a philosophic premise of objectivism and classical epistemology. Clearly, she has advanced a radically different conceptualization of the "Impossible Patient", of psychotic productions and their communicative value, purpose, and function; and of the objectives of psychoanalysis in working with the "Impossible Patient". Her conceptualizations have implicitly recentered the "Question of the Oughts" onto the "Question of the 'Is"' with implications for one's understanding of theory, technique and the objectives of psychoanalysis. And this recentering of conceptual focus upon the "Question of the 'Is’" carries with it radical and far reaching implications for psychoanalytic education.

This postmodern version of psychoanalysis attempts to understand the human condition from within a psychological framework, the essence of which derives from philosophy, the humanities, and the arts. One of the most immediate of implications for psychoanalytic education is to reconsider and reexamine the defining influences of philosophic presupposition on such seemingly abstract and remote topics as "What is the nature of reality?" and "What does a mental representation represent if not an objective and knowable essence?" And--so what! What difference does it make? What is the direct pragmatic consequence of such philosophic considerations on such questions as "How does one conceptualize?", "How does one listen and understand?", and "How does one respond in the analytic moment?....... Philosophic pre-supposition is inextricably linked to what one literally says in the analytic moment with a person who might like "The Man Who Made Time Stand Still" ---or, for that matter, whomever else might seek consultation.

Recent philosophical reexaminations of the relationship between the nature of reality, mental representation, and language have led to a much different understanding of metaphor which carries with it radically different implications for technique and for the objectives of psychoanalysis. This different understanding of metaphor views:

"...metaphor as inseparable from language which is "vitally metaphorical" and the reality which is ultimately the end product of essentially 'metaphorical interaction' between words and the sensory impressions of daily encounter" (Hawkes, 1972, p. 90)

From this understanding of metaphor, all thought, perception, cognition, and language is essentially and vitally metaphorical. But.. a question:.. Just how vitally metaphoric is "vitally metaphoric"? Well, it all depends........ From the perspective of C.S. Pierce, the noted semiotician, everything in the universe is considered to be, at least potentially, a sign of and a sign for something else. Every entity, including the human entity, is potentially a sign for something else --in the same sense as one might understand the visual images and language of dreams. All thinking is considered to be radically and vitally metaphoric. From this perspective, metaphor is not limited to "spoken words" but is broadened to include all behaviors. From this understanding of vitally and radically metaphoric, words, then, do not mean "something" as in representing and corresponding to an objective truth/world from which the meaning derives and which exists independently of the person and their perceptions. Rather,

".............. we mean by words. The total fabric of our meanings, which constitute the world as we know it, consists not of actual or inherited experience, each attached to an appropriate word or set of words, but linguistic and psychological laws regarding recurrent likenesses of behavior in our mind and in the world to whichwords are variously adapted by us." (Richards, 1965, p. l2)

Could it be that all of reality is in the eye of the beholder? Is all of reality psychic reality? Is all of reality constructed by linguistic relationships as would be suggested by Pierce's radical semiotic? Could it be that the human subject is constituted by the vitally metaphoric language of systems of signification and meanings? It might very well be that the "talking therapy" of psychoanalysis has tremendously undervalued the linguistic and psychological laws which in effect define language as being the function and the means by which meaning is given to other functions and experiences (Miller, 1991). -Linguistics, semiotics, the multidimensional and multilevel aspects of language, of metaphor, and of reality as would be found, for example, in poetry, in music and its lyrics, and in schizophrenic thinking speak quite directly to specific implications for psychoanalytic education. The implications for psychoanalytic education, however, extend far beyond the notion "Let's add a course here on philosophy during the second year." -or- "... an elective there on semiotics and linguistics during the third year." A radically different Theory of Psychoanalysis...... as theory, as methodology, and as education is being suggested. A postmodern Theory of Psychoanalysis that proceeds from a psychological conceptual framework --- And stands in marked contradistinction to the largely unquestioned medicalized conceptual framework --- in the United States, at least --- of symptomatology, etiology and pathology wherein which psychodynamics has become synonymous with psychopathology.

From this understanding of the relationship between reality thinking and language, there are many different meanings each word, each action, and each analytic session might represent for an individual, the particular meanings at any given moment derive from the context within which it appears. This understanding of metaphor speaks to the overdetermined nature of all thoughts, perceptions, and cognition and speaks to the importance of contextual comprehension in one's analytic work. The world is constructed according to the laws of the perceiver wherein which literality, itself, is contextual and is idiosyncratically defined by the perceiver. The laws of reality are determined by the individual and are provisional. And that which is perceived and experienced as "objective reality" is a function of idiosyncratic internal organizing dynamics and principles. This understanding of the relationship between language, reality, and metaphor moves closer to conceptually recentering the analytic question from the "Oughts" to the "Is", i.e. Where the person "Is" in terms of their relationship to the world --- and, Why?, How that world and others are perceived and constructed --- and, Why?, And the experience of the person in interaction with that world ------ and, Why? --- from that individual's perspective.

Some of the implications that derive from this understanding of metaphor: All behavior could be conceptualized as having a function and as constituting a multi-level and multi-dimensional statement (Searles, 1961, 1962). And the rhyme and reason, meaning and significance in all behaviors extends to psychotic communication. Psychotic communication expresses, as does all behavior, a multiplicity of meanings and purpose in the service of a complex, continuous, associative process of communication; as having an expressive, protective, and communicative function or aspect; and, as representing a very economic consequence of an intricately complex compromise of various internal psychic actions between and within conflicting and conflictually determined internal images of "Self" and of "Other". Perhaps Jonathan Lear (1995) speaks to this notion when he states that there is poetry to be found in the prose of each individual's everyday life.

From this philosophic-theoretical position, the assessment process is absolutely crucial. Assessment, however, is not to determine the individual's ability to participate in the analytic process. Rather, assessment is an attempt to understand the laws of the perceiver so that the analyst might be able to participate in the analytic process with the individual. The analyst who listens and speaks to the person from the conceptual land of the "Is" attempts to understand the world as it is seen by that individual; to learn and to speak the language of the individual's version of cause and effect. Understanding the "Is" becomes the goal and purpose of analysis. The "ideal" theoretical outcome of the "Oughts" is replaced by attempting to understand the elegance and complexity of the "Is".

So central are these issues of philosophic underpinning and theoretical conceptualization that it could be stated: The individual who is viewed as being "Impossible" for participation in an interpretive analytic process becomes "Impossible" as a function of the practitioner's philosophic-theoretical conceptualization. In effect: the individual is held captive in the institutional prison of the "impossible", a conceptual prison constructed in the mind of the psychoanalyst. The bars of this conceptual prison are made of an especially resistant metal called the "Question of the Oughts" consisting of the lack of that which, it has been believed, "ought" to be there for engagement and participation in the analytic process. It may very well be that the philosophic underpinnings of one's conceptualization of theory and technique as are imbedded in the "Question of the Oughts" have been the strongest weakness of the "Impossible Profession" in working with the so called "Impossible Patient".

Recentering the analytic question from the "Oughts" to the "Is" carries radically different implications for the very understanding of psychoanalysis, itself. For example, as the question of the "Is" comes to the foreground of one's thinking and conceptualization, it becomes increasingly obvious that it is the person who directs the analysis, establishes the objectives, and sets the rhythms and pace --Not the analyst --- The analyst has different responsibilities and functions. As the "Question of the Is" comes to the foreground the most radical and dangerous of all questions for the person and the analyst alike, comes to the forefront to guide the inquiry of the analysis: the "Why" of the "What Is". As the "Oughts" recede into the background of the analyst's thinking and theorizing, the analyst, in effect, foregoes the safety and the certitude provided by the theoretical "oughts". It is then that the passionate interest, involvement, and immersion into analytic inquiry begins. It might be noted, that with the so called "Impossible Patient" this passionate immersion and inquiry might intensely begin with the very first meeting. Of course, the emotional reactions and experiences of the analyst are conceptualized as necessary, vital, and crucial aspects in this analytic work of understanding. From the conceptual land of the "Is", it is the person who has the answer, the means to that answer, and this means might very well involve these emotional reactions of the analyst. The purpose of such involvement and inquiry in this postmodern Theory of Psychoanalysis? ...That of understanding the very personal struggle of the individual in determining their relationship to their own truth and ethic. In this version of the psychoanalytic discourse the understanding of these very personal meanings and private significances of life, of the world and of Self is inextricably linked to psychic integrity and survival of the Self. Such a postmodern Theory of Psychoanalysis as derived from philosophy, the humanities and the arts might be more compatible within a contextualizing metaphor such as, for example, "psychic theatre of the mind"-- in which contextualization psychodynamics are considered to be "the stuff of life"...not evidences of psychopathology. "The Man Who Made Time Stand Still " is then more readily seen as a person communicating his exquisitively intricate, complex and meaningful solution to the profound uncertainties of his past times, his present times, and his future times--all at the same time. And he could then be seen as being vitally instructive to us in our ongoing attempts to understand the uncertainties of life and of Self as are revealed in the Discourse of Other --- which, of course, is Self experienced as Other. If so, then, perhaps "The Man Who Made Time Stand Still" has provided us with an invaluable educational experience about himself .... And about life, about people, and about ourselves. ...And therein is to be found psychoanalytic education as is derived from philosophy, the humanities and the arts.

Impossible Conditions: "Impossible" In Relation to What?

As one might conceptualize a "psychoanalytic discourse" as taking place between the so-called "Impossible Patient" and the psychoanalyst, so might one conceptualize this "analytic discourse" as taking place within an "institutional discourse" of the psychiatric hospital. The concept of an "institutional discourse" (Rosenbaum & Sonne, 1986) refers to an institution's structure and framework, distinct ideology, philosophy of treatment, and espoused theoretical orientation. The "institutional discourse", itself, is shaped and defined through its incorporation of the requirements of other institutional structures such as accrediting, licensing, and regulatory agencies. This concept of "institutional discourse" represents a broad-based framework from within which "Impossible Conditions" for the psychoanalytic discourse could be understood as arising from a number of different but interrelated sources.

Within the psychiatric hospital, the "institutional discourse" is organized around and reflects an ethic which is woven and interwoven throughout the institutional fabric. The institutional ethic, particularly during this the Decade of the Brain, rests upon a neuro-biological deficiency basis for the understanding of psychosis metaphorized in the language of "mental disease" and "Illness" and bases its treatment, its philosophy, and its objectives upon the moral piety of presuming to know the "good", the "truth", and the "reality" for those afflicted with this mental disease. "Impossible Conditions" exist when the institutional discourse becomes the institutionalized adversary of the psychoanalytic discourse. More specifically, in the institutional discourse the analyst is empowered to be, and is expected to be, the representative of the institution's authority and ethic and the repository figure that represents the values of society. Within the whole cloth fabric of the institutional discourse, there is the expectation of a rather seamless extension of the analytic discourse and ethic with the treatment objectives of the insitution. And, also, the expectation to endorse the view of the person as being deficient and in need of some kind of psychic orthopedic to fix and repair maldeveloped psychic structures. In such a milieu, interpretation would be for the purpose of bringing thinking, perceptions, and behaviors into the socially accepted range of "the oughts". To that degree that the analytic discourse has different objectives or a different view of the person, then to that degree do "Impossible Conditions" exist. For example, to that degree the institutional discourse emphasizes and values the development of the milieu as a chemical cocoon, then to that degree does the institutional discourse becomes antithetical to the psychoanalytic discourse.

The institutional discourse and ethic of a psychiatric hospital has provided opportunities in the past to study and consider institutional structure, dynamic and process and to understand the enculturational processes and sociological "matrix of meanings" that generate and define position, power, and perogative within such institutions. Such in-depth study of the hospital's institutional discourse provides the rich opportunity to consider the powers and rhythms of this discourse in the shaping of a "way of thinking" that contextualizes and prescriptively proscribes hierarchically arranged roles, purposes, and functions for administration, staff, employees, patients, and trainees. Such in-depth study provides the opportunity to understand the vitally metaphoric language of the institutional discourse that shapes and constructs the reality of everyday life in the hospital, a reality constructed through the hospital's various interconnected and intersecting systems of signification. The institutional discourse is an institutional "way of thinking" and signification in which the institutional structure, its ideology, its philosophy, its mission statement and its ethic are inseparable from this reality constructed.

Within the Psychoanalytic Institute, such in-depth study of the institutional discourse provides the opportunity to study and understand an institutional discourse that reflects, embodies, and reproduces the ways of knowing, thinking, and perceiving of classical epistemology and the objectivist philosophic underpinnings and core values of the modern era. And quite simply put .... we are no longer living in the modern era. We are currently living in the Information Age of the Postmodern Era--a new cultural epoch and era in which there has developed radically different ways of knowing, thinking, and perceiving about people, the world, and life. The origins of the institutional structure, the philosophy, and the tripartite model for psychoanalytic education predates the Berlin Psychoanalytic Institute of 1920 and had their epistemological assumptions, premise and values developed during the 17th, 18th and 19th centuries. The world has been changing We live in a world of quantum science, quantum physics and quantum ways of thinking and conceptualizing. As an educational model for psychoanalytic education, the Psychoanalytic Institute of the modern era is antithetical to the psychoanalysis of the postmodern. The institutional discourse of the Psychoanalytic Institute has come to constitute "Impossible Conditions" for the psychoanalytic education of the postmodern era.

One of the clearest of implications for "psychoanalytic education" is the re-thinking of what is meant by "psychoanalytic education in terms of educational process, educational methods, and educational objectives. A major and ongoing postmortem project is indicated and needed. The quest of postmodern psychoanalytic education might very well prove to be in the finding of that space and place where the idealizing orthopedics and objectives of the traditional psychoanalysis of the Modem Era cannot go and do not exist. To find that space and place where the power inherent in the idealizing standards of "The Oughts" for the other do not have passage.

The quest of postmodern psychoanalytic education might be that of understanding the perspective of the "discourse of the 'Other’". And, in so doing, understanding the "World of Differences" within "Self" and amongst people. The quest in education might be found in the understanding that the essence of psychoanalysis is, paradoxically, that there is no essence; in the understanding that the theory of psychoanalysis is that there is no theory ; in the understanding that the model of the mind to be developed is that there is no model of the mind... In the understanding that the essence, theory, and model of the mind is as is already existent in the mind of the "other -- ------- which, paradoxically, is "Self"…… (Kavanaugh, 1995)


As one foregoes the certainty and security of the traditional "Question of the Oughts" as to how the individual "Ought" to be to enter, "Ought" to participate, and how things "Ought" to conclude in psychoanalysis then the frustration of not realizing the "ideal" therapeutic ambitions of the "Impossible Profession" becomes replaced with a growing respect for the elegance, intricacy, complexity, and the humanity of the "What Is" and why things "Ought" to be the way they are according to the person. Recentering the question from the "Oughts" to the "Is", recenters the objectives of analysis from the theoretical truth of "What Ought to Be" to the individual's truth of why things are the way they are.

At the outset of this afternoon's discussion, I had stated that the mythologies defining of psychoanalysis of the modern era as presented by Dr. Hyman and the material and theoretical conceptualizations presented by Dr. Young gave serious cause to reconsider and reexamine a whole series of questions as related to the "Question of the Oughts". Hopefully, this afternoon's discussion has made a contribution to that reexamination. If indeed it proves to be that the keepers of the gates of analytic wisdom are time, experience, and philosophic vision, then it might also prove to be that the scope of psychoanalysis will continue to widen to include the so called "Impossible Patient". However, for this conceptual scope of analysis to continue to widen, these keepers of the gates of wisdom must be accompanied by such faithful and ever present companions as Irreverence, Curiosity, Imagination, and a Sense of Humor. Quite possibly then, this continuous philosophic reexamination of largely unexamined basic psychoanalytic concepts and theoretical axioms could result in the so called "Impossible Patient" coming to meet with the so called "Impossible Profession ………. the "Impossible Conditions" would then become largely irrelevant.

And if the scope of psychoanalysis is to continue to widen, this unrelenting Curiosity and Questioning--and irreverential Imagination and Sense of Humor-- must also enter the hallways of the Psychoanalytic Institute and direct its gaze to its educational traditions. Otherwise, it seems to me, the traditional institutional structure, educational philosophy, educational methods, objectives, and tri-partite model of the Psychoanalytic Institute might unwittingly become the living and breathing institutional(ized) version of "The Man Who Made Time Stand Still"---And, in so doing, become entrapped, if not entombed, within an encrusted philosophic-conceptual prison that attempts to preserve, if not restore, a time from the modern era that has long since passed

......... Psychoanalysis as theory, as method and as education is now, in the postmodern era……

Thank You



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(1962a) The Differentiation Between Metaphorical and Concrete Thinking in the Recovering Schizophrenic Patient. in Collected Papers on Schizophrenia and Related Subjects.  Int. Univ. Press, 1965

Sledge, W. H. (1977)  The Therapist's Use of Metaphor. in Langs, R. (ed) International Journal of Psychoanalytic Psychotherapy, vol. 6:113-129.   Aronson, NY.

Turbayne, T. (1970). The Myth of Metaphor. Univ. of S.C. Press, Columbia, S.C. in Barker, P.  Using Metaphors In Psychotherapy.  Brunner-Mazel, NY. 1985

Dr. Kavanaugh received his doctorate in philosophy (psychology) from the University of Windsor in Ontario, Canada.  Since the completion of his doctoral studies, he has been active in the academic, organizational, and practice areas of the psychoanalytic-psychological community.  In the academic area, he has served as Director of Clinical Training and member of the core teaching and supervisory faculty in the doctoral program in psychoanalytic psychology at the University of Detroit; as a member of the teaching and supervisory faculty in the Program for Advanced Studies in Psychoanalysis in Wyandotte, Michigan, an interdisciplinary program for the study of the analytic discourse; and, as a member of the teaching and supervisory faculty in the pre-and post doctoral educational programs at the Detroit Psychiatric Institute, the Wyandotte General Hospital, and the V.A. Medical Center in Detroit.  In the organizational area, he is the founding and current president of the Academy for the Study of the Psychoanalytic Arts; past president of the International Federation for Psychoanalytic Education; the Michigan Psychological Association, and the Michigan Society of Clinical Psychologists.  In the practice area, many of his professional interests during the past 35 years are directly related to experiences in the discourses of various residential treatment facilities.

Dr. Kavanaugh is a recipient of  The Distinguished Psychologist Award  from the Michigan Psychological Association and the Master Lecturer Award from the doctoral students at the University of Detroit.

Currently Dr. Kavanaugh is in the private practice of psychoanalysis in Farmington Hills, Michigan:

Office:  31805 Middlebelt, Suite #305
               Farmington Hills, Michigan, USA  48334
               Phone: (248) 626-6460
               Fax:      (248) 626-4808